We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for systematic reviews. Studies investigating algorithm-managed and pharmacist-managed dosing of ESA in adult patients with renal anaemia were evaluated for inclusion. No restrictions were set on outcome parameters. Observational and interventional studies available as full-text articles with a control group and follow-up ≥6 months were eligible for inclusion. Relevant databases were searched from their inception through August 2024. Two independent reviewers evaluated all studies. The risk of bias was assessed by the ROBINS-I and RoB1 tools. The protocol of this study was registered in PROSPERO (CRD42021243678).

After screening 140 articles, 17 articles and 4313 patients could be included. Available evidence was of low to moderate quality with a high risk of bias. Data were summarised and tabulated. Meta-analysis was not possible due to the substantial heterogeneity in participants, study design, interventions, comparisons, and outcome parameters. However, standardised metrics could be identified and calculated for haemoglobin and ESA dose. The percentage in target range for haemoglobin varied between 3.5% lower (95% CI –18.67% to +11.67%) to 32.0% higher (95% CI 14.07% to 49.93%) in the pharmacist-managed group versus the control group (n=1401). The range in reduction in ESA dose was 5.45% (95% CI –7.97% to +18.87%) to 49.97% (95% CI 20.32% to 79.61%) in the pharmacist-managed group versus the control group (n=2115).

Low-quality data with high risk of bias suggest that pharmacist-managed renal anaemia may improve the percentage of haemoglobin within target range and reduce the ESA dose. However, meta-analysis was impossible due to substantial heterogeneity. Therefore, no definite conclusions could be drawn on the effectiveness of pharmacist-managed dosing of ESA in renal anaemia.

CRD42021243678.

A retrospective cross-sectional study was conducted to assess the resolution of prescribing errors, based on the analysis of electronic prescriptions. A prescribing error was defined as an alert that required intervention of the pharmacist to prevent harm or to optimise therapy. To identify prescribing errors, a medical doctor and hospital pharmacist analysed all alerts that were retained to be checked by a pharmacist. Resolution of a prescribing error was defined as resolution of the error within 24 hours after detection.

In total, 145 574 medication prescriptions were analysed and 448 prescribing errors were detected. Of these prescribing errors, 94.0% were resolved within 24 hours. No differences were found between the resolution rate of prescribing errors after advice from a specialised hospital pharmacists and their substitutes (94.4% vs 91.9%, p=0145 (² test)). Administrative prescribing errors, prescribing errors for patients aged >80 years and prescribing errors handled during weekends showed a relatively low-resolution rate. No other characteristics of the pharmacist, prescriber, patient, the drug involved or the intervention itself were associated with the resolution of the prescribing error.

In the temporarily absence of a specialised hospital pharmacist, the resolution rate of prescribing errors remains high when advice about prescribing errors is provided by a substitute hospital pharmacist.

A grounded theory approach was used to design, evaluate and develop the framework. Participants included healthcare professionals and laypersons with experience using narrow therapeutic index medications, as well as individuals recommended by them. Two focus group discussions were conducted (N₁=6 and N₂=5), each lasting approximately 2 hours and following the same agenda. In one case, a follow-up one-on-one interview was held because the participant indicated further insights at the end of the session.

Participants identified key decision-making questions for the framework, including the evidence base for interacting drugs, severity and documentation level of the interaction, availability of safer alternatives, and the presence of confounding factors. The framework was considered useful and, following refinement, potentially suitable for clinical implementation. A key insight was that integration into healthcare curricula is essential for achieving long-term impact. Overall, the proposed tool may assist in managing interaction risks in diverse clinical scenarios and reduce alert fatigue among healthcare professionals.

Although further clinical validation is needed, the framework provides a foundation for improving the management of database-detected drug interactions.

This observational study was conducted over 6 months. In the first 2 months, patients collecting CFM were invited to participate in an unused medication monitoring programme by completing an inclusion questionnaire. Those who consented were followed for four additional months and asked to report on unused medication during subsequent visits. Data on dispensed medication and patient-reported unused medication were collected using structured survey forms and analysed using descriptive statistics.

Thirteen per cent of patients reported unused medication from approximately 100 enrolled participants. Collecting CFM for themselves, the unused medication rate was 15%, compared with 8% among those collecting on behalf of others. No unused medication was reported by first-time collectors. Reported reasons included clinical changes (eg, dose adjustments, treatment discontinuation, adverse effects) and administrative errors (eg, excess quantities, incorrect formulations). The total value of unused medication was estimated at 83 000 Kr (11 100). Extrapolated to the annual distribution volume at the St Thomas Pharmacy, the annual loss from unused medication would be 900 000 Kr (120 000).

The small sample size in this project is a limitation and associated with an uncertain outcome. Unused medication related to CFM is a measurable and economically significant issue, primarily driven by clinical and administrative factors. While reducing pack sizes could help mitigate unused medication, this may increase logistical burdens on patients and healthcare providers. A larger distribution model, such as dispensing through all local community pharmacies under hospital tender agreements, may offer a more efficient solution but would require legislative reform. Broader, multi-site studies are needed to validate findings and inform future policy interventions.

This multicentre retrospective observational study included patients aged ≥18 years during a 3-year period with an estimated glomerular filtration rate of <60 mL/min/1.73 m² or on renal replacement therapy, receiving ≥7500 IU dalteparin daily. Only correctly sampled plasma anti-Xa levels were included and stratified into intensive care unit (ICU) and non-ICU patients. Stratum-adjusted odds ratios were determined to compare the likelihood of achieving adequate anti-Xa levels between a 75% and 100% dose. Bleeding events were classified into minor and major events.

A total of 167 anti-Xa levels were included, with 148 anti-Xa levels belonging to patients receiving a 75% or 100% dose. Anti-Xa levels were highly scattered: 55% below and 6% above the anti-Xa ranges. In all patients the probability that anti-Xa levels fell within the range was higher for patients receiving a 100% dose than for those receiving a 75% dose (OR 2.66, 95% CI 1.24 to 5.70, p=0.012). Eight bleeding events occurred, including one minor event in a patient with an anti-Xa level above range and five events in patients on renal replacement therapy with anti-Xa levels within or below range.

In renally impaired patients a 100% dalteparin dose increases the likelihood of achieving adequate anti-Xa levels compared with a 75% dose, without leading to over-exposure. The occurrence of bleeding events did not differ between the 75% and 100% dose groups and appeared unrelated to anti-Xa levels. Pre-emptive dose reduction of dalteparin in renally impaired patients is likely to be unnecessary.

The programme addressed challenges in operations, logistics, technology, legality, training and information. A protocol was developed defining the collaborative dispensing circuit, including criteria for patient selection and prioritisation.

Over 39 months, 13 310 shipments were made to 1039 patients, averaging 17 daily. Each patient received about 13 deliveries. A total of 14 283 medications from 258 specialties were dispensed. The programme saved 512 534 km and 542 164 min (356 days) in travel. Each patient saved approximately 493 km and 522 min, reducing CO2 emissions by 58–116 kg per patient, or 72–145 tonnes overall. A survey of 130 patients revealed a 93% preference for this model over home or healthcare facility delivery.

The implementation of telepharmacy programmes for dispensing hospital medication to community pharmacies marks a significant advancement in patient care. Initially rare, telepharmacy is now widespread, overcoming previous barriers. Programmes show similar effectiveness to home delivery, improving workflow and safety. Future improvements may include remote monitoring tools and video calls. Despite some limitations, such as economic analysis and tracking, telepharmacy has proven beneficial for patients, offering cost savings and enhanced confidentiality.

The collaborative telepharmacy circuit was efficiently and safely implemented, offering an innovative approach that meets the needs and expectations of patients in the OPCU.

This study aimed to assess the value of STs in an integrative cancer centre to address the treatment of patients with suspicion of HSRs to platinum salts (carboplatin, oxaliplatin, cisplatin), and taxanes (paclitaxel, docetaxel).

This single-centre, retrospective study was conducted on data collected from hospital medical records between August 2018 and December 2023. STs (prick tests and intradermal tests) were performed according to the recommendations of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology. The concordance between the allergist’s recommendations and the therapeutic strategies implemented in clinical practice following ST results was evaluated.

Among the 105 patients included (76 females, 29 males), the positive ST rate was 61%. In total, 71% of the reactions to platinum salts (n=82) were identified as allergies versus 26% for taxane reactions (n=23). We found a cross-reactivity of 34.5% for platinum salts and 66.7% for taxanes. The allergist’s recommendations were carried out in practice for a total of 56 patients (53%). For 47 patients (45%), a clinical reason justified not following the allergist’s recommendations and discontinuing treatment.

This study confirms the relevance of STs to help oncologists guide treatment strategies after a presumed allergy. As part of the allergological work-up, STs help prevent unnecessary changes to chemotherapy lines in patients with unproven allergies and facilitate the identification of alternative treatments following HSRs. In practice in our centre, allergists’ propositions are carried out as much as possible to guide the re-exposure strategy in patient care.

This prospective, cross-sectional study was conducted over a 2-month period among ambulatory patients with CML monitored at one of the country’s leading hospitals for diagnosing, treating and monitoring CML in Bulgaria.

Among 70 participants, 91.4% showed high medication adherence, with only 1.4% reporting low adherence. No significant differences in adherence between therapy groups (imatinib vs nilotinib, p=0.1830), gender (p=0.0887) or age groups (p=0.8748) were revealed. Education level was associated with adherence, with lower adherence observed in patients with primary education (p<0.0001). Quality of life, measured using utility values (median=0.8770) and visual analogue scale (mean=80), did not significantly differ based on adherence levels, therapy type or education level. Logistic regression showed that men had 1.9 times higher odds of high adherence compared with women (p>0.05). Patients under 65 had 3.3 times higher odds of adherence compared with those over 65 (p>0.05), and those on imatinib had 22.86% of the adherence odds compared with those on nilotinib. The findings suggest that maintaining high medication adherence is crucial for positive therapeutic outcomes in patients with CML.

Patients with CML in Bulgaria show high medication adherence, likely contributing to their overall quality of life. These findings emphasise the importance of maintaining adherence for optimal treatment outcomes in CML. Future research should explore the factors influencing adherence in this population and assess the role of hospital pharmacists in supporting medication management.

Risk analysis, conducted using the ‘failure modes and effects analysis’ approach, took place in 2024. It focused on the sterile medical devices supply chain within an operating room pharmaceutical unit. A multidisciplinary working group developed a risk map for stock discrepancies in four stages: identification of risks, risk rating based on occurrence and severity, listing of control measures and prioritisation of risks.

The risk analysis identified 52 risks across seven subprocesses, with 10% of these risks classified as priority. These priority risks mainly involved the emergency dispensing of equipment in the operating room, the scheduled provision of medical devices through the preparation of case carts, and the storage of products in the pharmaceutical unit. Key areas for improvement included staff training, enhancing software expertise and strengthening quality assurance.

This study presents the first risk map of stock errors for health products in a hospital setting. This approach is applicable to other supply chains in healthcare. Effective risk management depends on a collective effort and the engagement of all stakeholders. Optimising stock management is critical in enhancing the quality and safety of care provided to patients.

We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK centre providing hepatology pharmacy services. We collated information on workforce, service provision and pharmaceutical care activities provided by pharmacy teams in hepatology specialities.

Seventeen centres responded to this survey, which was composed of five (29%) district general hospitals, two (12%) providing both secondary and tertiary level hepatology services, three (18%) secondary care centres and seven (41%) centres providing tertiary level care. There are a greater number of posts in tertiary level care centres irrespective of inpatient beds covered. Consultant pharmacists were only present in tertiary level care centres. A large portion of pharmacy time is spent on indirect pharmaceutical care, which ranged from 10% to 50%. Overall, 75% of respondents felt that their team’s workload was safe, though this was only 45% in district general hospitals.

Clinical hepatology pharmacy staffing levels vary across the UK. Recognition and benchmarking are key across all levels of care to ensure this workforce remains sustainable given the increasing incidence of liver disease in the UK.

Residual amounts of infusion solutions prepared and administered at the adult intensive care unit were examined for visible and subvisible particles according to the recommendations of the European Pharmacopoeia monographs 2.9.19 and 2.9.20.

Samples from 169 infusion solutions were collected, 149 of which could be analysed. The Pharmacopoeia requirements for visible particles were not fulfilled in 42.9% (n=64/149) of the samples, while the requirements for subvisible particles were not met in 4.7% (n=7/149). A specific correlation between the pharmaceutical drugs or within the infusion set (bottle vs connected infusion line) and particulate contamination was not possible as the sample was too small for a correlation analysis. A Spearman rho analysis showed no correlation between particle contamination and administration mode (subvisible (10 µm): p=0.969, r=–0.005; subvisible (25 µm): p=0.834, r=–0.026; visible: p=0.711, r=–0.047) and particle contamination and dosage form (subvisible (10 µm): p=0.291, r=–0.092; subvisible (25 µm): p=0.513, r=0.057; visible: p=0.415, r=0.071).

This study showed that residuals of intravenously administered solutions have particulate contaminations. A specific causal factor was not identified.

Three bevacizumab 25 mg/mL vials (CT-P16) were stored punctured either light protected at 2–8°C or at 25±2°C for 28 days. Samples were withdrawn on day 0, 1, 7, 14, 21, 28 and analysed by size-exclusion chromatography (SE-HPLC), ion-exchange chromatography (IE-HPLC), and dynamic light scattering (DLS). In parallel, pH values were measured and test vials visually inspected for visible particles and colour changes.

After the 28-day storage period, the quantitative SE-HPLC analysis indicated bevacizumab concentrations above 95% of the initial concentration in each test vial. IE-HPLC analysis revealed no signs of instability. DLS measurements showed no significant variation in the mean hydrodynamic diameter and no appearance of small-sized aggregates. The pH values of all samples remained constant, and no visible particles or colour changes were observed.

CT-P16 25 mg/mL concentrate was found to be physicochemically stable in the original glass vial after first opening for at least 28 days when stored light protected at 2–8°C or at 25±2°C.

Samples were analysed immediately on compounding and then 1, 3, 6, 9 and 12 months after storage at –20°C (immediately after thawing, and also 1 month later keeping the vials at 2–8°C). The assays included a visual examination, measurement of the pH, osmolality, sub-visible particulate contamination, the concentration of PS80, and the concentration of oleic acid and peroxides (both major markers of PS80 degradation). Quantification of PS80 was challenging due to the substance’s molecular heterogeneity and the lack of a good chromophore. The strategy adopted consisted of hydrolysis in a strong base and then liquid-liquid extraction of the oleic acid (PS80’s hydrolysis product). The oleic acid content was determined using reversed phase high performance liquid chromatography with ultraviolet detection. The peroxide content was determined spectrophotometrically using a ferrous oxidation with xylenol orange assay.

Over 12 months, there was no significant change in the samples’ visual appearance, pH and osmolality. The PS80 concentration remained above 90% of the initial value. The subvisible particle counts remained far below the European Pharmacopoeia thresholds. The oleic acid content of the non-hydrolysed samples remained constant, and no peroxide was detected.

A PS80-containing solvent is stable for 1 year when stored at –20°C (±5°C) in amber glass vials. Moreover, the solvent is stable for up to 1 month after thawing if stored at 2–8°C.

This study involved determining the content of CEF, PAN and OND in infusion solutions, NS and 5D under varied temperature conditions, including 2°C to 8°C, 25°C, and 37°C at different time intervals using high performance liquid chromatography, visual description of solution mixture, pH measurement, osmolality, particulate matter (both visible and subvisible), as well as assessing the colour and clarity of the solution (measured by absorbance at 420 nm and % transmittance at 650 nm).

No significant changes were observed in pH, osmolality, particulate matter, colour and clarity of admixture in NS up to 48 hours at all conditions. CEF, PAN and OND retained more than 90% of their initial concentration at 2°C to 8°C for 48 hours, 25°C for 8 hours, and 37°C for 8 hours. Also, no significant changes were observed in pH and osmolality of admixture in 5D up to 48 hours at all conditions. CEF, PAN and OND retained more than 90% of their initial concentration at 2°C to 8°C for 4 hours, 25°C for less than 2 hours, and 37°C for less than 2 hours.

This study concludes that the physicochemical stability of a ternary admixture containing CEF, PAN and OND is diluent and temperature dependent. NS ensures acceptable stability, whereas 5D causes rapid degradation. For safety and efficacy, NS is recommended, with refrigerated storage preferred. Based on physicochemical stability data, the use of this parenteral admixture with 5D is not recommended.

To develop a protocol for preparing 0.05% atropine eye drops in a hospital pharmacy cleanroom as the first medical treatment option for myopia in Estonia. Additional objectives were to create affordable unit-dose eye drops, analyse their efficacy and tolerability in Estonian children, obtain health insurance funding, and enhance cooperation between hospital pharmacies nationwide.

A 12-month prospective study of 34 myopic children (median age 11.8 years; median SER –5.0 D) was conducted. Patients were treated with 0.05% atropine unit-dose eye drops prepared weekly under class A cleanroom conditions. Refraction was measured at baseline and at 3, 6, 9 and 12 months. Side effects were monitored at each visit.

The protocol for preparing 7-day unit-dose eye drops was successfully implemented. After 12 months, mean SER change was only –0.10 D. Since January 2025, treatment has been reimbursed by the Health Insurance Fund, and prescriptions have increased by over 26% annually. Since June 2025, Pärnu Hospital Pharmacy also prepares atropine drops, currently treating three patients. All children continue treatment due to excellent outcomes.

Conduct stability studies to extend shelf life beyond 1 week, scale up preparation to reach more patients, and expand production to other hospitals in Estonia. The long-term goal is to ensure wider European availability of 0.05% atropine eye drops.

This study aimed to evaluate the impact of hospital-affiliated pharmacist interventions on all-cause and HF-specific hospitalisations among adult patients with heart failure.

A systematic review and meta-analysis were conducted according to PRISMA guidelines. PubMed and Embase were searched for randomised controlled trials published up to November 2024. Eligible studies compared pharmacist interventions with usual care and reported hospitalisation or mortality outcomes. Interventions delivered in community pharmacies or home-based settings were excluded. Study quality was assessed using the Cochrane risk-of-bias tool. Random-effects models (DerSimonian–Laird) were used to calculate pooled odds ratios (OR) and 95% confidence intervals (CI). Statistical heterogeneity was quantified using the I² statistic and Cochrane’s Q test.

Eleven randomised controlled trials were included, enrolling 3576 patients with HF. Pharmacist interventions significantly reduced all-cause hospitalisations compared with usual care (3472 patients, 927 events; OR 0.67, 95% CI 0.49–0.92, p=0.0119). Similarly, HF-related hospitalisations were reduced (3442 patients, 504 events; OR 0.64, 95% CI 0.48–0.87, p=0.0038). Heterogeneity was moderate across analyses and sensitivity analyses confirmed robustness. Subgroup analyses suggested greater effectiveness in outpatient programmes and when interventions were longitudinal.

Hospital-based pharmacist interventions substantially reduced all-cause and HF-specific hospitalisations across inpatient and outpatient settings. These results underscore the value of integrating pharmacists within multidisciplinary HF care teams to improve outcomes and reduce re-hospitalisation risk. Future research should clarify the optimal structure and duration of pharmacist involvement.

Our aim was to review these laboratory parameters and analyse their relevance through case studies of vancomycin monitoring.

We identified and classified the laboratory parameters valuable for clinical decision making in TDM-guided vancomycin therapy. We evaluated the relevant clinical laboratory practice at Semmelweis University, the availability of the assays, and the significance of the identified laboratory parameters with respect to the outcomes of pharmacokinetic modelling and the clinical management of patients.

The laboratory parameter groups relevant to vancomycin therapy include (A) parameters characterising renal function, (B) additional laboratory parameters required for pharmacokinetic modelling, (C) acute-phase laboratory parameters, (D) parameters indicating acute adverse effects, and (E) microbiological parameters.

At Semmelweis University, serum creatinine, urea, albumin, C-reactive protein, procalcitonin, and lactate levels can be requested in addition to vancomycin levels as urgent tests, with differences in their availability to various clinical departments. The minimum inhibitory concentration is determined by broth microdilution in the microbiology laboratory. The case studies presented demonstrate that the relationship between renal function and vancomycin pharmacokinetics can be most effectively characterised by calculating creatinine clearance. The calculated 24-hour area under the concentration–time curve depends strongly on the applied pharmacokinetic model. C-reactive protein concentrations reflected the clinical status reliably, whereas procalcitonin levels were not relevant. Albumin and urea levels were required inputs for a population model incorporated in the TDMx online pharmacokinetic calculator, but their influence on modelling outcomes was negligible.

The measurement of the laboratory parameters identified in this study is essential for conducting clinically meaningful vancomycin TDM, as is the integrated interpretation of pharmacokinetic results and those of the clinical laboratory assays.

To evaluate the correlation between theoretical pharmacokinetic predictions and real-world outcomes (visual acuity, exudation, and central retinal thickness) in patients treated with AFLI8 under a T&E regimen within an early access programme.

Retrospective study of nAMD patients with subfoveal type 1 neovascularisation switched from AFLI2 to AFLI8. Inclusion required ≥6 months of prior AFLI2 with persistent retinal fluid 4 weeks after the last injection and at least one assessment 2 weeks after AFLI8. Best-corrected visual acuity (BCVA) was measured using the Snellen chart; spectral-domain OCT and OCT angiography were performed. A time-dependent pharmacokinetic model (Python-based) estimated intraocular concentrations for AFLI2 and AFLI8, which were compared with clinical outcomes (BCVA, central retinal thickness (CRT) and neovascular activity).

Twenty eyes from 20 patients were included. Before switching, mean number of injections = 8, mean BCVA = 0.22 logMAR, and mean CRT = 283.5 µm. Theoretical intraocular concentrations showed an 18-day difference between doses (p = 0.042), indicating equivalence between 14 days/ AFLI2 and 32 days/ AFLI8. Comparing 2-week/ 2 mg vs 4-week/ 8 mg intervals, no significant differences were found in BCVA (p = 0.317), exudation (p = 0.707), or CRT (p = 0.779). A trend towards CRT reduction (283 -> 255 µm; p = 0.128) and significant improvement in exudative activity at 2 weeks/ 8 mg (p = 0.013) were observed.

Knowledge of AFLI ocular pharmacokinetics may aid identification of candidates for higher-dose therapy and guide interval extension. The 18-day theoretical increment aligned with clinical outcomes, and early improvement confirmed sustained efficacy without a dose-dependent ceiling effect.

In order to avoid dosing errors using medicinal products with different reference values, relevant monographs were identified in a web-based database for evidence-based drug information during childhood and information on the reference value was added.

The issue of reference values was discussed in round-table meetings involving an interprofessional group of experts consisting of pharmacists and paediatricians from university children’s hospitals and the Paediatrics Committee of the Federal Association of German Hospital Pharmacists (ADKA e.V.). Based on scientific evidence and clinical experience, criteria were established for selecting relevant monographs from the database, including the presence of different salt forms of an active ingredient. A revision process was developed to ensure that reference values are clearly labelled. Monographs with the above-mentioned risk constellation were revised.

As of January 2025, 102 of the 671 monographs (15.2%) in the database were identified for which a reference value label is relevant. In these cases, the relevant reference values were labelled and their conversion factors were added to the ‘Formulations’ section of the database. In 80 monographs (11.9%), the reference value was also labelled at the dosage level (e.g. enalapril, sildenafil). The standardised revision of all monographs is ongoing.

The aim of this project is to increase vigilance for the risk of different reference values. Clear labelling in the database contributes to greater safety in prescribing and manufacturing.

The aim of this study was to analyse the occurrence of DRPs in hospitalised patients and to evaluate the effectiveness of pharmaceutical interventions within consulting activities.

The research was conducted at the Central Slovak Institute of Cardiovascular Diseases in Banská Bystrica between October 2024 and February 2025. Data were obtained through the PROMIS medical information system, with patients selected based on excessive polypharmacy (≥10 medications) and the presence of at least one severe drug interaction. DRPs were classified according to the PCNE (Pharmaceutical Care Network Europe) classification system (version 9.1), and pharmaceutical interventions were assessed based on their acceptance and implementation into pharmacotherapy.

In total, 60 patients were analysed, with 209 DRPs identified. The most common problems included inappropriate drug combinations (n=119), inappropriate treatment in elderly patients (n=38), inappropriate drug dosing (n=15), and unclear drug indications (n=14). Pharmacist interventions were fully accepted and implemented in 57% of cases, accepted but not implemented in 31%, partially implemented in 6%, and implementation status was unknown in the remaining 6%. Statistical analysis demonstrated a highly significant correlation between the number of medications taken and the occurrence of severe drug interactions (p=0.0001).

The results confirm that the consulting activities of a pharmacist in a hospital pharmacy contribute to optimising pharmacotherapy, reducing the risk of DRPs, and increasing the safety of treatment for hospitalised patients.

To develop a population pharmacokinetic (popPK) model for vedolizumab in adult patients with malignant haematological neoplasms (MHN) and refractory GI-GVHD, and to propose a dosing regimen to achieve therapeutic plasma concentrations from the start of treatment.

A prospective multidisciplinary study (January 2021–February 2025) was conducted in adults with MHN receiving vedolizumab for refractory GI-GVHD. Demographic, clinical, and biochemical data were collected. Patients received an initial 300 mg IV dose; plasma concentrations (VPC) were measured at 72 hours and subsequently as guided by the pharmacist. VPC were quantified by ELISA.

The popPK model was developed using NONMEM v7.3 with the FOCEI method, and simulations were performed in R v4.3.2. The dosing required to maintain VPC >25 µg/mL (target induction level in ulcerative colitis) was estimated through deterministic simulations.

Fifteen patients (nine females; median age 54 (18–66) years; weight 71 (40–100) kg) were included. Underlying MHN included acute myeloid leukaemia (n=7), acute lymphoblastic leukaemia (n=2), myelodysplastic syndrome (n=2), and others (n=4). Vedolizumab was used as third-line therapy in seven patients, fourth-line in three, and ≥fifth-line in five patients.

A total of 70 samples (median 4 (2–10) per patient) yielded a mean (SD) VPC of 36.56 (14.97) µg/mL. A one-compartment model with first-order elimination best described the data. Volume of distribution (Vd) was 5.53 L; clearance (CL) was estimated as:

CL (L/h) = 0.053 x ((BSA/1.9)^2.23) x (1 + 0.022 x (AGE–54)).

Simulations suggested maintaining >25 µg/mL requires 300 mg IV at days 0, 3, and 6, followed by 300 mg every 7 days for BSA <1.5 m², every 5 days for 1.5–2 m², and every 4 days for BSA >2 m².

A novel popPK model was developed describing vedolizumab kinetics in haematological patients with refractory GI-GVHD. Body surface area and age were identified as determinants of clearance. Model based dosing may optimise early drug exposure, potentially improving clinical outcomes and response times in this complex patient population.

The objective of this study is to evaluate the impact of different galenic formulation parameters on the migration of 2,4 DTBP and the sorption of TAC.

An experimental design was established by varying the concentrations of the active substance: TAC (0.04, 0.2, and 1 mg/mL), as well as those of the excipients: polyoxyethylene castor oil (KEL) (32, 80, and 200 mg/ml) and absolute ethanol (EtOH) (10 and 100 mg/ml), as well as the storage temperature (5°C and 25°C). The various formulations were placed in static contact for three days with silicone valves from a multi-dose ophthalmic device constituting the "contact" group and compared to a group without valves constituting the ‘control’ group. The concentration of 2,4 DTBP and TAC was monitored by liquid chromatography coupled with a UV-visible detector.

There was no significant difference in TAC concentration between the control and contact groups. However, in all formulations in contact with the valves, 2,4 DTBP was detected and increased over time, whereas it was not detected in the control group samples. The migration capacity of 2,4 DTBP was mainly influenced by the TAC concentration: the higher the TAC concentration, the less 2,4 DTBP was extracted. To a lesser degree, the EtOH concentration promoted migration, while increasing KEL concentration and temperature limited it.

Our study highlighted the impact of formulation on the leaching of 2,4 DTBP from silicone valves. The decrease of its extraction in the presence of higher TAC concentrations may be related to the sorption of TAC or KEL on the surface of the valves. In the absence of toxicological data on the impact of 2,4 DTBP on the eye at the quantities found, cytotoxicity studies should be performed. In the meantime, manufacturers of delivery devices are encouraged to conduct leachability studies in real-world use situations.

1. Lockhart H, Paine FA. Introduction to the packaging of pharmaceuticals and healthcare products. In: Lockhart H, Paine FA, éditeurs. Packaging of Pharmaceuticals and Healthcare Products. Boston, MA: Springer US; 1996. p. 1-12.

2. Barrieu M, Chennell P, Yessaad M, Bouattour Y, Wasiak M, Jouannet M, et al. Physicochemical stability of a novel tacrolimus ophthalmic formulation for the treatment of ophthalmic inflammatory diseases. Pharmaceutics. Janv. 2022;14(1):118.

A retrospective study was conducted using dispensing data collected through the DPC channel for the period 2021–2024.

Patients with a new prescription of GLP1-RA were selected. New users were defined as individuals who received a first dispensing at least 120 days after the start of the observation period, in order to exclude patients already on treatment and ensure the inclusion exclusively of new users. A minimum follow-up of 12 months from the date of first dispensing was required.

Persistence at 12 months, defined as the time in days between the first and last dispensing (including the days covered by the final supply) in the absence of a time gap greater than 60 days, was analysed using Kaplan-Meier curves. Statistical analyses included the log-rank test and Cox regression models adjusted for active substance, age, and gender.

A total of 12,468 patients were included, with 3,417 discontinuation events observed at one year. Persistence differed significantly across treatments (log-rank p<0.0001), with the highest values recorded for dulaglutide (78.7%), followed by semaglutide (69.6%), exenatide (49.6%), and liraglutide (39.6%).

Cox regression analysis (reference: dulaglutide) showed a progressively increasing risk of discontinuation for semaglutide (HR=1.56; p<0.001), exenatide (HR=3.05; p<0.001), and liraglutide (HR=3.65; p<0.001).

Gender had no significant impact on persistence (p=0.72). Conversely, age proved to be a determining factor: patients aged 45-64 years (HR=0.62) and 65-79 years (HR=0.72) showed higher persistence compared with those aged ≥80 years (p<0.001).

This real-world analysis highlights important differences in persistence among GLP1-RA, with a favourable profile for dulaglutide and greater critical issues for liraglutide and exenatide.

The impact of advanced age suggests the need to adopt a more personalised therapeutic approach, favouring medicines with greater continuity of use and including intensified monitoring strategies in elderly patients or in those treated with active substances associated with a higher risk of discontinuation.

This study aimed to evaluate the feasibility and benefits of administering piperacillin/tazobactam as continuous infusion via elastomeric pumps in paediatric patients, focusing on hospital stay reduction, improved quality of life, and healthcare resource optimization.

Pump dosing was standardized for children weighing 15–37.5 kg in 2.5 kg increments, with the attending physician determining the appropriate dose. For children ≥40 kg, adult pumps containing 12/1.5 g of piperacillin/tazobactam were used. Two different Folfusor elastomeric pump sizes were utilised depending on the dose. Dose-specific batch protocols were developed to eliminate manual calculations and reduce manufacturing errors.

Children weighing ≥15 kg across the Northern Finland collaboration area were successfully treated with elastomeric pumps. Families reported improved appetite and activity levels in children at home and valued the opportunity to return home earlier. Hospital ward burden decreased due to earlier discharges. Each pump saved one hospital day, with a total of 117 hospital days saved during the pilot period (November 1, 2024 – April 30, 2025).

Elastomeric pumps, already widely adopted in adult care, demonstrated significant benefits in infection treatment among paediatric haematology and oncology patients. Pumps can be easily customised by size, enabling safe and effective antimicrobial delivery. This approach frees patient beds, reduces healthcare staff workload, and generates financial savings. Most importantly, it enhances the quality of life for children and their families during demanding treatment periods.

1. Eiland LS, Benner K, Gumpper KF, et al. ASHP-PPAG guidelines for providing pediatric pharmacy services in hospitals and health systems. Am J Health Syst Pharm. 2018;75:1151–65. Journal of Biology 2:1–2.

2. Sentinel event alert 39: Preventing pediatric medication errors. The Joint Comission 11.4.2008. https://jointcomission.org/resources/patient-safety-topics

1. Kuitunen S, Luukkainen P. Turvallisen lääkehoidon erityispiirteitä lapsilla. Duodecim 2021;137:515–23.

The aim of this study was to assess the extent, quality and economic impact of unused, returned targeted anticancer medication at Landspítali – The National University Hospital of Iceland. Objectives included evaluating treatment use and costs, examining the amount and quality of returned medication, identifying reasons for return, assessing patient and healthcare-professional attitudes toward redispensing, and proposing procedures to minimise medication waste.

A multifaceted retrospective and prospective study was undertaken. Retrospective data (2020) included economic value and use of PKH and LTP medications. Prospective data (Jan–Mar 2021) assessed quantity, quality, reasons for return and economic value of unused medication. A questionnaire evaluated attitudes toward waste, redispensing and proposed interventions. Findings informed suggested procedures to reduce waste and support safe redispensing.

In 2020, 453 treatments were dispensed to 283 patients, with a total economic value of 608 million ISK (4.2 million EUR). During the prospective phase, 2,193 prescription units of unused medication were returned, valued at 24 million ISK (168,000 EUR). Approximately 71% met criteria for potential reuse, indicating possible savings of up to 75%. The most common reasons for return were treatment discontinuation due to adverse effects or cancer progression. Both patients and healthcare professionals showed strong support for reducing waste and for redispensing unused high-cost medication.

Targeted anticancer treatments represent substantial economic investment. Most unused returned medication was of high quality and suitable for redispensing. Positive attitudes among patients and healthcare professionals support implementing structured procedures to reduce medication waste and promote sustainable oncology practice.

This study evaluated whether upfront 30% dose reductions of irinotecan in UGT1A1 PMs affect survival by comparing progression-free (PFS) and overall survival (OS) between PMs treated with an initial 30% dose-reduction and fully dosed intermediate and normal metabolizers (IM/NMs).

We conducted a retrospective, multicentre cohort study in patients with pancreatic cancer (PC) or colorectal cancer (CRC) treated with UGT1A1 genotype-guided irinotecan dosing at six Dutch hospitals between Aug 2017–Apr 2024. Patients were included in the primary analysis if irinotecan was dosed according to UGT1A1 genotype (i.e. 100%±10% dose intensity for IM/NMs and 70%±10% for PMs) in at least cycle 1. Survival analyses were performed using Kaplan-Meier estimates and multivariable Cox regressions, stratified by tumor type. Safety was also assessed.

In total, 779 patients were included in the primary analysis, 76 (9.8%) of whom were PMs. PFS and OS rates were comparable over time between PMs and IM/NMs (stratified log-rank test: PFS: P = 0.542; OS: P = 0.419) (figure 1). For patients with PC, median PFS was 9.0 months (95%CI: 6.2-11.8) in PMs and 8.3 months (95%CI: 7.2-9.4) in IM/NMs. For patients with CRC, median PFS was 6.2 months (95%CI: 5.1-7.3) in PMs and 6.0 months (95%CI: 5.3-6.7) in IM/NMs. Median OS was not statistically significant between PMs and IM/NMs. The adjusted hazard ratio of PMs vs IM/NMs was 1.015 (95%CI: 0.78-1.32; P = 0.90) for PFS and was 1.10 (95%CI: 0.82-1.48; P = 0.51) for OS, indicating no significant differences in survival outcomes between 30% dose-reduced PMs and fully dosed IM/NMs. Severe toxicity rates were comparable between PMs and IM/NMs.

Abstract NP-012 Figure 1

Carbon footprint savings achieved by delivering outpatient medications to community pharmacies

Survival of UGT1A1 poor metabolizers is not affected by an upfront 30% dose reduction of irinotecan. Therefore, UGT1A1 genotype-guided dosing of irinotecan can be confidently performed and should become the new standard-of-care dosing strategy for irinotecan to improve patient safety.

The aim of this study was to investigate the knowledge and habits, concerning disposal of household pharmaceutical waste, of hospital pharmacy dispensing service users in a hospital, in order to develop a proper system for raising consciousness about drug pollution.

Data were collected by means of anonymous and voluntary survey, consisting of five multiple choice-items, in a 2-month period. A total of 120 users (34 people of 18-40 years; 60 of 40-65 years; 26 of 65 years and more) answered the questionnaire; the responses were analysed using a spreadsheet and expressed as weighted average of the three age-categories.

According to the survey, 112/120 of users understand the environmental impact of an incorrect disposal of expired/unused drugs; however, the concept of ecopharmacovigilance is not widespread (only 53/120 of respondents had knowledge of it).

Survey results showed that the role of digital media (website, social network) in sharing this information was essential in the 18-40 years age group (24/34); the same role was played by traditional media, including television in the 40-65 years age group and the 65 years and more age groups (37/60 and 19/26, respectively).

The survey also indicates that 104/120 of respondents pay close attention to proper disposal of pharmaceutical waste, dropping them off at designed location, like community pharmacies (19/34 of the 18-40 years age group, 53/60 of the 40-65 years age group and 18/26 of the 65 years and more age group).

Although a relevant percentage of respondents understands the importance of a proper use and disposal of pharmaceutical products, awareness activities, involving hospital pharmacists, are essential in promoting correct behaviours.

For this purpose, simplified guidelines on the proper disposal of household pharmaceutical waste (drugs, medical device) were developed and made available through a QR code to all users of direct hospital pharmacy dispensing service.

No conflict of interest

The overall aim of the study was to map the current hospital pharmacy workforce. Key objectives included analysing the age composition, reviewing the placement of staff aged over 60, and quantifying the speed of demographic change through a comparative analysis of the 2023 demographic baseline against projections for the year 2025.

The initial study by ESHP in 2023 encompassed the entire hospital pharmacy workforce (total 108 professionals) across 22 hospital pharmacies. The personnel analysed consisted of 77 pharmacists and 31 pharmacy assistants. The analysis focused on professional tenure (categorised as <5y, 5–10y, >10y) and age distribution (seven cohorts, up to 71+). To estimate emerging trends and future challenges, the 2023 baseline data were analysed comparatively against demographic projections for the year 2025.

The workforce exhibits high stability, with 71% of pharmacists and 58% of pharmacy assistants having worked in the hospital pharmacy system for more than 10 years. Overall, 57 pharmacists and 22 pharmacy assistants have more than 3years of experience (>3a). The comparison revealed a significant acceleration of ageing trends. In 2023, 31% of all hospital pharmacists were older than 60 years. Pharmacy assistant cohort faces the highest demographic risk, with 47% of pharmacy assistants projected to be 61 years or older by 2025. For pharmacy assistants, the 61–65 age cohort is projected to rise sharply from 13% in 2023 to 25% in 2025.

The comparison of the 2023 baseline with the 2025 projections reveals a critical contradiction: exceptional professional stability is coupled with an impending, accelerated demographic crisis. The projected high proportion of staff reaching retirement age by 2025, particularly among pharmacy assistants, poses a severe and immediate threat to service continuity. Strategic focus must urgently be directed towards effective succession planning, recruitment, and increasing the overall valuation of hospital pharmacy work, especially in smaller hospitals.

No conflict of interest

Estimate the HD of our preparations under EAA and CUA over an 18-month period.

First, the cost of these preparations was worked out according to the number of vials and their unit price.

This amount was corrected by hourly contribution to value-added on variable costs (HCVAVC), which is the real average cost of 1 hour of human activity within a company (1) to include the human time to prepare.

Finally, we calculated the HC of non-compliance for our preparations. They include overconsumption and overtime. Knowing our rejection rate (RR) for preparations (which we assumed to be constant in 2025), as well as the average number of vials consumed for a preparation according to our records and the average unit price, we were able to calculate these HC.

We made 4291 preparations between January 24 and June 2025.

Our HCVAVC was 47 in 2024. Total time for a preparation was 30 minutes.

Our RR was 2%, so 85 preparations have to be redone. Three vials were used per preparation and average unit price was 2302, that was 587 000 of overconsumption and 1998 of overtime.

In total, the HD represented 588 998.

Based on the SEAM we found that the HD represents almost 600 000 mainly due to overconsumption.

It is essential to structure the training and deepen it; the better trained the hospital’s technicians are, the less non-compliance there will be. Plus using more preparation robots is essential to reduce non-compliance and preparation times.

1. Cappelletti L, Savall H, Zardet V. Socio-economic approach to management: science-based consulting for sustainability. Springer Nature Switzerland; 2024.

No conflict of interest

This study aimed to evaluate the cost-effectiveness of bempedoic acid compared with ezetimibe in statin-intolerant patients using a lifetime Markov model from a payer perspective.

A Markov model with six health states (no cardiovascular disease, non-fatal myocardial infarction, non-fatal stroke, post-myocardial infarction, post-stroke, death) was developed to simulate outcomes over a lifetime horizon. Patients entered the model at age 65. Transition probabilities were derived from risk equations and life tables. Treatment effects, utility values, and cost parameters were obtained through a structured review of published literature, including randomised controlled trials, meta-analyses, and standard cost databases. Costs included drug acquisition, medical management, and post-event care, adjusted to 2025 values. Both costs and outcomes were discounted at 3% annually. Results were expressed as total costs, life years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Deterministic sensitivity analysis and price-reduction scenarios were performed.

Ezetimibe generated 10.31 discounted QALYs at a lifetime cost of 166,513 units, while bempedoic acid yielded 11.01 discounted QALYs at 389,310 units. Compared with ezetimibe, bempedoic acid produced an incremental gain of 0.70 QALYs at an additional cost of 222,797 units, resulting in an ICER of 318,282 per QALY. This exceeded the accepted cost-effectiveness threshold. Sensitivity analyses confirmed robustness, with drug acquisition cost as the most influential parameter. Scenario analysis showed that bempedoic acid would become cost-effective only if its price decreased by ~45%, equal to a 28.5% reduction in lifetime costs.

Bempedoic acid provides incremental health benefits compared with ezetimibe in statin-intolerant patients but is not cost-effective at current prices. Substantial price reductions would be required for it to represent value for money. These findings provide evidence to guide hospital pharmacy practice and payer decision making in evaluating lipid-lowering therapies.

No conflict of interest

This study aimed to investigate the relationship between leadership styles in pharmacy management and medication safety outcomes, focusing on the incidence of medication errors, adverse drug events (ADEs), and staff satisfaction.

A cross-sectional study was conducted at five different hospital pharmacies, each managed by a different leadership style (transformational, transactional, laissez-faire, and autocratic). Data was collected on medication errors and ADEs, using incident reports over a 12-month period. Additionally, pharmacy staff satisfaction was measured using a standardised survey. The data were analysed using ANOVA for differences between leadership styles and multiple regression for predicting medication errors based on leadership type.

The analysis showed that pharmacies led by transformational leaders had a 30% lower rate of medication errors (p = 0.02) and a 25% lower rate of ADEs (p = 0.03) compared to pharmacies led by autocratic managers. Additionally, staff satisfaction was 35% higher in transformational leadership settings (p = 0.01). No significant differences were found between other leadership styles.

The findings suggest that transformational leadership in pharmacy management is associated with improved medication safety outcomes and greater staff satisfaction. These results underline the importance of leadership development in pharmacy settings as a strategy for improving patient safety and operational performance.

1. Guntschnig S, Barbosa R, Jenzer H, Greening M, Hayde J, Heery H, Iglesias Serrano MC, Lajtmanová K, Rossin E, Tentova-Peceva S, Kohl S, Mulac A. Tackling medication errors: how a systems approach improves patient safety. Eur J Hosp Pharm. 2025 Apr 30:ejhpharm-2025-004533. doi: 10.1136/ejhpharm-2025-004533. Epub ahead of print. PMID: 40280735.

No conflict of interest

Disease-related malnutrition (DRM), an underdiagnosed, undertreated public health problem that affects 30–50% of hospital inpatients, results in poor health outcomes and higher costs.¹ Multidisciplinary care, including pharmacists, is essential to ensure optimal nutritional interventions.² Pharmacists are vital to multidisciplinary care coordination. Medical nutrition therapy is cost-effective and improves health outcomes, yet inequity exists in access.¹ This survey was conducted to address the limited insight across countries into the major barriers to implementation of equitable nutritional care beyond health technology assessment.

An online survey was developed by the MNI, and members (n=6) participated between April and December 2024. Additional responses were included (National Industry Groups n=2; additional MNI members n=2). Results covered Croatia, France, Germany, Italy, Poland, Portugal, Spain, Switzerland, The Netherlands and the United Kingdom. Quantitative data were reported as percentages and qualitative data as key themes.

Although screening for DRM was reported as being available in 80% of countries surveyed, it was mandatory in only 20% and often poorly implemented. Knowledge of nutritional care was described as inconsistent and specialty-dependent, with 56% reporting access to expert nutrition professionals as limited to hospital settings. Barriers identified included lack of funding, limited workforce availability and nutrition seen as a low priority. Although reimbursement of food for special medical purposes (FSMP) (medical nutrition products for oral or enteral nutrition) was reported by 90% of country respondents it varied by healthcare setting, and 50% reported that obtaining FSMP is ‘difficult/not easy’. Awareness of DRM amongst patients was reported as low, with difficulties navigating complex healthcare systems citied by 70% of country respondents as a key contributing factor to inequity.

Knowledge of system-level barriers to nutritional care, beyond HTA, highlights actionable gaps within hospital practice. Hospital pharmacists can act as drivers of change. Through their roles in therapeutic committees, and care coordination, they can help embed medical nutrition into hospital standards and reduce access inequities.

1. WHO-ESPEN 2023. https://www.who.int/europe/publications/i/item/WHO-EURO-2023-8931-48703-72392

2. Cederholm, et al. 2017. https://www.ncbi.nlm.nih.gov/pubmed/27642056

Corporate sponsored research or other substantive relationships:

MNI represents the companies that were surveyed for this exercise.

To evaluate the rate of PCSK9 inhibitor prescriptions not meeting reimbursement criteria and identify the main reasons for non-initiation treatment in a tertiary care hospital during 2024.

A retrospective review was conducted of all PCSK9 inhibitor prescriptions submitted via the electronic prescription and dispensing system during 2024. Medical records were reviewed to collect data on lipid profiles, statin adherence, and prior prescription history. Particular attention was given to verifying high-intensity statin use and documented statin intolerance. Reasons for non-initiation were categorised as absence of high-intensity statin therapy, poor adherence, LDL-C <100 mg/dL, primary prevention without HeFH and others such as needle phobia.

A total of 107 prescriptions were reviewed for 97 patients. After further evaluation, 20 prescriptions (18.7%) from 20 patients did not lead to treatment initiation. The mean age of these patients was 59.7 years (range: 40–77), with nine females and 11 males. Ten prescriptions came from cardiology, nine from endocrinology, and one from internal medicine. Eleven of them were for evolocumab, eight for alirocumab, and one for inclisiran. Main reasons for non-approval included absence of high-intensity statin therapy (n=7), poor adherence (n=4), LDL-C <100 mg/dL (n=3), primary prevention without HeFH (n=5) and needle phobia (n=1).

Nearly one-fifth of PCSK9 inhibitor prescriptions did not result in treatment initiation due to non-compliance with reimbursement criteria. This result highlights the misalignment between clinical guidelines and regulatory reimbursement policies, which represents a major challenge. Strengthening interdisciplinary collaboration and enhancing prescriber awareness may facilitate appropriate use of lipid-lowering therapies and improve patient outcomes.

No conflict of interest

To estimate the HC associated with the management of CTs DR at a cancer centre pharmacy.

31 semi-structured interviews were conducted involving 59 pharmacy staff members to identify dysfunctions in our pharmacy. Some concerned DR from CTs.

Regulation mechanisms were identified in collaboration with the compliance officer.

The hourly contribution to value-added on variable costs (HCAVVC), corresponding to the real average cost of 1 hour of human activity,¹ was used to value the time spent managing these dysfunctions.

HC were calculated by multiplying the time spent regulating each dysfunction by the HCAVVC.

Six key dysfunctions were identified:

The calculated HCAVVC was 47/hour.

The total HC associated with DR management was estimated at 67,294 per year, representing approximately 3.5% of the pharmacy’s annual CT management costs, equivalent of about a 1.5 full-time clinical research associate.

This amounted of 67,294 per year, confirming the economic impact of dysfunctions.

Quantifying and contextualising HC provides a management tool to prioritise corrective actions (CA) according to their economic significance.

Employees’ involvement is essential for change management and remains at the heart of SEAM.

The next assessment will quantify performance gains and validate the benefits of the CA.

1. Cappelletti L, Savall H, Zardet V. Socio-economic approach to management: science-based consulting for sustainability. Springer Nature Switzerland; 2024.

No conflict of interest

This study aimed to assess digital literacy among patients receiving direct drug distribution, in order to evaluate if they are ready to adopt current and future digital health services.

Between December 2024 and March 2025, an anonymous multiple choice questionnaire with simple questions was distributed to patients collecting medications from the hospital pharmacy. The survey was approved by the Data Protection Officer.

Of 3,684 patients, 1,804 questionnaires were collected (49%), representative across age groups. Most respondents (74%) were aged 41–80 years. A complete lack of digital skills combined with absence of caregiver support was reported by 4% (n=69). Among patients >80 years, 16% identified as ‘digitally illiterate,’ compared with 8% in the 66–80 group. Full digital autonomy (defined as the independent use of at least one device) was reported by 67% (n=1,207), with a marked decline by age: 96% in 18–40 years, 79% in 41–65, 46% in 66–80, and only 10% in those >80. Partial autonomy, requiring caregiver support, was reported by 20%, with higher prevalence in older adults (>66 years). Combining full and partial autonomy, 87% of respondents demonstrated some ability to use digital tools, primarily smartphones (97%). In total, 234 participants were digitally illiterate; of these, 70% could rely on caregiver support, while only 4% (n=69) were completely excluded from technological assistance.

The majority of patients receiving direct drug distribution demonstrated that can use digital health services. A small minority (mainly those over 80 years) remain at risk of exclusion, although caregiver support mitigates this vulnerability in most cases. This study provides evidence to guide targeted strategies for digital inclusion in healthcare, helping prevent inequities during the ongoing digital transition.

No conflict of interest

The study aimed to evaluate parental satisfaction with hospital pharmacy services, focusing specifically on the effects of nationality and income status. The objective was to determine whether these demographic factors significantly influenced perceptions of communication, accessibility, and overall satisfaction, and to identify specific service elements where disparities may occur.

A cross-sectional quantitative survey using an adapted Pharmacy Services Patient Satisfaction Questionnaire (PSPSQ 2.0) was distributed to parents of paediatric patients over three months. Satisfaction across five domains-communication, clarity, professionalism, accessibility, and waiting time was rated on a five-point Likert scale. Data were analysed in SPSS to examine associations between parental nationality, income, and satisfaction.

A total of 233 parents completed the survey. The overall satisfaction with hospital pharmacy services was high (mean score 4.57± 0.7). Analysis showed statistically significant differences in satisfaction related to both nationality and income. Parents with lower income (< 20,000/year) reported higher appreciation for pharmacist communication (4.4 ± 0.5) and clarity of verbal instructions (4.3 ± 0.6) but expressed more concerns about waiting times (3.1 ± 0.8) and medicine availability (3.2 ± 0.8). Families with higher income (> 40,000/year) were less satisfied with the organisation of the pharmacy (3.0 ± 0.7) and longer waiting times (3.0 ± 0.8), reflecting higher expectations of efficiency and comfort. Non-native parents (28% of the sample) reported more communication difficulties and lower overall satisfaction (3.2 ± 0.9) compared with native parents (4.0 ± 0.7, p < 0.01), particularly in understanding medication instructions and navigating the pharmacy process.

Income status and nationality play decisive roles in shaping parental satisfaction with paediatric hospital pharmacy services. Overall satisfaction was higher among parents who reported clear communication and shorter waiting times. These findings highlight the need for tailored interventions that enhance language support for non-native parents and improve efficiency for higher income families. Demographic-sensitive pharmacy service design can promote equity, adherence, trust across diverse paediatric populations.

No conflict of interest

To quantify the economic savings generated by the inclusion of melanoma patients in clinical trials during 2024 and to evaluate their impact on the costs associated with standard treatments.

A retrospective observational study was conducted including all melanoma patients enrolled in CTs between January and December 2024 at a tertiary hospital. Economic savings were defined as the avoided cost of standard of care (SoC) drugs replaced by investigational products supplied by sponsors. For each patient, the estimated dose and number of cycles of SoC therapy were calculated based on the duration of participation in the trial. Standard therapies considered were: pembrolizumab (adjuvant, high risk stage II–IV melanoma); dabrafenib + trametinib (first-line (1L) metastatic BRAF-mutated melanoma); pembrolizumab (second-line (2L) metastatic BRAF-mutated melanoma); and pembrolizumab (1L metastatic BRAF wild-type melanoma). Data were obtained from Pk-ensayos and Farmis-Oncofarm software.

Thirty-seven patients were included across eight active melanoma CTs: 11 in 1L metastatic BRAF wild-type trials, 3 in 1L metastatic BRAF-mutated trials, and 23 in adjuvant studies. The mean number of treatment cycles was seven (range 2–12). Based on 2024 average drug prices, total economic savings were estimated at 511,054.14, corresponding to a mean of 13,812.28 per patient.

Participation in melanoma clinical trials generates substantial economic savings by reducing the use of costly standard therapies. These findings highlight the dual benefit of clinical research—improving patient access to innovative treatments and optimising healthcare resource utilisation. Strengthening hospital infrastructures dedicated to clinical research is essential to sustain these benefits and ensure the efficient and safe management of trials

No conflict of interest

This study aimed to assess the impact of a pharmacist-led intervention on the financial performance of vascular surgery procedures. A secondary objective was to identify variables associated with reimbursement deficits.

A before-after interventional study was conducted from December 2023 to April 2025. The analysis focused on endovascular dilatation procedures (INAMI code 589050–589061). The study included three phases: baseline financial analysis, pharmacist-led feedback, and post-intervention evaluation. Pharmacists met with vascular surgeons to explain the reimbursement model, present margin data by physician, and highlight price differences among equivalent devices. Primary outcomes were the average financial margin per procedure and the proportion of interventions exceeding the reimbursed amount. Secondary analyses explored associations between selected variables and the likelihood of generating a device-related financial deficit.

Among 199 procedures, 193 were included in the final analysis. Patient and surgery characteristics were comparable between periods. The average margin increased by 59.7 (+23.3%) (p=0,51), and the proportion of negative-margin procedures declined from 31.7% to 27.2% (p=0,53) though not statistically significant. Margins were negatively correlated with procedure duration (p < 0.001*) and number of comorbidities (p = 0.016*), but not with age or sex.

Although statistical significance was not reached, the study revealed encouraging trends. The observed correlation between clinical complexity and lower margins suggests that fixed reimbursement schemes may be inadequate for complex patients. These findings highlight the relevance of hospital pharmacists in promoting cost-awareness and optimising the use of surgical devices.

No conflict of interest

This study aimed to perform a Budget Impact Analysis (BIA) to estimate potential savings resulting from the introduction of UB in a hospital setting, considering its approved indications: plaque psoriasis, active psoriatic arthritis, and Crohn’s disease.

A 5-year BIA was conducted under three scenarios: exclusive use of UO, mixed use of UO and UB, and exclusive use of UB. The analysis used 2024 dispensing data (2,100/year) distributed by indication. Direct costs, including VAT, consisting of drug acquisition (tender prices/vial: UO 130 mg 2,225; UO 90 mg 1,800; UB 130 mg and 90 mg 291) and intravenous administration (set 2.5/unit, nurse 30/h, 3 dispensations/nurse). A 5% annual increase in dispensations and a 5% discount from year three were assumed, based on internal data. A stochastic sensitivity analysis with Monte Carlo simulation (n=10,000) was performed on the mixed scenario, varying the switch to UB (60–100%) and return to UO (0–20%). Analyses were conducted using R Studio, version 4.3.3.

Over five years, total costs were 42.7 million for UO-only, 22.2 million for mixed use, and 14.2 million for UB-only. This corresponds to savings of about 20.5 million with mixed use and an even greater reduction of about 28.5 million with exclusive UB use, compared to UO-only. Sensitivity analysis estimated a mean cost of about 20.1 million (range 13.9–26.7 million; standard deviation 2.0 million).

Introducing UB could significantly improve the economic sustainability of hospital pharmaceutical expenditure without compromising therapeutic efficacy. The BIA showed substantial savings even in the mixed use scenario, further increased under exclusive biosimilar adoption. Stochastic sensitivity confirmed robust results, with minimum savings of 16,027,250 in the highest-cost simulation. This study underscores the key role of hospital pharmacists in promoting clinically and economically sustainable decisions within the National Health Service.

No conflict of interest

To conduct a five-year budget impact analysis (BIA) comparing IV natalizumab biosimilar with the SC originator in a hospital setting, and a cost-minimisation analysis (CMA) to identify the lowest cost option per dispensation, assuming therapeutic equivalence.

The BIA model considered 1,168 annual dispensations (2024 baseline). Direct costs included drug acquisition (1,090 SC; 873 IV biosimilar), administration (12 SC; 33 IV), monitoring (67 both), and adverse event management (0.30 SC; 0.35 IV). Scenarios were: exclusive SC originator, exclusive IV biosimilar, and mixed (50/50 in year 1; 30/70 thereafter). Sensitivity analysis with 10,000 Monte Carlo simulations varied biosimilar uptake (50–90%) and annual dispensations (900–1,300). The CMA compared unit costs to estimate per dispensation savings.

The IV biosimilar cost 975 per dispensation compared with 1,170 for the SC originator, yielding savings of 195 per dispensation. With 1,168 annual dispensations, this corresponded to approximately 228,000 per year and 1.14 million over five years. Over the same time horizon, total costs were 6.83 million for the SC originator, 5.68 million for the IV biosimilar, and 6.07 million for the mixed scenario. Sensitivity analysis of the mixed scenario, based on 10,000 Monte Carlo simulations varying biosimilar uptake (50–90%) and annual dispensations (900–1,300), showed an average cost of 5.63 million (SD 0.60 million; range 4.43–6.93 million).

The CMA identified the IV biosimilar as the cost-minimising option, saving 195 per dispensation compared with the SC originator. The BIA confirmed that exclusive biosimilar use yields the greatest savings, while mixed adoption offers a pragmatic compromise, combining cost reduction with therapeutic continuity and an alternative for patients intolerant to the biosimilar. These evaluations may support sustainable decision making and improve patient access in MS care.

No conflict of interest

This study aimed to evaluate the impact of AIFA registry digitalisation for reserve antibiotics as a tool for prescribing governance and support to antimicrobial stewardship in an Italian infectious disease hospital.

The observation period was divided into two phases: January–June 2025 (paper-based forms) and July–October 2025 (digital registry implementation, AIFA Resolution No. 52/2025). Consumption data were extracted from the Regional Accounting Information System, while clinical and prescribing data were collected from AIFA registries. The hospital pharmacist developed an internal analysis file to assess prescribing appropriateness, integrating clinical and therapeutic information for each patient. The pharmacist also coordinated the retrospective reconciliation of paper records and continuously monitored data consistency.

During the observation period (January–October 2025), 137 patients were treated with reserve antibiotics. In the paper-based phase, prescriptions included meropenem/vaborbactam (22 patients), imipenem/cilastatin/relebactam (18), ceftazidime/avibactam (32), and ceftolozane/tazobactam (26). In the digital phase (July–October 2025), treated patients were 9, 5, 11, and 14 for the same agents, respectively. Retrospective reconciliation of paper forms, later uploaded to the digital registry, showed a 2% discrepancy between original and electronic records, mainly due to incomplete documentation (missing antibiogram or infectious disease consultation). During the paper phase, the hospital pharmacist actively contributed to clinical-therapeutic validation and correction of records, ensuring compliance with AIFA eligibility criteria.

The implementation of AIFA digital registries improved traceability, consistency, and quality of prescribing data. At the international level, programmes such as DARWIN EU and GLASS promote antimicrobial use surveillance, while Italy stands out for its mandatory, digitalised prescribing approach. This system represents an innovative model of clinical pharmaceutical management that integrates innovation, therapeutic safety, and economic sustainability.

No conflict of interest

This study aimed to calculate the carbon footprint of the pharmacy department of a mother–child university hospital using a new tool developed by the International Reference Centre for Life Cycle Assessment and Sustainable Transition (CIRAIG) for the provincial health network.

A descriptive retrospective study was conducted from June to September 2025. The CIRAIG tool is an Excel-based calculator designed to standardise GHG inventories across healthcare institutions. It structures data according to the three scopes of the GHG Protocol: Scope 1 (direct emissions), Scope 2 (indirect energy-related emissions), and Scope 3 (other indirect emissions). The calculator includes 29 thematic modules (eg, energy, procurement, waste, mobility) and integrates emission factors from official databases, including national energy agencies and the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report. Data were collected from local administrative and technical sources covering energy consumption, purchasing, transportation, waste, and staff commuting. Financial data were retrieved from institutional management systems, while physical data were obtained from facility management and sustainability departments.

The pharmacy department’s total emissions were estimated at 13,549.4 tCO₂e (tonne of carbon dioxide) for fiscal year 2024–2025. Scope 3 represented 98.2% of total emissions, while Scope 2 and Scope 1 accounted for <0.1% and <1.8%, respectively. Within Scope 3, purchased goods and services (mainly medicines and pharmaceutical supplies) contributed 89.5% of total emissions, employee commuting 6.7%, inhaler use 1.1%, and waste management 0.2%. Exploratory benchmarking ratios were calculated: 27.1 tCO₂e per bed, 139.7 tCO₂e per 1,000 patient-days, 352.2 tCO₂e per million CAD spent on medicines, 25.5 tCO₂e per centrally compounded drug, 5.0 tCO₂e per 1,000 administered doses, and 112.9 tCO₂e per employee.

Using the CIRAIG calculator, hospital pharmacy departments can feasibly quantify their carbon footprint. This approach highlights the predominance of medication procurement in overall emissions and supports the prioritisation of targeted reduction strategies to advance healthcare decarbonisation.

No conflict of interest

To evaluate the appropriateness of SAP in two surgical units of a teaching hospital, identify the main deviations from current guidelines, and provide evidence to support targeted AMS interventions.

A Point Prevalence Survey (PPS) was conducted as part of a single-centre cross-sectional study. Data were collected from adult patients undergoing surgery in the Cardiac Surgery Unit (CSU) and the General Surgery Unit (GSU). SAP appropriateness was assessed by a multidisciplinary team based on six predefined indicators (indication, antibiotic selection, dosage, preoperative timing, intraoperative redosing, postoperative duration), following official guidelines. Associations with postoperative outcomes (SSI, healthcare-associated infections - HAI, length of stay) were analysed.

A total of 93 patients were included (CSU=51; GSU=42). Overall, full adherence to the six indicators was 35.5% (CSU 52.9%, GSU 14.3%; p<0.001). The indication for prophylaxis was appropriate in 96.8% of patients, and antibiotic selection in 81.6%, with cefazolin being the most commonly used agent. Dosage was appropriate in 84.9% of patients, preoperative timing in 59.3%, intraoperative redosing in 42.9%, and postoperative duration in 90.7%. Significant differences emerged between the two units, with higher adherence rates observed in the CSU. After adjustment for surgical unit and ASA score, full appropriateness was associated with lower SSI rates (OR: 0.22, 95% CI 0.01–1.03), lower HAI rates (OR: 0.72, 95% CI 0.43–1.22), and shorter hospital stays (β = -1.1 days, 95% CI -3.0 to -0.8).

Full adherence to SAP guidelines was low but associated with improved clinical outcomes. Although antibiotic selection and dosing were largely appropriate, preoperative timing and intraoperative redosing remained critical areas for improvement. The PPS proved to be an effective tool not only for monitoring SAP appropriateness, but also for guiding targeted improvement strategies. Implementation of standardised protocols, real-time auditing, and AMS-driven educational initiatives may foster a progressive enhancement of adherence over time.

No conflict of interest

To synthesise evidence on clinical outcomes, health-related quality of life, and healthcare resource use and costs (direct and indirect) following EL-EX compared with best supportive care (BSC).

Targeted review of PubMed/PMC and regulatory/HTA sources through 02 Oct 2025, prioritising peer-reviewed trials and economic evaluations. Study outcomes included motor milestone attainment, oculogyric crises, caregiver and patient HRQoL, safety, survival and quality-adjusted life years (QALYs), and healthcare resource use and cost drivers.

Open-label trials show clinically meaningful, durable gains in motor function and symptom control. In a prospective series, 67% achieved gross motor milestones by week 48 (PDMS-2); sitting and walking goals occurred in subsets. Oculogyric crises markedly improved. Safety was acceptable.¹ Long-term pooled analyses reported sustained milestone acquisition and caregiver HRQoL gains. Natural-history comparators show minimal milestone attainment with BSC over 5 years, underscoring treatment effect.² Economic evaluations from a US perspective reported discounted (3%) incremental QALYs of 20.83 (PDMS-2 MSD approach) and 18.44 (motor milestone), with ICERs of $199,007 and $224,104 per QALY versus BSC, respectively.³ Scenario/sensitivity analyses were consistent. Models attribute cost offsets to fewer crisis-related admissions/emergency visits, reduced supportive therapies, and lower informal care time, balancing one-time acquisition/procedure costs. Empirical real-world resource use data remain limited. Regulatory/HTA reviews concur on substantial benefits but note uncertainties from small samples and long-term extrapolation; HRQoL was not measured in all trials, informing use of utility vignettes in models.

EL-EX confers durable benefits in severe AADC deficiency, with sustained motor improvement, fewer oculogyric crises, caregiver-reported HRQoL gains, and acceptable long-term safety. Health-economic models show substantial QALY gains and cost offsets from fewer acute events and lower care intensity, though lifetime costs may increase with longer survival. For hospital pharmacy, findings support multidisciplinary adoption, robust peri-operative management, and prospective tracking of resource use to validate savings and guide budget impact analyses.

1. Golikeri A, et al. JAMA 2025. doi:10.1001/jama.2024.28666

2. Tai CH, et al. Molecular-Therapy 2022. doi.org/10.1016/j.ymthe.2021.11.005

3. Zhang R, et al. PharmacoEconomics 2025. doi.org/10.1007/s40273-025-01542-8

No conflict of interest

The primary aim of this study was to assess the economic sustainability of the innovative therapy (osimertinib) compared to the standard of care (afatinib).

A retrospective, observational study was performed, analysing the medical records of adult patients with EGFR-mutated NSCLC. The analysis was conducted from the Regional Health Service (SSR) perspective over a 1 year period.

The dosage evaluated was a daily intake of one tablet for each drug: osimertinib 80 mg (112.25 per tablet ) and afatinib 40 mg (59.87 per tablet). The annual treatment cost for osimertinib was calculated as 40,971.25, and for afatinib, as 21,852.55. The one-year progression-free survival (PFS) data were also analysed, with rates of 72.22% and 48.1%, respectively.

The Incremental Cost-Effectiveness Ratio (ICER) was estimated as the increase in cost per unit of effectiveness gained, with a willingness-to-pay (WTP) threshold set at 50,000 per PFS event. Osimertinib data were obtained from 43 patients undergoing treatment, while Afatinib data were extrapolated from clinical trials.

The Incremental Cost-Effectiveness Ratio (ICER) estimated for osimertinib versus afatinib was determined to be 78,963.74. This value exceeds the willingness-to-pay (WTP) threshold, suggesting that osimertinib therapy is not cost-effective within the clinical and economic context of this study. The Number Needed to Treat (NNT) with osimertinib to observe one additional progression-free survival event compared to afatinib was 4.13.

In a backward sensitivity analysis, setting the WTP at 50,000, the maximum sustainable cost for osimertinib therapy would be 33,958.55 per year, equivalent to 93.04 per tablet.

The analysis suggests that, although osimertinib offers a clinical advantage in terms of PFS, it has a high incremental cost compared to afatinib. Therefore, the treatment is not cost-effective based on the threshold value adopted. However, it is essential to note that additional considerations related to toxicity, quality of life and long-term benefits could influence and potentially modify the overall assessment of the cost-benefit profile.

No conflict of interest

This study analysed drug consumption in nursing homes across different healthcare management areas.

Data from January-December 2024 obtained from the national healthcare service database were analysed. Nursing homes were classified by size (<25 beds, 25–100 beds, and >100 beds) and by territory.

Statistical analyses evaluated relationships among medication pack prices, total drug costs, consumption levels, net expenditure, number of patients and cost per patient.

The study included 75.302 patients from nursing homes: 9% from <25 beds (n = 6.437), 58% from 25-100 beds (n = 43.807), and 33% from >100 beds (n = 25.058).

The average cost per bed was 1.424,53 and per patient 1.167. The mean cost per medicine pack was 14,47, consistent across the territory (14–16) and 20,9–38,2% higher than in community pharmacies (11,58).

No significant correlation was observed between average pack cost and total costs: <25 beds (r=-0,04), 25-100 beds (r=0,38) and >100 beds (r=0,35). Total costs were driven mainly on the number and complexity of patients rather than pack cost.

Net expenditure depended on the number of patients and cost per patient. Interannual analysis showed that changes between 2023 and 2024 were explained by increased total cost per patient (<25 beds: r=0,72, 25-100 beds: r=0,65, >100 beds: r=0,80), whereas total 2024 expenditure was strongly associated by number of patients (r=0,99 for all types).

Drug consumption patterns showed contrasting trends: antibiotic use increased with size (49,85% in <25 beds to 54,60% in >100 beds), while antipsychotic use decreased (49,70% to 44,75%). One-tailed t-tests revealed significant differences between <25 and >100 beds for antibiotics (p=0,031) and antipsychotics (p=0,046), while <25 vs 25-100, and 25-100 vs >100 comparisons were not significant (p>0,05).

Territorial analysis demonstrated significant variability in drug costs across different healthcare management areas, independent of nursing home size. However, drug consumption patterns differed by facility size, with opposite trends observed for antibiotic and antipsychotic use.

No conflict of interest

To identify PrEP drugs currently approved in different countries and examine their dispensation and financing mechanisms. Additionally, to estimate the economic impact of a potential transition from hospital to community pharmacy dispensing and to explore possible models to enable community pharmacy dispensing.

Information on PrEP approval, access, and financing across countries was collected from publicly available sources, including official health reports, institutional websites, and scientific literature. The economic impact of TDF/FTC in Spain was assessed using tender and retail prices (PVP including VAT) as of August 2025. Potential models for community pharmacy dispensing were also reviewed.

At the European level, most countries reimburse oral TDF/FTC, although dispensing channels vary. France, Germany, and Portugal allow community pharmacy dispensing, whereas Spain and Italy restrict access to hospital pharmacies. In the United Kingdom, broader access is provided through NHS clinics, which also include tenofovir Alafenamide/Emtricitabine and cabotegravir among available options.

Based on public procurement data, the average net monthly cost of TDF/FTC in hospital pharmacies is approximately 75% lower than the retail price in community pharmacies (10.61 vs 43.71). With an estimated 30,000 patients in 2025, this difference translates into a potential budget impact of around 993,000 per year.

Transitioning to community pharmacy dispensing would require regulatory changes, such as drug reclassification of TDF/FTC, potential expansion of prescribing rights, and targeted training for prescribers and pharmacists. Potential implementation models include prescriptions issued in primary care with dispensing through community pharmacies.

Community pharmacy dispensing of PrEP could improve accessibility and align Spain with other European models. However, the transition would entail regulatory adjustments and higher drug costs compared with the current hospital pharmacy system.

No conflict of interest

To identify medicines affected by shortages and supplied through foreign imports, and to assess their economic, resource, and safety impact.

A retrospective observational study was conducted in the Pharmacy Service of a tertiary hospital from January 2024 to July 2025, including all medicines affected by shortages and replaced with foreign imports. Stock data, national drug prices, and consumption were obtained from the hospital logistics management software (Orion Logis), while foreign medicine prices were provided by the AEMPS. Economic impact was assessed by comparing unit sale prices of national and foreign medicines, considering monthly consumption and months of foreign supply. Resource and safety impacts were jointly evaluated through the need for relabelling foreign medicines when labelling was in a complex language, and through the drafting of informative notes for hospital units in cases of major changes in dose, concentration, or volume.

Forty-one national medicines in shortage were replaced with foreign imports, of which 24 (58.5%) later returned to national supply. The most affected pharmacotherapeutic groups were anti-infectives (31.7%, n=13), psychotropics (17.1%, n=7), cardiovascular drugs (14.6%, n=6), and antineoplastics (9.8%, n=4). In five cases (12.2%), a second substitution with a foreign medicine was required due to recurrent shortages. Economically, the price of foreign medicines was higher in all cases, with a median of 4.3 (1.8–7.5) times higher. Considering monthly consumption and the shortage period, total expenditure increased by 209,419. Regarding safety and resource impact, four drugs (9.8%) required relabelling due to poorly understandable foreign-language labelling, and six (14.6%) required informative notes for hospital units owing to presentation differences (dose, concentration, or volume) that could pose patient risks.

Managing drug shortages with foreign imports requires a necessary strategy but entails substantial economic and organisational impact, along with safety risks from foreign-language labelling and presentation differences. Larger studies and preventive strategies are needed to mitigate these consequences and optimise hospital pharmacy practice.

No conflict of interest

As part of the environmental sustainability improvement framework of a third-level hospital’s Pharmacy Department (PD), the creation of indicators for weight, volume, and density of non-cytotoxic drugs disposed of in selective containers was proposed. The goal was to assess efficiency and minimisation of waste generation, ensuring proper treatment and reducing environmental exposure.

Indicators were calculated in relation to PD activity. Data on waste weight and volume disposed of in specific containers (2022–2024) and annual dispensed medication units were collected. Reference values and acceptance limits were defined (mean waste weight 2022–2023 ± SD). Indicators included:

The values for waste disposal indicators were as follows:

Year Weight (g/unit dispensed) Volume (cm³/unit dispensed) Density (g/cm³) 2022 0.329 0.196 1.679 2023 0.255 0.165 1.549 2024 0.265 0.185 1.437

Acceptance Limits:

The density value for 2024 was below the acceptance limit.

For each dispensed medication unit, we are generating increasingly voluminous and lighter waste, indicating improper segregation. Items of lower density are being disposed of in the selective pharmaceutical container, even though they should be classified in other groups and treated differently (eg, cardboard packaging, plastic blisters, gloves, masks, paper etc). In this context, measures are being taken to optimise the waste management process: introducing containers to separate and dispose of paper and plastic, providing specific training on healthcare waste handling for PD staff and creating an infographic for proper disposal guidance.

1. Health care’s climate footprint. Washington, DC: HCWH; 2019.

No conflict of interest

To analyse the clinical utility of NGS in implementing targeted therapies for patients with neoplasms.

Retrospective observational study of all patients undergoing NGS testing in 2024 at a tertiary hospital. Clinically relevant mutations were classified using the ESCAT scale (I/II). Data on treatment implementation were obtained from medical records, molecular pathology reports, and OncoKB .

Among the 204 patients analysed, 77 (38%) had mutations classified as ESCAT I or II, indicating clinically relevant alterations. These included: ALK (anaplastic lymphoma kinase) (n=3), BRAF (RAF kinase-encoding) (n=2), CTNNB1 (β-catenin-encoding) (n=1), EGFR (epidermal growth factor receptor) (n=22), ERBB2 (Erb-B2 tyrosine kinase receptor 2) (n=3), ESR1 (oestrogen receptor) (n=1), IDH (isocitrate dehydrogenase) (n=3), KIT (tyrosine kinase receptor) (n=9), KRAS G12C (Kirsten rat sarcoma viral oncogene) (n=21), MET (hepatocyte growth factor receptor) (n=7), PDGFRA (platelet-derived growth factor receptor alpha) (n=2), and RET (tyrosine kinase receptor) (n=3). 79% of patients with actionable mutations (n=61, 30% of the total cohort) received funded targeted therapies in first or subsequent lines (eg, lorlatinib, osimertinib, imatinib, tepotinib, selpercatinib). Additionally, one patient accessed targeted therapy via expanded access (elacestrant), and another through compassionate use (avapritinib). Furthermore, five patients had actionable mutations with non-funded targeted treatments (dabrafenib, amivantamab), and three patients had mutations for which the targeted drug was under funding evaluation (ivosidenib). Finally, six patients had clinically relevant mutations for which no targeted therapy was available.

NGS proved to be a valuable tool for identifying clinically relevant mutations, enabling the implementation of targeted therapies in 30% of the analysed patients. The majority of patients with actionable mutations (79%) benefited from funded targeted treatments, highlighting the importance of integrating NGS into clinical practice to select the most appropriate therapy for each patient.

No conflict of interest

To describe and analyse medicine shortages in Bosnia and Herzegovina (BiH) over an 8 year period.

A study was conducted by analysing data on medicine shortages published in the National Register of medicine shortages available on the Agency for Medicinal Products and Medical Devices BiH website from 2018 to 2025. The extracted data were classified using the ATC Classification, the route of administration, duration and reasons for the medicine supply disruptions.

Out of 844 medicine shortages reported during this 8 year period, 66% corresponded to oral medications, and only 20% to intravenous medications. The shortages primarily involved cardiovascular medicines (17%), nervous system therapeutics (16%), antineoplastic agents (12%), followed by medicines affecting the musculoskeletal system (10%) and antimicrobials for systemic use (10%). The highest number of shortages occurred in 2023 (n=192) and 2024 (n=177), which corresponds to the special report published by the European Court of Auditors.¹ The majority of reported shortages (62%) were only temporary, while 38% were permanent, often due to the non-renewal of a marketing authorisation or withdrawal from the market. The highest number of permanent shortages reported in 1 year was in 2019 (n=61; 74%), while the temporary shortages reached their maximum in the last 3 years, 2023 (n=136; 71%), 2024 (n=132; 75%) and 2025 (n=111; 73%). Commercial reasons were identified as the leading cause of medicine supply disruptions during the entire observed period (n=407; 48%).

A significant increase in reported shortages could be attributed to limited pharmaceutical profitability, inadequate regulatory measures and increased demand for medicines within our economically constrained healthcare system. However, a low number of reported shortages of intravenous medications might imply that marketing authorisation holders have been failing to adequately report existing medicine shortages in hospitals, which highlights the need for a practical framework to address them.

1. The European Court of Auditors. Special report 19/2025: Critical shortages of medicines – EU measures were of added value, but structural problems remain. Available at: https://www.eca.europa.eu/ECAPublications/SR-2025-19/SR-2025-19_EN.pdf.

No conflict of interest

To analyse the evolution of intravitreal treatment prescribing patterns in patients with macular diseases between 2021 and 2024, assessing the impact of newly introduced therapeutic options and the increasing complexity of treated patients.

We conducted a retrospective observational study including all patients who received intravitreal injections between January 2021 and December 2024. Data extraction, integration, and processing were performed using Power BI as part of a multidisciplinary project. Descriptive statistics and simple linear regression were applied to evaluate temporal trends (p<0.05).

A total of 3,223 patients received 31,826 intravitreal injections. Bevacizumab was the most frequently prescribed drug (58.73%, n=18,690), followed by aflibercept (25.99%, n=8,270) and ranibizumab (9.01%, n=2,869).

The number of treated patients increased from 1,330 in 2021 to 1,911 in 2024 (+43.7%), while total injections rose from 6,134 to 9,345 (+52.3%).

Between 2023 and 2024, bevacizumab and ranibizumab use decreased by 13.78% and 1.24%, respectively, whereas aflibercept prescriptions increased by 13.38%. Notable findings included a rise in brolucizumab use (from 96 to 311 injections) and the introduction of faricimab (419 injections in 179 patients). Dexamethasone use increased by 14.63%, while fluocinolone remained stable.

Regarding clinical complexity, treatment lines were distributed as follows: 657 patients in first-line, 411 in second, 180 in third, 70 in fourth, and 26 in fifth-line. The mean number of treatment lines per patient increased from 1.35 (2021) to 1.76 (2024), showing a statistically significant upward trend (annual coefficient: 0.130; 95% CI: 0.048–0.212; standard error: 0.019; p=0.021).

Findings demonstrate a progressive increase in care demand, accompanied by changes in prescribing trends, with greater adoption of innovative therapies and higher clinical complexity among treated patients. These results underscore the importance of integrating data analytics into daily practice to optimise therapeutic decision making and anticipate the growing healthcare demand in ophthalmology.

No conflict of interest

This study aimed to investigate real-world practices across Europe related to the management and disposal of unused or expired household medicines. The objective was to identify areas in which clinical pharmacists can contribute to reducing medication waste, fostering proper disposal practices, and minimising environmental impacts.

Stemming from the IHI ENKORE Project, this European online expert survey assessed national legislation, awareness campaigns, and disposal practices for unused household medicines. The survey examined the volume of pharmaceutical waste generated, as well as economic aspects, including costs and financial responsibilities for disposal. Data were analysed to identify cross-country differences and define priority areas where clinical pharmacists can play a significant role.

Valid responses were collected from 33 European countries. In most of them, neither medication packaging nor public campaigns provided patients with information on how to manage unused medicines. On the other hand, most national collection systems for unused drugs involved pharmacists—obligatory collection in pharmacies was reported in 16 countries, while voluntary in 7. Similarly, in real-world settings, the most common disposal practice was returning unused medicines to community pharmacies (21 countries). However, in 7 countries, the most common method was discarding them in household waste. Consequently, a large proportion of unused medicines were disposed of improperly, leading to environmental pollution.

Unused and expired medicines remain a persistent and costly problem with serious implications for health systems and the environment. With their expertise in medication management, clinical pharmacists are well positioned to address this challenge by counselling patients on proper use, adherence, and—where appropriate—safe disposal of unused medicines. Their more frequent involvement can help reduce pharmaceutical waste, limit environmental harm, and strengthen healthcare sustainability. This provides a strong incentive to broaden the scope and availability of clinical pharmacy services across Europe.

Corporate sponsored research or other substantive relationships:

I (PK) received speaker’s honoraria from Procter & Gamble Company for a presentation over which the paying company had no influence. Additionally, my university received funding from the European Union’s Horizon 2020 for the ODIN Project (Grant Agreement N° 101017331) and from IHI for the ENKORE Project (Project Number: 101166707), and CAREPATH Project (Project Number: 101192133) outside this work.

To quantitatively assess the time required for manual label application within pharmacy dispensing workflows by collecting and analysing timing data from hospital and retail pharmacies. The findings will establish a baseline for workflow efficiency and inform opportunities to optimise operations through automation.

Time in motion data were collected from a sample of 5 hospital and retail pharmacies in the UK and Netherlands during routine dispensing workflows involving manual application of dispensing labels to medication packaging. Duration of the manual label application process, along with the staff grade performing the process and their average annual salary, were recorded. Process steps within the hospital and retail pharmacy workflows were documented to provide contextual insight into operational differences across settings.

Across the five study sites, the average time to manually print and apply a dispensing label was calculated at 12 seconds per medication pack.

To estimate the potential efficiency gains from removing this manual step, projected annual time savings were calculated for pharmacies. For a pharmacy dispensing 500 packs per day:

Estimated total time saved = 608.3 hours

Full-Time Equivalent (FTE) Technician = 0.29 (based on 2,080 working hours/year)

Estimated salary savings = £9,733 (based on £16/hour technician)

The findings from this study highlight the measurable time burden associated with manual label application during dispensing. An average of 12 seconds per medication pack may appear minimal in isolation, but when scaled to high-volume dispensing environments, the cumulative time impact becomes significant. For pharmacies dispensing 500 packs per day, the potential annual time savings exceed 600 hours—equivalent to nearly one-third of an FTE’s workload. Establishing this baseline provides an important foundation for assessing the operational benefits and potential return on investment of automated labelling solutions.

Corporate sponsored research or other substantive relationships:

Alice Dainty is an employee and shareholder of Becton Dickinson and Company.

The aim was to evaluate the preparedness of hospital pharmacies for emergencies, crises, and disasters. Specific objectives included assessing the presence of institutional protocols, the availability of critical medicines and medical supplies, and the demographic and organisational characteristics of pharmacies and their staff.

A cross-sectional survey was conducted among hospital pharmacists using a structured 25-item questionnaire covering demographics, hospital type and capacity, pharmacy structure, preparedness protocols, and medicine availability rated on a 5-point Likert scale. Descriptive analysis examined respondents by hospital category, position, and preparedness indicators.

Of 35 pharmacists invited, 27 participated. The mean age was 46 years (median 49) with 22 years of experience. Participants represented general (n=9), university (n=9), clinical (n=5), and specialised hospitals (n=5), mostly with 100–300 beds. Nineteen were heads of pharmacies. Sixteen reported having a preparedness protocol, while eleven did not. Analgesics, antimicrobials, and infusion solutions were adequately stocked, but shortages were noted for intubation supplies (n=4), vasopressors (n=2), antiemetics (n=2), respiratory drugs (n=2), ophthalmological medicines (n=9), and antidotes (n=11).

Hospital pharmacists in our country are experienced but work in institutions with uneven preparedness. The catastrophic fire underscored the urgent need to strengthen disaster response capacity. While essential medicines are generally available, shortages of critical and rarely used drugs remain a key vulnerability. Strengthening hospital pharmacy resilience requires the implementation of standardised protocols, training and coordinated national stockpiling strategies. These measures are essential to ensure a timely, consistent and effective response during future emergencies.

No conflict of interest

This study aimed to evaluate the effectiveness of a JIT inventory system in reducing pharmaceutical waste in a tertiary care hospital.

A prospective study was conducted over a 6 month period at a large tertiary care hospital, where a JIT inventory system was implemented for high-turnover medications. Data on medication waste, inventory turnover, and stockouts were collected before and after the JIT system’s introduction. Statistical analysis included paired t-tests for waste reduction and Chi-squared tests for stockout frequency.

The introduction of the JIT system resulted in a 25% reduction in pharmaceutical waste (p = 0.04) and a 15% increase in medication turnover (p = 0.03). Stockouts were reduced by 20%, with no significant increase in the number of emergency orders (p = 0.05).

The JIT inventory system significantly reduced pharmaceutical waste and improved medication turnover. These findings support the adoption of JIT systems in hospital pharmacies as a strategy for reducing waste while maintaining medication availability.

1. Alanazi MQ, Alkhadhairi EK, Alrumi WH, Alajlan SA. Reducing pharmaceutical and non-pharmaceutical inventory waste in tertiary hospital: impact of ABC-VEN analysis in a zero-waste strategy over 7 years. Risk Manag Healthc Policy 2024 Nov 4;17:2659–2675. doi: 10.2147/RMHP.S467230. PMID: 39525683; PMCID: PMC11545607.

No conflict of interest

This study aimed to identify the disposal practices of unused medications among the general public, HPHs, and municipalities, and to determine factors influencing proper disposal practices among the general public.

Data were collected from three groups: 1) the general public (N=500), 2) all HPHs in the province (N=79), and 3) three municipalities representing sub-district, town, and city levels, respectively. Validated questionnaires were used for the general public and the HPHs. Response to the survey was done through Google forms using the QR code scan. Semi-structured interviews were used for the municipalities. Data were analysed using descriptive statistics and multiple logistic regression to explore predictors of proper disposal.

The most common disposal method among the general public was placing unused medications in regular trash bins with intact packaging (65.2%). One-fifth returned them to hospitals including HPHs. Factors significantly associated with appropriate disposal practices were older age (OR 3.98; 95% CI 1.48, 10.69), being female (OR 1.82; 95% CI 1.04, 3.19), and having received disposal information (OR 9.04; 95% CI 5.15, 15.88). Of the HPHs that responded (54/79), the majority reported proper disposal, primarily through hazardous waste receivers, 51% of which were further managed by outsource agency. All participating municipalities lacked specific household medication waste management and relied entirely on HPHs.

The majority of the general public improperly discarded unused medications. Interventions should target younger populations and males, emphasising the influence of access to the disposal guidance. While HPHs demonstrated high compliance, the lack of policies and management system within municipalities highlighted a gap in the comprehensive local medication waste management.

The study was funded by the Faculty of Pharmacy, Thammasat University. We are grateful to all participating general public, HPHs, and municipalities for their contributions in the study.

No conflict of interest

We aimed to reduce the environmental impact of this activity, ensure patient safety, and better meet their needs by optimising this pathway.

A review of current practices in France was conducted. We assembled a multidisciplinary working group to address the following challenges:

A collaborative methodology was adopted, involving all stakeholders at each stage. Following institutional validation (management, regional health agency, pharmacy inspection, regional healthcare coordination bodies), the project was presented to the Medical Commission of the Establishment.

The project is based on strengthened collaboration between the hospital pharmacy, community pharmacies, and the logistics of a private partner using an electric vehicle fleet. Specific training was provided to community pharmacists.

After one month of implementation, the uptake rate for this system is 45%, against a success target of 50%. The project has had an impact at various levels within the HPD:

Regarding environmental impact, a 45% uptake results in an estimated annual saving of 12 tonnes of CO₂ equivalent.

This initiative tackles challenges related to organisation, the environment, and society. By integrating sustainable logistics, local proximity, and improved connections between the city and hospital, it aims to improve both care quality and patient services. A survey is currently being conducted to evaluate the satisfaction of patients and community pharmacies.

No conflict of interest

In this context, the pharmacy is tasked with reviewing the composition of surgical kits no longer aligned with current practices. This work is carried out with consideration for the three pillars of sustainable development: environmental, economic, and social.

This project is conducted by a pharmacist and an intern, in collaboration with medical and paramedical teams. Optimal kit compositions are developed and submitted to suppliers. Trials are organised to validate the proposed modifications. Environmental impact is assessed by measuring the amount of waste avoided: unused and discarded medical devices (MDs), and the packaging of ‘satellite’ MDs. To evaluate economic impact, the new kits’ prices are compared with current costs, including the prices of the previously referenced kits and the ‘satellite’ MDs. Finally, users receive a satisfaction survey.

Nine surgical kits were revised. The VASCULAR kit required the most changes, with 10 references to be removed and 10 new ones added. The environmental impact is estimated at 2.2 tonnes of waste avoided annually, including 800 kg from the CARDIAC kit due to optimised drapes. Annual savings of 45000 are estimated. Savings from multiple kits help fund more expensive kits, as a safer CAESAREAN kit. Analysis of the surveys shows 96% (96/100) satisfaction. Numerous exchanges with healthcare providers confirm a positive social impact: time savings, reduced musculoskeletal disorders, and improved safety. However, some limitations appeared: difficulty in standardising practices, storage issues and supply chain disruptions.

Beyond positive ecological impact, the revision of surgical kits offers numerous benefits: enhanced safety, time savings and cost reduction. However, some limitations have emerged and need to be considered.

The project is strongly supported by our institution’s Sustainable Development Steering Committee. Through this initiative, evaluation of additional kits has begun as preparation for the next tender process.

No conflict of interest

To perform a network meta-analysis (NMA) assessing the efficacy and safety of anti-VEGF agents for nAMD.

A PubMed search was conducted to identify phase III randomised controlled trials (RCTs) evaluating ranibizumab, brolucizumab, aflibercept, and faricimab in nAMD. Baseline characteristics included age, sex, race, best-corrected visual acuity (BCVA), and central subfield thickness (CST).

The primary efficacy endpoint was mean change in BCVA, measured using the ETDRS letter score. Analyses were performed with R v4.4.1. Anti-VEGF agents were compared using aflibercept 2mg Q8W as the reference.

Nine RCTs were included. Populations were comparable: mean age similar across trials, women represented approximately 55% of patients, baseline BCVA ranged 50–60 letters, and CST 350–460 μm.

At week 48, all active regimens yielded similar improvements in BCVA. The greatest numerical gain was observed with aflibercept 2 mg Q4W (SMD 0.93, 95% CI -1.22, 3.07), though not statistically significant. Verteporfin (SMD -19.81, 95% CI -22.77, -16.85), was associated with marked visual decline.

Regarding safety, the highest odds ratios (OR) for serious ocular adverse events were reported with aflibercept 8 mg Q12W (OR 3.05, 95% CI 0.61, 15.20) and Q16W (OR 2.51, 95% CI 0.48, 13.02), though with wide confidence intervals. Brolucizumab 6 mg Q12W (OR 2.86, 95% CI 1.20, 6.85) was the only regimen with a statistically significant increase in risk. Elevated but uncertain risks were also observed with brolucizumab 3 mg Q12W and ranibizumab 0.5 mg Q4W.

This NMA confirms that anti-VEGF therapies are significantly more effective than verteporfin photodynamic therapy in preserving visual acuity in nAMD. No major safety differences were observed for most agents, although brolucizumab 6 mg Q12W may carry a higher risk of ocular adverse events. Further long-term studies are needed to clarify comparative outcomes.

No conflict of interest

To develop a systematic search and evaluation about efficacy of immunotherapies in rNSCLC based on subgroup analysis according to patient smoking status.

Systematic review was conducted in EMBASE and Pubmed databases until 17 September 2024. Randomised phase III clinical trials on perioperative immunotherapies for rNSCLC with ≥50 patients were selected. Review records with languages other than English or Spanish were excluded. Progression-free survival (PFS) was the efficacy endpoint evaluated. Analysis of efficacy was performed using aggregated data on immunotherapy regimens. This efficacy analysis differentiated two patient subgroups: current/former smokers and never smokers. Heterogeneous efficacy of immunotherapy regimens between aggregated subgroup of current/former smokers and never smokers was defined as p < 0.1, as these were subpopulation analyses. The calculations were obtained from the hazard ratio values from clinical trials and the variances of their natural logarithms.

A total of 69 search records were found in EMBASE and PubMed databases. Of these, 65 were excluded for the following reasons: 38 studies did not involve immunotherapies, 12 duplicate publications, 11 records without selected clinical trial design, two studies on different pathologies, one evaluated different endpoints and another for using an excluded language. Therefore, four clinical trials were included. A total of 2835 patients were recruited in the selected clinical trials. The immunotherapeutic agents involved in the perioperative regimens for rNSCLC were durvalumab, nivolumab, pembrolizumab and toripalimab. The estimated hazard ratio of immunotherapy regimens for the aggregate subgroup of current/former smokers was 0.55 (95% CI 0.48–0.64). The calculated hazard ratio of immunotherapy schemes for the aggregate subgroup of never smokers was 0.76 (95% CI 0.52–1.13). P between subgroups according to smoking status reached a value of 0.12 (no heterogeneous efficacy).

Our study found no difference in the efficacy of perioperative immunotherapy regimens between current/former smokers and never smokers diagnosed with rNSCLC.

None

No conflict of interest

To describe the cost saving of switching from pembrolizumab and nivolumab FD to weight-based dosing (WBD), as recommended by hospital management, in real-world clinical practice.

A retrospective observational study was conducted in a tertiary hospital, including patients who received at least one dose of pembrolizumab or nivolumab between September 2024 and August 2025. Collected data (extracted Farmatools ) from F included patient weight, dosage regimen and number of administrations. FD and WBD followed the official product label. Cost analysis considered vial prices (pembrolizumab 1081.75; nivolumab 641.73), quantities used, and vial optimisation. The cost of WBD was compared with a hypothetical FD scenario, estimating the percentage of patients receiving WBD and potential savings. Differences between groups were assessed using an independent samples Student’s t-test.

Pembrolizumab was administered to 287 patients: 223 (weight 69.50 ± 28.22kg) received fixed doses and 64 (weight 62.61 ± 14.37kg) received weight-based doses. Annual cost was 3,684,439.82 for fixed dosing and 454,925.32 for weight-based dosing, saving 267,683.32 (6.47%). Weight-based dosing was used in 22.3% of patients. No significant difference in mean bodyweight was found between groups.

Nivolumab was administered to 108 patients: 64 (weight 62.29 ± 32.06kg) received fixed doses and 44 (weight 64.95 ± 14.79kg) received weight-based doses. Annual cost was 1,058,857.64 with fixed dosing and 297,505.63 with weight-based dosing, saving 244,629.48 (18.04%). Weight-based dosing was applied in 40.74% of patients. Although a significant difference in mean bodyweight was found (t=2.81, p < 0.05), the absolute difference was small and likely clinically irrelevant.

Individualised dosing of nivolumab and pembrolizumab can represent a strategy to optimise treatment costs in clinical practice. However, in our institution, the proportion of patients receiving WBD remains suboptimal. Continued education, data sharing, and consensus protocols with prescribers are needed to promote WBD for these monoclonal antibodies, optimising treatment outcomes and reducing healthcare costs.

No conflict of interest

To evaluate therapeutic adaptations to the olanzapine shortage and analyse clinical consequences in patients stabilised on OLAI.

A single-centre retrospective cohort study was conducted between May and August 2025. Eligible patients were men and women of all ages from the active caseload of a public psychiatric hospital, either hospitalised or outpatient, stabilised on OLAI 300 mg or 405 mg – with at least three previous injections. Data were extracted from patient records and nursing reports. Primary outcomes were therapeutic adaptations (oral switch, antipsychotic change, dose adjustment) and clinical course (decompensation/rehospitalisation).

Among the 34 patients, only two (6%) maintained their usual injection dosage. Most required adaptation: 22 (65%) switched to oral olanzapine, 10 (29%) underwent OLAI dose change. Of these, nine later switched to oral olanzapine, and one changed to another antipsychotic. Overall, 31 out of 34 patients switched to oral olanzapine. Among them, seven (21%) experienced decompensation, including one rehospitalisation. After the shortage, only 16 (47%) resumed OLAI.

The shortage led to therapeutic adjustments in nearly all patients, with 21% decompensating, and one readmission. Although the rehospitalisation rate was low (3%), at a national scale, it could represent a major public health burden. These results highlight the vulnerability of psychiatric care pathways to shortages. Limitations include the retrospective, single-centre design, reducing generalisability of the results. Multicentre studies with health-economic analyses are needed to confirm these findings and better estimate the global impact. This study illustrates how a drug shortage can undermine years of clinical stability within weeks, underscoring the need for therapeutic continuity in psychiatry.

No conflict of interest

To perform indirect comparisons (ICs) between innovative therapeutic alternatives using a common comparator in patients diagnosed with moderate-to-severe AD.

A PubMed review of pivotal randomised clinical trials (RCTs) responsible for the authorisation of selected therapies (abrocitinib, baricitinib, dupilumab, lebrikizumab, tralokinumab and upadacitinib) was conducted. Inclusion criteria: phase III RCTs of treatments cited with a double-blind and placebo-controlled design, which included patients with moderate-to-severe AD. Investigator’s Global Assessment score of 0-1 (IGA 0-1, clear to almost clear skin) at 16 weeks were selected as the endpoint to estimate absolute risk reduction (ARR) for each drug. We conducted adjusted ICs using Bucher’s method. The regimen with the greatest magnitude of effect was selected as reference therapy. The maximum difference without clinical relevance () was defined as ±23% according to the average of IGA 0-1 value used in studies to calculate the sample size.

Twelve RCTs were included. All treatments showed benefit over placebo (common comparator). Regarding upadacitinib 30 mg diary (reference therapy), ARRs were: -13.50% (95% CI, -19.98 to -7.02) vs upadacitinib 15 mg diary; -17.65% (95% CI, -25.95 to -9.35) vs abrocitinib 200 mg diary ; -22.9% (95% CI, -29.79 to -16.01) vs dupilumab 300 mg biweekly; -24.10% (95% CI, -31.22 to -16.98) vs lebrikizumab 250 mg biweekly; -32.55% (95% CI, -40.50 to -24.60) vs abrocitinib 100 mg diary; -39.85% (95% CI -46.51 to -33.19) vs baricitinib 4 mg diary: -41.50% (95% CI -47.29 to -35.71) vs tralokinumab 300 mg biweekly; and -44.15% (95% CI -50.44 to -37.86) vs baricitinib 2 mg diary. Statistically significant differences were found between upadacitinib 30 mg daily and the rest of therapies examined. Upadacitinib 30 mg only demonstrated a clinically relevant benefit versus lebrikizumab, abrocitinib 100 mg, tralokinumab, baricitinib 4 mg and 2 mg.

Our ICs provide comparative efficacy data on therapeutic alternatives for moderate-to-severe AD in terms of IGA 0-1. Statistically significant benefit was observed between upadacitinib 30 mg with respect to all treatments, but only relevant clinical superiority over lebrikizumab, abrocitinib 100 mg , tralokinumab, baricitinib 4 mg and 2 mg.

No conflict of interest

To evaluate the feasibility of applying life cycle assessment (LCA) to a biological drug, adalimumab, in order to estimate its carbon footprint and to explore the integration of such an approach into hospital referral decisions.

Seven adalimumab products in prefilled pen presentations were analysed (one originator and six biosimilars, at 40 mg and 80 mg doses). The Carebone tool, developed by our institution, was used to perform a life cycle assessment including the production of the active substance, excipients, packaging materials, energy consumption during formulation and packaging, transport, and end of life of packaging. Data were collected from regulatory databases and from documentation provided by pharmaceutical companies.

The carbon footprint of adalimumab pens varies between 515 and 1,887 grams of carbon dioxide equivalent, depending on the product and dosage, with an uncertainty rate ranging from 9% to 30%. The production of the active substance is the main source of emissions (up to 70% of the total), whereas excipients have a negligible impact. The estimates are consistent with available industrial data and with results reported for other injectable devices.

This study provides the first comprehensive life cycle assessment of adalimumab. It confirms technical feasibility using the Carebone tool, while highlighting challenges related to the lengthy analysis time and to the collection of industrial data. It supports the inclusion of environmental criteria in the evaluation and selection of medicines in hospitals, alongside established clinical and economic considerations.

The authors acknowledge the contribution of the team involved in the development of the Carebone tool.

No conflict of interest

To determine whether tislelizumab, atezolizumab and durvalumab can be considered clinically equivalent therapeutic alternatives (CETAs) in patients with ES-SCLC through an adjusted indirect treatment comparison (ITC) using a common comparator.

A literature search was conducted to identify phase III clinical trials (CTs) involving tislelizumab, atezolizumab or durvalumab in comparable populations, study durations, and endpoints. The primary outcomes were progression-free survival (PFS) and overall survival (OS). An ITC between tislelizumab, atezolizumab and durvalumab was performed using the Bucher method, supported by the Canadian Agency for Drugs and Technologies in Health (CADTH) ITC calculator. According to ESMO, a hazard ratio (HR) <0.65 (and its inverse, 1.54) is considered clinically meaningful for treatment differences in this setting. Results were graphically analysed, focusing on the relative position of the 95% CI relative to the predefined equivalence margin.

Three CTs were included: RATIONALE-312 (tislelizumab), IMpower133 (atezolizumab) and CASPIAN (durvalumab). The selected trials were phase III, multicentre, randomised, placebo-controlled studies involving patients with ES-SCLC in first-line treatment and Performance Status 0-1. The individual CTs outcomes in terms of PFS were tislelizumab HR=0.64 (95% CI 0.52-0.78), atezolizumab HR=0.77 (95% CI 0.63-0.96) and durvalumab HR=0.78 (95% CI 0.65-0.94); and in terms of OS 0.75 (95% CI 0.61-0.93), 0.70 (95% CI 0.54-0.91) and 0.73 (95% CI 0.59-0.91) respectively. The results of the ITC are summarised in table 1.

Abstract 2SPD-021 Table 1ITC PFS HR (95% CI) OS HR (95% CI) Tislelizumab vs atezolizumab 0.83 (0.62-1.11) 1.07 (0.77-1.50) Tislelizumab vs durvalumab 0.82 (0.62-1.08) 1.03 (0.83-1.28) Atezolizumab vs durvalumab 0.99 (0.73-1.33) 0.96 (0.68-1.35)

No statistically significant difference was observed for PFS or OS.

Tislelizumab, atezolizumab, and durvalumab show no significant differences in PFS or OS. Given similar mechanisms and consistent placebo outcomes, they may be considered CETAs for ES-SCLC first-line treatment, despite potential OS bias from subsequent therapies, particularly in the RATIONALE-312, where a higher proportion of patients received subsequent systemic therapies—including immunotherapy.

No conflict of interest

This study aimed to assess the organisational and technical measures implemented by healthcare institutions to prevent, detect, and respond to the risks and impacts of a cyberattack on the MD network.

A 3 month audit was conducted using an online questionnaire distributed to public and private hospital pharmacies. The survey was developed based on existing regulatory frameworks and shared experience feedback to evaluate preparedness practices for cyberattacks involving medical devices. Responses were analysed using descriptive quantitative and qualitative methods to identify trends, practice gaps, and common limitations.

Among the 31 responding institutions, one had previously experienced a cyberattack. Data related to medical devices were mainly stored on secure internal servers (57%), while a minority were kept on USB drives and personal computers. Access control was primarily based on password authentication (84%), although in 3% of cases, data remained freely accessible to pharmacy staff. Cyberattack procedures have been formalised in 54% of HIs, under development in 27%, and absent in 19%. Among those with a procedure, only 18% had tested it. Major areas for improvement included limited staff training and difficulties in performing regular data backups. In practice, 52% of pharmacists reported having a defined Business Continuity and Recovery Plan (BCRP). Logistically, 80% of hospital pharmacies declared having sufficient stock levels; however, visibility regarding non-stocked medical devices and consumables remained limited. Key strengths included the implementation of ‘crash boxes’, effective territorial cooperation, and regular data backups. Reported limitations involved insufficient IT (information technology) department support, irregular training, limited financial resources, and understaffing.

This audit reveals varied cybersecurity preparedness for medical devices. Formal procedures exist in some institutions but are poorly implemented. Harmonisation at national and European levels, along with routine integration and staff training, is essential to protect patient safety.

No conflict of interest

This work, part of the COPIL DMI action plan, aims to establish a degraded procedure enabling the tracking, traceability, and provision of IMDs when IS systems are inaccessible, due to either a major outage or a cyberattack.

A working group from COPIL DMI was created, bringing together the hospital pharmacy (PUI) team (pharmacists, technicians, RSMQ), operating room managers, the Digital Services Department (DSN), and the hospital quality department. The IMD circuit was analysed, and its critical steps were identified using the FMEA (Failure Mode, Effects, and Criticality Analysis) method. Based on the control points identified, a degraded procedure was developed and tested in a simulated IS outage scenario.

The FMEA highlighted the most critical steps, particularly implant traceability in the electronic patient record (EPR) and order transmission to suppliers. The degraded procedure, based on paper documentation, offline Excel files, and extracted product and supplier references, allowed for minimal continuity of activity. The simulation confirmed that the procedure was functional but also revealed increased risks of errors due to manual data entry and a heavier workload for staff.

This work emphasises the strong reliance of the IMD circuit on hospital IS and its vulnerabilities during outages or cyberattacks. The degraded procedure and its testing are essential to ensure continuity of care and minimum device traceability. These efforts must be part of an institutional approach involving the PUI and clinical departments. Once validated by COPIL DMI and COVIRIS, the next steps will include the development of a business recovery plan and formalisation of the associated procedures

No conflict of interest

To implement PDAs into the medication distribution (dispensing) and medication return processes.

The processes were evaluated in three phases: planning/acquisition, execution, and evaluation. To measure the results, data were collected on the time dedicated to medication distribution, receiving, and return activities, as well as costs associated with labour and paper consumption, using automated records from the distribution system, pharmacy control spreadsheets, and nursing team audits. Indicators analysed included hours per day spent on each process, cost per hour ratio, number of paper packages used, and detailed reasons for returns, during the period from January to July 2025, covering 551 patient-days. The comparative analysis before and after implementation utilised descriptive statistics and internal validation by a multidisciplinary team.

The patient discharge dispensing and medication verification processes were optimised, resulting in a reduction of 11.8 hours/day (354 hours/month) in labour time, yielding a saving of 1,288.10 in man-hour costs. For medication receiving, there was a reduction of 6.1 hours/day (183 hours/month), resulting in a saving of 1,549.47 in man-hour costs. Paper consumption was significantly reduced from 81 to 30 packages of 500 sheets (January to July 2025). Additionally, the time spent on medication returns decreased by 52% and the accuracy of return reasons was significantly improved.

The adoption of new technologies, such as PDAs and barcode scanners, promotes the optimisation of clinical support processes, resulting in faster patient discharge dispensing, picking verification, and medication receiving. The electronic medication return process performed by the nursing team enhances the accuracy of reasons and streamlines reverse logistics, contributing to more efficient and safer medication management.

No conflict of interest

This study aimed to evaluate real-world V2Vt in patients receiving autologous CAR T-cell therapies at a tertiary oncology centre, and to compare differences across available products.

Requests for CAR T-cell therapies and administration records received by the hospital pharmacy were reviewed to determine the number of therapies administered and V2Vt. Treatments administered between 1 January 2021, and 31 December 2024, were included. V2Vt was expressed in days as mean ± standard deviation and median values for each product. Data normality was assessed using the D’Agostino-Pearson omnibus test. Since distributions were not Gaussian, the Kruskal-Wallis test was used to compare differences among groups. When the overall test was significant, post hoc pairwise comparisons were performed using Dunn’s multiple comparison test (significance level p<0.05). Statistical analyses were conducted using GraphPad Prism 8.

A total of 73 CAR T-cell therapies were administered during the study period, increasing from nine (12%) in 2021 to 36 (49%) in 2024. Specifically, 31 (42%) were axicabtagene ciloleucel (axi-cel), 31 (42%) tisagenlecleucel (tisa-cel), and 11 (16%) brexucabtagene autoleucel (brexi-cel). Mean V2Vt was 48±19 days (median 42) for axi-cel, 67±29 days (median 57) for tisa-cel, and 53±35 days (median 41) for brexi-cel. The Kruskal-Wallis test showed a significant overall difference (p=0.002), with Dunn’s post hoc test indicating significant differences between axi-cel and tisa-cel (p=0.003), and between tisa-cel and brexi-cel (p=0.035).

V2Vt varied significantly among CAR T-cell products, with axi-cel showing the shortest mean time. Manufacturing and logistical delays remain key barriers to ensure timely treatment. Decentralised manufacturing and off-the-shelf allogeneic platforms may reduce waiting times and costs. In this evolving scenario, hospital pharmacists play a pivotal role in process optimisation, ensuring timely access to advanced therapies.

1. Bryla A, et al. Involvement of the hospital pharmacist in securing the chimeric antigen receptor (CAR)-T cell circuit. Eur J Hosp Pharm. 2025 Mar 6:ejhpharm-2024-004454.

No conflict of interest

The objective is to verify the control level reported during the development of the RM.

An analysis of failure modes, their effects, and their criticality was conducted on the entire ASDD process. Each sub-step was examined using an Ishikawa diagram. The risks associated with the method were documented using data from the supplier. The rating was carried out according to the HAS grid, whose control level scale was adapted to the automated context. Level 1 was associated with situations causing the software or equipment to block the action. When the alert message was present but not blocking, the control level assigned was level 2. The lowest level was level 5, indicating a risk that has not yet been controlled. The residual criticality of each risk was thus obtained. For many risks, the level of control was set at 5 due to a lack of data provided by the supplier. The OQ was carried out in relation to this RM.

Sixty-three of the 246 risks included in the RM were modified following the results of the OQ tests. The reassessment of the level of control always resulted in a higher level of control.

This process of updating the RM’s risk management level should not be necessary. It highlights the importance of the supplier providing detailed technical documentation on the behaviour of the software and equipment. Close collaboration between the supplier and customer is essential in order to have a complete risk analysis before the OQ phase.

No conflict of interest

To evaluate the appropriateness of overrides in a tertiary care hospital, analyse data from the Grifols Reporting NextGen (GRN) system and identify reasons for direct dispensing via ADS without prior medical prescription.

A descriptive study was conducted in June 2025 in a clinical unit of a tertiary care hospital. Medication dispensed without prescription in a clinical unit was recorded. Variables collected included: justified override, medication not prescribed at any time, medication dispensed prior to prescription, medication dispensed prior to validation, and medication prescribed and validated but with deviation from the established circuit.

Out of 6,845 dispensations via ADS, 401 were overrides (5.86%). Breakdown: 49.63% without prescription, 9.98% prior to prescription without justification, 5.23% prior to validation, 19.45% with incorrect circuit, and 15.71% prior to prescription justified.

Frequently involved medications included paracetamol, morphine, omeprazole and dexketoprofen. Justification rates varied: morphine 1% ampoules (54.54%), paracetamol 1 g tablets (31.43%), omeprazole 20 mg capsules (0%), omeprazole 40 mg vials (7.14%) and dexketoprofen 25 mg/mL ampoules (15.38%).

The analysis revealed that NPMD exceeded the 5% safety threshold (5.86%), with most cases lacking registered prescriptions or involving circuit deviations. Only 15.71% were justified, indicating a need for improved control and staff training. Recommended actions include mandatory documentation of clinical justification and periodic review of override patterns. These measures aim to optimise ADS use, enhance patient safety, and ensure therapeutic appropriateness.

No conflict of interest

Our goal was to implement budgets that accurately reflect each ward’s actual drug expenditures, and to assess how departmental budget monitoring affected hospital-wide costs and the therapeutic choices of specific wards. Furthermore, we aimed to evaluate the system’s effectiveness.

To establish the new budgets, we analysed each ward’s total drug requirements in 2024 and averaged the 12 month financial costs. Considering changes in drug prices, we added a 10% margin to prevent the new limits from being overly restrictive. This adjusted cost estimation defined the monthly drug budgets from 1 April 2025. For comparability, we examined the deviation between the total medication costs and the available budget over the same 5 month period (April–August) in both years.

Between April and August 2024, wards exceeded their allocated budgets in four out of five months, with an average overspend of 9.77%. In contrast, during the same period in 2025—after introducing the new monthly budgets and direct accountability—departments generally stayed within limits, with orders averaging 3.6% below the set limit. The savings ensured larger safety stocks (6 weeks reserve vs 2 weeks reserve in 2024).

The introduction of ward-based budget management produced significant economic and clinical advantages. Making wards responsible for their own budgets improved cost control and encouraged more deliberate therapeutic choices, while ensuring continuous drug availability and comforting safety stocks. Enhanced collaboration with the pharmacy in selecting cost-effective equivalents strengthened clinical communication and teamwork.

No conflict of interest

To analyse dietetic products and thickeners dispensed in 2024 to eight affiliated private or publicly contracted LTCFs and to evaluate the economic impact of hospital pharmacist interventions in optimising orders and stock management.

A retrospective observational study was conducted including all institutionalised patients receiving dietetic products and/or thickeners dispensed during 2024. The hospital pharmacist reviewed monthly active treatments and surplus stocks at each centre, resulting from hospital admissions, therapy modifications, transfers, or deaths. Subsequent orders were adjusted to promote stock rotation and prevent accumulation. Surplus products unfit for local use were reallocated to avoid expiry. Urgent deliveries due to new prescriptions were coordinated to prevent delays.

Data were collected from outpatient dispensing records, order lists, and monthly stock reports. Dispensed units were analysed, and costs according to our regional centralised procurement framework were compared with their retail price (RP) in community pharmacies. The economic impact of pharmacist interventions was calculated based on avoided shipments, returns, and redistributions.

390 institutionalised patients received dietetic products and/or thickener and 249 remained on active therapy at year-end. A total of 105.084 units were dispensed at a cost of 191.355,73, compared with an estimated RP of 750.587,50, representing a 74,5% saving (559.231,77). Most frequently dispensed products were high-protein, high-calorie oral nutritional supplements (57,27%), diabetes-specific supplements (19,03%), and renal-specific formulas (8,82%).

Stock optimisation enabled the reallocation of 977 units (avoiding 9.021,17 RP) and prevented unnecessary dispensing of 21.961 surplus units (155.448,07 RP), resulting in an additional saving of 164.469,24. Overall, the avoided expenditure attributable to pharmacist intervention reached 723.701,01, corresponding to a 79,1% reduction.

Hospital pharmacy-led dispensing of dietetic products to LTCFs represents a successful model of integrated pharmaceutical care requiring close coordination between prescribers, pharmacists, LTCFs, and manufacturers. Integration of hospital pharmacists into the care process optimised resources, reduced costs, prevented product expiry, and maintained nutritional therapy continuity.

No conflict of interest

To compare the efficacy, safety, and cost-effectiveness of anti-VEGF agents used in nAMD based on pivotal clinical trials and local cost data, supporting evidence-based treatment selection.

A structured literature review of phase III randomised clinical trials was performed (MARINA, ANCHOR, VIEW 1–2, HAWK, HARRIER, TENAYA, LUCERNE, and PULSAR). Efficacy was assessed by change in best-corrected visual acuity (BCVA, ETDRS letters). Safety outcomes included ocular and systemic adverse events, serious ocular adverse events, and endophthalmitis rates. Economic evaluation was based on Spanish ex-factory prices (PVL+VAT) considering labelled dosing regimens, with and without vial sharing.

All anti-VEGF agents demonstrated comparable efficacy to aflibercept 2 mg every 8 weeks, with significant improvement in BCVA versus placebo or verteporfin. No significant differences were found in ocular or systemic adverse events, although brolucizumab 6 mg q12w showed a higher risk of serious ocular events. Aflibercept 8 mg and brolucizumab were associated with lower systemic adverse event rates. Without vial sharing, aflibercept 8 mg prefilled syringe was the most cost-efficient option; with vial sharing, faricimab vials offered the lowest annual treatment cost. All anti-VEGF agents demonstrated comparable efficacy to aflibercept 2 mg every 8 weeks, with significant improvement in BCVA versus placebo or verteporfin. No significant differences were found in ocular or systemic adverse events, although brolucizumab 6 mg q12w showed a higher risk of serious ocular events.

Anti-VEGF therapies present similar efficacy and safety profiles, with differences mainly in dosing intervals and cost efficiency. Economic optimisation depends on hospital logistics and vial use policies.

No conflict of interest

This study aimed to describe the structured technical and scientific evaluation process that led to the introduction of the EVOQUE system into clinical practice, analysing clinical, organisational, and sustainability aspects.

A multidisciplinary evaluation was conducted to assess the device’s technical characteristics, intended use, and clinical rationale, together with the available evidence from pivotal and early feasibility studies. The assessment included expected impacts on care pathways, resource requirements, and procedural logistics. Particular attention was given to defining patient selection criteria, team training needs, and follow-up parameters to ensure consistent procedural quality and monitoring of post-implant outcomes.

In the first five patients treated, the EVOQUE system was successfully implanted, confirming the clinical and procedural feasibility of the technique. Considering the complexity of the procedure and the economic impact of the technology, an innovative outcome-based model was introduced: from the eighth implantation onwards, the device payment is linked to achieving an intra-procedural clinical outcome, defined as a reduction of tricuspid regurgitation to ≤ grade 1 confirmed by echocardiography. If this target is not met, a predefined adjustment is applied. This outcome-based approach, applied for the first time to medical devices within a regional governance framework, allows the adoption of high-value technologies while ensuring structured monitoring of effectiveness and economic sustainability.

This experience demonstrates that innovation can be integrated with safety, appropriateness, and sustainability through a structured evaluation and monitoring pathway. Hospital pharmacists play a central role by linking clinical and technological evaluation with economic management, supporting the rational and effective introduction of advanced medical technologies for patient benefit and the healthcare system.

No conflict of interest

To assess the impact of an innovative medicines management policy on expenditure, sustainability, and dispensary workload in secondary care.

The medicines management policy was updated such that rather than 14 days’ To Take Out (TTO) medication supplied routinely, only ‘sufficient supply’ was provided (in line with Standard Contract for NHS Providers). ‘Medicines Assessment for Discharge’ (MA4D), undertaken by ward-based staff (pharmacy and nursing) involved review of all medication already available, including patients own drugs (PODs) at home, or soon to be delivered, before any additional items were dispensed for discharge. Primary outcome: number of discharge medication items avoided per month.

Secondary outcomes:

In the first 5 months, discharge items avoided increased from 18% to 21%. Comparing January 2025 with January 2024 an extra 1 719 items were avoided, saving 290 staff hours (5.74 whole time equivalents). Extrapolated to full year benefits, this equates to an additional £369,542 and 214.7 tonnes CO2e saved across the trust.

The simple tasks involved in MA4D have reduced unnecessary re-dispensing, minimised medicines costs and cut carbon emissions, within a secondary care organisation. The project now forms a key part of the trust’s Green Plan. The collaboration between pharmacy and nursing staff to deliver MA4D leads to earlier patient discharge and a safer home environment due to reduced medication duplication.

The initiative is easily replicable within similar organisations, providing a practical model for hospitals seeking to advance their sustainability goals.

1. Delivering-a-net-zero-nhs-july-2022.pdf

2. How-to-produce-a-green-plan-three-year-strategy-towards-net-zero-june-2021.pdf

3. UK and England’s carbon footprint to 2022 - GOV.UK

No conflict of interest

Hypothesis: Vial manipulation negatively influences CDI resolution.

Objective: To analyse whether the pharmaceutical form of vancomycin used for the treatment of CDI influences its effectiveness, measured as the percentage of patients who relapse.

Retrospective observational study. Adult patients receiving oral vancomycin for CDI between 01/07/2023 and 01/07/2025 were included. The following variables were collected: age, vancomycin pharmaceutical form, presence of relapse (3 months post-treatment), subsequent lines of treatment, serum leukocyte, albumin and creatinine levels, and concomitant antibiotic treatment during CDI treatment. The ATLAS score was calculated to estimate the risk of relapse of each patient. When the score is three or higher mortality rate rises to 3.6% and the cure rate decreases to 89.5%.

We included 107 patients receiving oral vancomycin (53 received capsules and 54 vials). The median age of patients in both groups was similar (70.0 vs 70.4 years). First-line treatment was capsules in the 90.5% of patients and vials in 85.2%. Patients receiving capsules had an average risk of relapse (SCORE ATLAS) of 3.15 points versus 2.70 points in patients receiving vials (p=0.01). Relapse rate was 11.3% for patients treated with capsules versus 24.1% of those receiving vials (p=0.08) (13). Only four patients switched from vancomycin vials to capsules for second-line treatment; the rest used fidaxomicin. At the end, 100% of the CDI cases resolved.

Patients treated with capsules had a higher risk of relapse but also a higher cure rate than patients treated with oral reconstituted vancomycin vials.

The difference may not have been statistically significant due to the small sample size.

Handling vancomycin vials could be a risk factor for relapse in the resolution of the CDI.

No conflict of interest

To evaluate the compliance of standardised PN bags with individualised prescriptions for newborns admitted to a neonatal intensive care unit (NICU).

Four standardised aqueous formulations (Bags 1–4) and one lipid emulsion were developed according to international recommendations and institutional expertise. Individualised PN prescriptions issued between January 2024 and August 2025 were analysed. Based on each newborn’s weight and prescribed infusion rates, prescriptions were compared with the composition of the standardised bags at different infusion rates (±5% and ±10%). Prescriptions with any parameter deviating more than 5% from the recommended range were excluded. Parameters assessed included protein (g/kg/day), glucose (mg/kg/min), calcium, phosphorus, magnesium (mg/kg/day), sodium, potassium (mEq/kg/day), zinc (µg/kg/day), lipids (g/kg/day), and fat- and water-soluble vitamins (ml/kg/day). Compliance was defined as a maximum deviation of 5% from recommendations.

A total of 381 prescriptions from 44 newborns were screened, with a median gestational age (GA) of 30 weeks (IQR 29–31). Of these, 252 (66.1%) were excluded. The 129 included prescriptions were prescribed to 27 newborns with a median GA of 29 weeks (IQR 28–30), postnatal age of 9 days (IQR 6–14), and weight of 1.180 kg (IQR 1.000–1.350). Compliance rates for glucose, sodium, and calcium were 93.8%, 98.4%, and 95.3%, respectively, across 20 simulations (four aqueous bags, five infusion rates) and 86.8% for lipids across five simulations (one lipid emulsion, five infusion rates). Median compliance for the remaining components was 15 for phosphorus and magnesium, 10 for amino acids and potassium, five for lipids, three for fat-soluble vitamins, and one for water-soluble vitamins. Zinc compliance was not achieved in any simulation. For all 129 prescriptions, one aqueous bag provided compliance for 7 out of 8 components (except zinc). In 83 prescriptions (64.3%), one lipid emulsion infusion rate ensured compliance for all three components.

Standardisation proved feasible. Adjusting zinc content in aqueous bags would allow full compliance with 100% of prescriptions. For lipid emulsions, compliance was achieved in approximately 64% of cases, with further optimisation of vitamin content required for complete standardisation.

No conflict of interest

To evaluate and compare the stability of fortified gentamicin eye drops during four weeks of storage at room temperature and in the refrigerator in relation to the method of preparation and type of solvent.

We prepared fortified gentamicin eye drops (1.36%) by using two methods: (i) adding a vial of intravenous gentamicin (80 mg/2 mL) to gentamicin eye drops 0.3% (5 mL) prepared in 1.92% boric acid solution and citrate buffer, and (ii) dissolving gentamicin sulphate in 1.92% boric acid solution and citrate buffer. We examined changes in pH, concentration and absorption values over four weeks related to the method of preparation, type of solvent and storage conditions.

Our results demonstrated that the pH remained within stability limits (<10% change from the initial pH value) in all formulations, regardless of method of preparation, solvents or storage temperature. In fortified gentamicin eye drops prepared by dissolving gentamicin sulphate in 1.92% boric acid solution, gentamicin content decreased to almost half of its initial amount (57.2%) after the seventh day of storage, regardless of storage conditions. However, when prepared in citrate buffer, a slight loss of gentamicin content (up to 10%) was observed after 28 days of storage under ambient (25 °C) and refrigerated (2-8 °C) conditions. For formulations obtained by adding an intravenous gentamicin vial to ophthalmic gentamicin solution (0.3%) in 1.92% boric acid solution, the absorption values remained stable for 21 days. In contrast, the stability of formulations in citrate buffer appeared to be no more than 14 days.

Significant differences were found between gentamicin ophthalmic formulations related to their method of preparation and type of solvent, while temperature had no effect on physicochemical characteristics. The optimal gentamicin ophthalmic formulation (1.36%) should be prepared by dissolving gentamicin sulphate in citrate buffer, as it has been proven to be the most stable.

No conflict of interest

To standardise the method of preparation of fluorescein sodium ophthalmic strips by comparing the differences in the amount of released fluorescein sodium related to the impregnated surface area.

One edge of each paper strip is dipped into 10% sterile fluorescein sodium solution, prepared by dissolving fluorescein sodium into sterile water for injection and autoclaved. The paper strips are further air-dried for about 15 minutes in a laminar-flow hood. Using this method, strips with four different fluorescein-impregnated surface areas (15 mm², 25 mm², 35 mm², and 50 mm²) were prepared. The quantity of fluorescein sodium extracted from the strips in aqueous solution was determined spectrophotometrically at 492 nm.

We established a direct correlation between the quantity of fluorescein sodium and the impregnated surface area, as the amounts of fluorescein sodium extracted from the strips with surface area of 15 mm², 25 mm², 35 mm² and 50 mm² were 235 μg, 366 μg, 617 μg and 1100 μg, respectively. In relation to the standardised amount of fluorescein sodium of 300 μg, the percentages of fluorescein sodium released from the strips of surface area of 15 mm², 25 mm², 35 mm² and 50 mm² were 78%, 122%, 206% and 367%, respectively. Therefore, only the amount of fluorescein sodium released from the strip of 25 mm² met the requirements of USP-NF 2025 monography (100-160% of the labelled amount of fluorescein sodium).

Modification of the impregnated surface area provides the possibility of achieving the desirable amount of released fluorescein sodium, thus reducing excessive dye use and waste, as well as ensuring reliable and consistent results. These results could lead to the optimal use of fluorescein sodium ophthalmic strips for diagnostic purposes and consequently improve patient outcomes.

No conflict of interest

The aim of the study was to evaluate the physicochemical and microbiological stability of 0.1 mg/ml atropine eye drops prepared extemporaneously in a hospital pharmacy. The study included a 14-week closed-container stability assessment and a 4-week in use stability evaluation.

Atropine sulfate 0.1 mg/ml eye drops remained sterile throughout both the 14-week stability study and the 4-week in use study.

Abstract 3PC-005 Tabel 1

Average concentration of atropine sulfate (mg/ml)

Abstract 3PC-005 Tabel 2

Average pH of atropine sulfate eye drops during stability studies

Abstract 3PC-005 Tabel 3

Average osmolality of atropine sulfate eye drops

Hospital pharmacy–prepared atropine sulfate 0.1 mg/ml eye drops remained sterile throughout a 14-week closed-container stability study and a 4-week in-use period. Stability data from the lowest tested concentration 0.1 mg/ml support extrapolation to 0.5 mg/ml, indicating that an extended shelf life may enhance patient convenience and cost-effectiveness.

No conflict of interest

To analyse the decision making process regarding operational and therapeutic management of drug shortages affecting automated PN preparation, in order to support proactive and efficient future strategies.

An observational, retrospective study (October 2022–September 2025) was carried out in a tertiary hospital. All incidents involving PN shortages elaborated by two ACD, one for the neonatal/paediatric and the other for adult population, were registered. Collected variables included logistic measures, prescription adjustments, and workflow changes in the robot compounding process.

A total of 17 shortages of eight drugs were recorded. The affected products were calcium gluconate (n=4), adult (n=2) and paediatric amino acids (n=3), potassium acetate (n=3), vitamins (n=2), trace elements (n=1), magnesium sulfate (n=1), and glucose 70% (n=1). Shortages affected both populations, but in nine events the supply was conserved in neonatal/paediatric elaborations, and an alternative drug was looked for adult use due to specific excipient (aluminium in calcium) or concentration requirements (calcium, glucose 70%). Prescription algorithms and vademecum database changes were required in 76.5% and 52.9% of cases, respectively. Starter PN for neonates was affected by 29.4% of the shortages, and home PN by 35.3%. Robot parameter adjustments were necessary in 82.4% of cases. These included changes in product identification, vial density, codes, type of infusion line, recalibration of the flow factor by an external professional and new compounding configuration with the order of addition. Temporary manual compounding was required for adult PN (due to shortages of glucose 70%, paediatric amino acids and calcium gluconate), but not in neonatal/paediatric patients because stock was prioritised for them. Biochemical monitoring was performed for electrolyte alternatives to ensure equivalence, along with weight deviation analysis during processing for quality control.

PN shortages have a magnified impact in automated compounding, demanding extensive pharmacist intervention to ensure continuity and safety. Our experience highlights the paradox of automation: while improving traceability and safety, it reduces adaptability, making PN services more vulnerable to supply disruptions.

No conflict of interest

The general aim was to optimise production of autologous serum eye drops by ensuring microbiological safety without altering their properties. The specific objective was to measure vitamin A concentrations under five conditions: no filtration, and filtration through two materials at two porosities each, to evaluate the impact of filtration.

Blood samples from five healthy volunteers were collected in trace element–free tubes, allowed to coagulate for 2 hours at room temperature, and centrifuged at 1500 g for 10 minutes at +4°C. The resulting sera were aliquoted under five conditions: no filtration, filtration through polyethersulfone (PES) membranes at 0.22 µm and 0.45 µm, and filtration through cellulose acetate (CA) membranes at 0.22 µm and 0.45 µm, then stored protected from light. Vitamin A concentrations were quantified by high performance liquid chromatography with ultraviolet and bar detector detection. Paired samples were compared using the Wilcoxon signed-rank test, with a significance threshold of p = 0.05.

In the absence of filtration, the mean vitamin A concentration for the five volunteers was 57 ± 7.3 µg/dL. After filtration, concentrations were: C_PES-0.22 = 59 ± 7.0 µg/dL, C_PES-0.45 = 59 ± 7.9 µg/dL, C_CA-0.22 = 62 ± 8.2 µg/dL, and C_CA-0.45 = 62 ± 6.9 µg/dL. Comparisons of filtered vs non-filtered sera yielded p < 0.05, whereas comparisons between materials of identical porosity showed no significant difference (p 0.06).

For autologous serum eye drops, it is important to ensure that sterilising filtration does not lower active molecule concentrations to levels that could compromise efficacy. For vitamin A, filtration appeared not to affect concentrations. Although not statistically significant, a trend toward differences between PES and CA membranes at identical porosities was observed and will be further investigated in a larger cohort.

No conflict of interest

To compare the carbon footprint of gemcitabine prepared in HCU versus industrial RTU formats and evaluate their impact on workflow efficiency.

A life cycle assessment (LCA) compliant with ISO 14040 was conducted using Ecovamed 2025 (a private platform assessing the environmental footprint of pharmaceuticals) and Carebone v2.3 (a sustainability tool from the Paris public hospital network). Internal process data refined emission estimates. All marketed RTU doses (1200–2200 mg) were compared with equivalent compounded preparations, analysing active ingredient, packaging, transport, consumables, and end of life management. Packaging and consumables were weighed, and waste volumes were measured to quantify material savings. Workflow data were extracted from Chimio (software for chemotherapy compounding traceability and time monitoring) between January 2024 and March 2025. The production coverage rate—the share of treatments prepared with RTU formats—was calculated using Noxelia, a French AI-based tool optimising hospital pharmacy production workflows.

Approximately 2,000 RTU gemcitabine bags were used, accounting for 82% of total production. Each RTU dose avoided 0.8–1.7 kg CO₂ eq., a 40–60% reduction versus vial preparation. Major contributors were the replacement of glass vials by polypropylene bags (42%), the elimination of single-use sterile devices (19%), and the reduction of incinerated waste (14%). Measured consumables showed a 120–160 g weight reduction per dose, corresponding to about 0.8 m³ less waste per 1,000 bags. The total saving reached 3.6 tonnes CO₂ eq. and 0.9 tonnes of waste—equivalent to 20 inpatient hospital days—with 250 saved in disposal costs. Preparation time improved by 12% overall (p < 0.05) and 17% for RTU batches.

Industrial RTU gemcitabine provides measurable environmental and organisational benefits without compromising safety or workflow integrity. Scaled to annual use, carbon savings approach 3 tonnes CO₂ eq. per site. Extending RTU adoption to other cytotoxics could strengthen decarbonisation and efficiency in hospital pharmacy practice.

Corporate sponsored research or other substantive relationships:

A. Plan and D. Protzenko promote the use of dose banding strategies in France through their start-up Noxelia and give lectures on the implementation of dose banding in hospital workflows for SunPharma.

The aim of this study is to evaluate the economic impact of automating adult PN preparation and to identify strategies to minimise costs while ensuring quality and safety.

A retrospective study was conducted at a tertiary hospital comparing the direct costs of PN preparation in 2023 (manual) and 2024 (automated). These costs include: Costs for macronutrients, micronutrients, three-chamber bags, and disposable materials (e.g. packaging bags). Infrastructure and personnel costs were considered constant across both years. Results were compared and areas for potential cost reduction were identified.

In 2023, a total of 7.068 adult PNs were prepared, of which 42% were individualised manual preparations and 58% were three-chamber bags. The direct cost of preparation products was 229.415, and the cost of preparation bags was 10.910, leading to a total cost of 240.325, with an average cost per PN of 34.0.

In 2024, a total of 7.322 adult PNs were prepared, of which 73% were individualised automated preparations and 27% were three-chamber bags. The direct cost of preparation products was 190.472, the cost of preparation bags was 40.678, and the cost of consumables for repackaging and robot equipment amounted to 114.907, for a total cost of 346.057, with an average cost per PN of 47.2.

The automation resulted in an additional 13.2 per PN, a 39% cost increase. Proposed cost reduction strategies included using repackaging bags instead of vacuum bottles, optimising repackaging volumes, and introducing a multi-electrolyte solution with potassium.

Automation in PN preparation led to a significant 39% increase in costs. However, implementing corrective strategies, mainly in repackaging, could reduce expenses by approximately 8%. The findings suggest that while automation has clear advantages, targeted interventions could optimise the economic impact and provide a more cost-effective model for PN preparation in hospital settings.

No conflict of interest

To identify radiolabelling conditions that consistently generate a single predominant ^99mTc-iPSMA isoform with high radiochemical purity (RCP).

A total of 21 labelling protocols were systematically assessed in triplicate. Experimental variables included buffer composition, presence or absence of stannous chloride (SnCl₂), use of transfer and co-ligands (tricine, EDDA, nicotinic acid), and addition of radiolysis stabilisers such as ascorbic acid or methionine. Reaction mixtures were analysed by radio-HPLC to quantify RCP and the relative proportion of each isoform.

Reactions performed without SnCl₂ yielded very low RCP values (<5%), demonstrating its essential reducing role. Use of tricine alone or with antioxidant additives improved labelling efficiency but failed to generate a single species, with the main isoform accounting for only ~75% of total activity and unbound ^99mTc remaining between 4-6%. Substitution of EDDA with alternative co-ligands, including nicotinic acid, systematically led to the formation of two isoforms in comparable proportions. Among all parameters tested, the buffer system was the most influential. The combination of 0.2 M sodium acetate buffer (pH 7) with EDDA, tricine, SnCl₂, and iPSMA, followed by heating at 95 °C for 15 min, produced the best outcome, yielding an RCP >95% and a single dominant isoform (>92%). Similar results were obtained when the heating time was reduced to 7 min.

This study defines a robust and reproducible protocol for the preparation of ^99mTc-iPSMA with high purity and isoform homogeneity. Optimised reaction conditions could be suitable for further development such as kit-based formulation and are currently being adapted for automated synthesis to facilitate clinical translation.

1. Mena E, et al. Semin Nucl Med. 2024;54:941–950.

2. Ferro-Flores G, et al. Nucl. Med. Biol. 2017;48:36–44.

No conflict of interest

This study aimed to compare the accuracy, safety, and efficiency of manual versus automated compounding of PN solutions in a hospital pharmacy setting

A retrospective study was conducted at a tertiary care hospital, comparing 500 manually prepared PN solutions with 500 prepared using an ACS. Data on compounding errors, preparation time, and staff satisfaction were collected. Errors were classified as major or minor, and preparation time was measured in minutes. Statistical analysis involved Chi-squared tests for error rates and paired t-tests for preparation times.

The ACS group demonstrated a 70% reduction in major errors (p = 0.01) and a 50% reduction in minor errors (p = 0.02) compared to the manual group. Preparation time was 30% shorter in the ACS group (p = 0.03), and staff satisfaction increased by 40% (p = 0.04).

Automated compounding of PN solutions significantly reduces errors and preparation time while improving staff satisfaction. These findings suggest that ACS should be integrated into hospital pharmacy practice for PN preparation to improve patient safety and operational efficiency.

1. Perrier Q, Hosni A, Leenhardt J, Desruet MD, Durand M, Bedouch P. Automation of parenteral nutrition: impact on process and cost analysis. Eur J Hosp Pharm. 2024 Aug 22;31(5):468–473. doi: 10.1136/ejhpharm-2022-003602. PMID: 37068926.

No conflict of interest

The study aims to optimise a formulation for immediate-release 3D-printed amitriptyline tablets and to develop a non-destructive NIR model. The overall goal was to create a suitable base formulation for semi-solid extrusion (SSE) printing and to gain insight in how variations in formulations affect the printability and quality of the tablets.

Formulations containing 5, 15 and 30% (w/w) amitriptyline with 0, 5 and 10% (w/w) glycerol in a Gelucire 48/16 matrix were printed with the DoseRx1 printer. Tablets were evaluated according to the European Pharmacopoeia (EP) for uniformity of mass and dosage units, impurities and dissolution. A 5% drug load tablet was also prepared using crushed commercial amitriptyline tablets. Additionally, a non-destructive NIR-spectroscopy model was developed to predict amitriptyline and glycerol content in the tablets.

All tablets met the specifications for uniformity of mass and dosage units and impurities. Tablets with higher drug load and higher glycerol content showed lower hardness and required larger nozzle diameters during printing. Dissolution testing showed that higher drug load tablets showed faster drug release. The tablets containing commercial amitriptyline tablets showed a slower dissolution profile compared to the equivalent dosage per tablet using pure API. The NIR model was able to predict both amitriptyline and glycerol content across the tested formulations.

Amitriptyline was successfully 3D-printed in a Gelucire 48/16 matrix. Glycerol improved printability but decreased tablet hardness. Decreasing the amount of matrix (high drug load, pure API) accelerated dissolution. The NIR model made it possible to semi-quantify both amitriptyline and glycerol, supporting its potential as a non-destructive quality control tool. These findings provide a foundation for optimisation of 3D-printed formulations and control strategies.

No conflict of interest

Therefore, the aim of this study is to examine national legislation to identify and compare requirements EU member states implement for compounding.

National legislation of 12 countries was compared: Denmark, Latvia, Finland, France, Germany, the Netherlands, Poland, Czech Republic, Slovakia, Italy, Spain and Portugal. For each country, an overview was created describing how and where compounding is defined in its national legislation, and who the responsible regulatory authorities are. In addition, seven compounding requirements were identified and compared between countries.

All 12 countries provide a definition for magistral formula, while nine countries provide one for officinal formulae. One country offers a third definition: hospital preparation. Four countries require an additional permit or authorisation for a pharmacy to compound, while two countries include permission in the pharmacy licence. Three countries suggest the possibility of compounding if a suitable, licensed alternative is available. The conditions for this requirement differed per country. Three countries have additional rules in place for active ingredients (eg, excluding highly potent, narcotic or psychotropic substances from compounding). All countries permit pharmacy-to-pharmacy delivery under the condition that a written contract exists between parties, or authorisation is granted to the preparing or dispensing pharmacy. Four countries provide a description about the scale of compounding, with two countries setting explicit restrictions preventing large-scale use. Only two countries specify allowance of compounding in special circumstances such as war conditions.

Legislative frameworks for compounding are heterogenous across EU member states, leading to questions about equitable patient access and uncertainties for policy makers. The findings of this study call for more harmonisation.

No conflict of interest

Suppositories (n=10) were made both, manually (SuH), and mechanically (SuP) and processes and results were compared. We focused on appearance, mass and content of the suppositories, and preparation time.

Suppositories were prepared with 5 mg diclofenac-sodium each (total mass: 1 g). Hardfat was chosen for the handmade suppositories, SuppoBase by CurifyLabs (containing hard fat, polysorbate 80 and colloidal silica) was chosen for the PharmaPrinter. The final suppositories were evaluated for appearance, mass uniformity and content uniformity (Ph. Eur. 2.9.40). Diclofenac-sodium content was assessed by a validated HPLC-UV method, adapted from Ph. Eur., after methanolic extraction. Additionally, production time was reported.

The SuH had a smooth surface and finish. SuP had a smooth surface as well but a hole on the finish and the moulds were not filled completely.

The masses (mean ± RSD) were 1.09 g ± 0.56% (SuH) rsp. 0.97 g ± 1.06% (SuP) and the contents of diclofenac-sodium (mean ± RSD) were 4.91 mg ± 0.84% (SuH) rsp. 4.68 mg ± 1.3% (SuP). Both met the criteria of mass and content uniformity (AV max. 15).

Preparation times were 65 min. (SuH) rsp. 48 min. (SuP).

Both techniques resulted in suppositories of good quality, whereas production time was a little shorter for machine production. Explanatory videos from the homepage of CurifyLabs also make it easier for inexperienced manufacturers. During the process the PharmaPrinter reported each mass of the resulting suppository. If there are deviations of ±10%, the suppository was marked and can therefore be sorted out. The PharmaPrinter can therefore facilitate and automate the production of suppositories.

No conflict of interest

In this project, a formulation is exposed to solve this problem. The formulation consists of a suspension of drug-loaded microcapsules of PEOT/PBT polymer for extended release by intravitreal administration.

The methodology used to make the microcapsules was double emulsion-solvent evaporation using ultrasound. The emulsion was W/O/W sign. The microparticles presented an aqueous core with hydroxocobalamin and a sustained release polymeric shell.

Scanning electron microscopy (SEM) was performed to verify the homogeneity of the outer shell. To obtain microcapsules with an adequate release profile, a rotational mathematical design consisting of 23 different tests and an ANOVA analysis was carried out. The intention was to maximise size homogeneity and encapsulation performance.

The results showed a maximum microcapsule load, better release profile, and greater homogeneity with a lower weight polymer and intermediate agitation speed. Further studies will be needed to assess the in vivo ocular viability of the formulation.

The studies carried out to date indicate that microcapsules have potential in the ocular treatment of this disease. Although the findings are not discouraging, much more evidence is needed to bring this formulation to the clinical setting. It would be interesting to perform longer release profiles and in vivo tests.

1. Rickes EL, Brink NG, Koniuszy FR, Wood TR, Folkers K. Crystalline vitamin B12. Science. 16 de abril de 1948;107(2781):396–7.

2. Wang Y, Liu C, Fan L, Sheng Y, Mao J, Chao G, et al. Synthesis of biodegradable poly(butylene terephthalate)/poly(ethylene glycol) (PBT/PEG) multiblock copolymers and preparation of indirubin loaded microspheres. Polym Bull. 1 de enero de 2005;53(3):147–54.

3. Cuello-Rodríguez S, Blanco-Fernández G, García-Otero X, Díaz-Tome V, Otero-Espinar FJ, Seoane-Viaño I. Long acting injectables & implants: advances in intraocular drug delivery. Int J Pharm. 2025 Oct 15;683:126058. doi: 10.1016/j.ijpharm.2025.126058.

No conflict of interest

The aim of this research was to determine whether insourcing the manufacture of RTA PipTaz doses to Pharmacy Aseptic Services could provide a sustainable solution.

Manufacturing process development was carried out in accordance with ICH guidelines and Good Manufacturing Practice. Stability studies were carried out following the NHS Yellow Cover Document. Time in motion and production studies were carried out to obtain efficiency data.

A semi-automated manufacturing method utilising the PipTaz multidose pack was developed. This produces a yield of 49 doses in approximately 45 minutes using 51 aseptic manipulations.

The number of disposable consumables used in the process was reduced from 196 to 3.

Stability for 21 days after reconstitution when stored at 5°C ±3°C.

This research demonstrates that by utilising new technologies including the multidose PipTaz bag; Pharmacy Aseptic Services can insource the manufacture of RTA doses to help overcome downstream issues within the healthcare environment.

In doing so the manufacturing process sees a reduction in manufacturing time by 81% of aseptic manipulations by 74% and in waste generation by 98% by weight.

The host site prescribes an average 130,000 doses of intravenous PipTaz each year. This indicates that the sustainable insourcing of manufacturing could be an enabler of meeting the targets outlined in Governmental policy.

1. Department of Health and Social Care. Transforming NHS pharmacy aseptic services in England, 2020.

2. Department of Health and Social Care. Fit for Future: 10-year health plan for England, 2025.

No conflict of interest

The objectives were to determine if and how much 2,4 DTBP migrates into eye drops from the MDC and to assess its cytotoxicity threshold.

Tests simulating the patient‘s use of eye drops were carried out on seven preparations (tacrolimus = TAC, ciclosporin = CsA, voriconazole = VCZ, atropin, vancomycin, ceftazidime and Costec) packaged in the same kind of MDC. The drops were collected twice a day for 1 month and then analysed by liquid chromatography to detect and quantify 2,4 DTBP. The in vitro cytotoxicity threshold of 2,4 DTBP was determined on L929 mouse fibroblasts, according to the 3- (4,5-dimethylthiazol-2-yl)-2,5-bromide (MTT) cytotoxicity test of ISO standard 10993-5.

The average amount per drop (± standard deviation) varied between the first and last day of drop emission from 47 ± 13 to 20 ± 4 ng for TAC, 401 ± 102 to 32 ± 4 ng for CsA, and from 235 ± 45 to 101 ± 28 ng for VCZ, corresponding to calculated monthly cumulative doses of 1,687 ng, 4,939 ng, and 9,108 ng, respectively. After exposing the cells to various amounts of 2,4 DTBP for 24 hours, all doses above 1,200 ng led to cytotoxicity, as assessed by the morphological and metabolic assays.

The nature of the formulation seems to influence the migration of 2,4 DTBP, as it was only found in eye drops composed of a hydrophobic active ingredient solubilised by a surfactant for TAC and CsA and cyclodextrin for VCZ. None of the daily amounts per drop exceeded the dose of 1,200 ng, but further studies are needed to determine its cumulative toxicity during chronic administration. Adapting the MTT assay to corneal cells would enable a more accurate evaluation of its ocular cytotoxicity.

No conflict of interest

To evaluate the physicochemical stability of Losartan 0.8 mg/mL eye drops over a 56-day period under refrigerated storage (2-8 °C) and establish a period of validity for its use in clinical practice.

The active pharmaceutical ingredient concentration was determined using an Ultraviolet-Visible spectrophotometric method at a wavelength of 227 nm. Method validation included the design of a calibration curve where Losartan standards were prepared from a 100 µg/mL stock solution, dissolved in Balanced Salt Solution (BSS), and measured across six concentrations (2-25 µg/mL). All dilutions were prepared in 0.01 N Hydrochloric Acid (HCl), and the curve demonstrated linearity (R² = 0.9997).

For the stability study, three independent batches of Losartan 0.8 mg/mL in BSS were prepared with an initial pH between 6.7-7.0. Solutions were aseptically prepared by sterile filtration under a biological safety cabinet, filled in low-density polyethylene containers, and stored refrigerated. Triplicate samples from each batch were analysed on Days 0, 7, 14, 28, 42 and 56. All measurements were performed using a 0.01 N HCl blank after a 1:100 dilution in 0.01 N HCl.

Mean initial concentration of the diluted sample was 8.28 µg/mL (corresponding to 0.828 mg/mL in the original solution). The concentration remained highly stable throughout the study, exhibiting no significant change or degradative trend over the 56-day period. At Day 56, the mean residual concentration was 8.14 µg/mL, representing 98.32% of the initial concentration.

Losartan 0.8 mg/mL eye drops formulation demonstrated excellent physicochemical stability over the 56-day period under refrigeration, with the active ingredient concentration remaining highly stable (98.32%). These robust analytical findings provide strong evidence to support a 56-day period of validity. Further studies include monitoring pH and osmolarity throughout the validity period.

1. Rathee P, Rathee S, Chaudhary H, Rathee D. Development and validation of a stability indicating UV-spectrophotometric method for the estimation of losartan potassium in bulk and tablet dosage form. Journal of Pharmacy Research 2008;1(2):188–191.

2. Wilson SE. Topical losartan: practical guidance for clinical trials in the prevention and treatment of corneal scarring fibrosis and other eye diseases and disorders. Journal of Ocular Pharmacology and Therapeutics 2023;39(3).

No conflict of interest

The objective was to develop a sample preparation method for quantifying BET in a lipid matrix using the rFC method.

Fluorescence was measured using a plate reader (Agilent BioTek) with the Endozyme II Go kit (Endonext-Biomérieux). Each sample was analysed with two sample wells and two control wells at 0.5 EU/mL associated with a calibration curve. According to the PE, the spike recovery (SR) must be between 50 and 200%. Sensitivity was set at 0.005 EU/mL in line with the BET limit concentration (3.3 EU/mL) and the maximum significant dilution calculated from the analysis of 600 ELIV prescriptions. Samples were prepared with or without heating and sonication, varying dilution factor (undiluted, 1/20, 1/40, 1/100 and 1/200) and diluent (NaCl and EPPI with or without addition of polysorbate 20 (PS) at 0.025%, 0.05% or 0.1%). After selecting the optimal parameters, the ELIVs were doped at 0.01, 0.02, 0.03 and 0.05 EU/mL to validate the absence of interference.

Sonication, heating, and dilutions at 1/20 and 1/40 were not enough to remove the interference, unlike dilutions at 1/100 and 1/200 with PS concentrations of 0.05% and 0.025%. Dilutions at 1/100 and 1/200 with EPPI-PS at 0.025% gave an average SR ± 95% confidence interval (CI95) of 97% ± 4 and 103% ± 6, respectively, with an average error percentage ± CI95 of 31% ± 6.

This work validates the BET using the rFC method in ELIVs. This approach opens the way to more environmentally friendly and ethical microbiological monitoring than the LAL method, applicable to other parenteral preparations.

Corporate sponsored research or other substantive relationships: bioMérieux kindly supplied analytic equipment and consumables free of charge.

To determine the physicochemical stability of two acetylcysteine 10% eye drop formulations prepared in two hospitals.

Both hospitals provided six samples. Stability was assessed under storage at 5 °C, protected from light. Chemical stability was determined by ultra-high performance liquid chromatography (Acquity, Waters Corporation, ): stationary phase Acquity UPLC BEH column (C18, 2.1 x 100 mm, 1.7 μm), mobile phase 0.1 M phosphate buffer adjusted to pH 3.0 with phosphoric acid, flow rate 0.5 mL/min, injection volume 10 μL, detection wavelength 214 nm and run time 10 minutes. Acetylcysteine content was analysed in three unopened samples on days 0, 21, and 30, and in three opened samples on days 0, 2, 4, 7, 9, 11, 21, and 30. Results were expressed as a percentage of declared value. pH was measured using a Crison GLP21 pH metre on days 0 and 30 in both opened and unopened samples.

Acetylcysteine concentrations remained above 90% up to day 30 in Eye Drop-C and up to day 11 in Eye Drop-M. No relevant pH variations were observed (Eye Drop-M: day 0 pH 6.51, day 30 pH 6.42; Eye Drop-C: day 0 pH 6.16, day 30 pH 6.07).

Eye Drop-C maintained its stability for 30 days, extending its original expiration date. Eye Drop-M showed an increase in stability from 9 to 11 days. Microbiological stability studies will be conducted to ensure their long-term safety and efficacy.

No conflict of interest

To analyse the composition of epicutaneous PTs prepared in the Pharmacy Department for the diagnosis of DCH to drugs.

To identify the most frequently requested drugs in order to obtain consumption data and optimise preparation.

To evaluate patch test outcomes across therapeutic groups.

A 2-year observational, descriptive, and retrospective study (April 2023 – March 2025) in a tertiary hospital.

demographics (age and sex), data on prepared PTs (preparation date, drug and ATC therapeutic group), and test results after 96 hours (positive/negative).

Data were obtained from pharmacy compounding records and electronic medical records and later analysed using Excel.

A descriptive statistical analysis was performed. Categorical variables were expressed as frequencies and percentages, and quantitative variables as measures of central tendency (mean or median depending on the distribution assessed with the Kolmogorov–Smirnov test) and dispersion. The positivity rate was calculated for each ATC group.

A total of 261 PTs were compounded for 96 patients (58.3% female, mean age 58.9±18.7 years). Drugs belonged mainly to anti-infectives (106), cardiovascular (49), and nervous system (39).

Most frequently tested drugs were amoxicillin (14), furosemide (9) and levofloxacin (8). Based on 6-month stability, the estimated number of units needed per semester for these drugs was 4, 3, and 2, respectively.

Overall, 21 PTs (8.2%) were positive. The groups with the highest positivity rates were nervous system drugs (20.5%) followed by cardiovascular drugs (14.2%). No drug tested positive more than once.

Compounded patch tests covered a wide range of drugs, mainly anti-infectives and cardiovascular agents, reflecting diverse clinical demand for allergy assessment. Amoxicillin, furosemide, and levofloxacin accounted for nearly one-quarter of preparations.

The study helped to estimate the number of units needed per semester to ensure availability without wastage.

Although the overall positivity rate was low, nervous system and cardiovascular drugs showed the highest frequency of delayed hypersensitivity.

No conflict of interest

We aimed to determine whether an RBIA program is at least as effective as a compliance-based system audit (SA) program in identifying both total and severe (major or critical) nonconformities of the hospital pharmacy compounding unit.

Compounding processes subject to RBIA were selected through risk analysis using an algorithm validated by the Belgian pharmaceutical association (Algemene Pharmaceutische Bond (APB)). This was followed by a prospective comparison of multiple audits by independent assessors using either the RBIA or SA approach. A multicentre expert Delphi panel classified the nonconform findings by severity, which served as a proxy of audit effectiveness.

In total, eight audits were conducted by four RBIA and four SA auditors. Both groups audited a median of 75% out of the total 222 standard. RBIA auditors identified significantly more nonconformities than SA auditors, especially those scored critical (p= .049) and major (p= .021).

This pioneering study demonstrates that risk-based auditing, guided by algorithm-driven risk analysis, is more effective at identifying severe nonconformities within the same timeframe. This results in an increase in regulatory compliance and may improve the quality of the compounding operations and its products.

No conflict of interest

Simulate the results of implementing dose banding for the preparation of anticancer drugs in a district general hospital.

A retrospective study was conducted based on preparations made during 2023. All drugs with more than 250 preparations, which were physically and chemically stable for at least 7 days, were considered. Using the logarithmic method to establish the intervals for each band, five bands were defined to cover 60% of preparations, with differences of less than 5% from the individualised dose. The weekly stock required and the waste due to expiration were calculated.

Four candidate drugs met the criteria: bevacizumab, irinotecan, paclitaxel and trastuzumab. Of the 557 bevacizumab preparations, 322 could be assigned to a defined band, with dose differences ranging from -3.3% to +3.3%. Of the 1,001 irinotecan preparations, 571 could use the defined bands, with dose differences ranging from -3.9% to +4.2%. Of the 1,157 paclitaxel preparations, 619 could use the defined bands, with dose differences ranging from -2.2% to +2.6%. Of the 684 trastuzumab preparations, 404 could use the defined bands, with dose differences ranging from -2.6% to +2.7%. Preparing these four substances in dose banding would result in a waste for expiration of 20 bevacizumab preparations (3.6%), 20 irinotecan (2.0%), 196 paclitaxel (16.6%), and 21 trastuzumab (3.1%).

A simulation analysis of a dose banding system showed that the potential benefits of dose banding are accompanied by significant waste. Further analysis is required to determine the feasibility of implementing this strategy, considering the drugs involved, the number of bands and the potential gains and losses for patients and the hospital.

1. Albert-Marí A, Valero-García S, Fornés-Ferrer V, et al. Exploratory analysis for the implementation of antineoplastic logarithmic dose banding. Int J Clin Pharm 2018;40:1281–1291. https://doi.org/10.1007/s11096-018-0714-9

No conflict of interest

Study the galenic and microbiological stability of a 25% sodium thiosulphate gel formulation.

Sodium thiosulphate 5H2O Ph. Eur. 25.00 g Sodium carmellose Ph. Eur. 2.50 g Purified water Ph. Eur. q.s 100.00 g

Tests performed for galenic stability study:

Test performed for microbiological stability study: growth of aerobic (environmental) microorganisms.

The samples are kept at ambient temperature (TA) (22-25°C) and in a refrigerator (4-8°C) in opaque plastic containers, with checks carried out on days 1, 6, 13, 35, 42, 48 and 51 after preparation.

None of the samples, either at room temperature or refrigerated, showed aggregates or exudation, all maintained a pH of 6.5 (within the maximum stability pH of sodium thiosulphate: 6-8.4) and the aerobic bacteria culture was negative from day 1 to day 51.

Our 25% thiosulphate gel formula has proven to be stable from a galenic and microbiological point of view for at least 51 days at both room temperature and refrigerated.

No conflict of interest

To evaluate the 30-day physicochemical and microbiological stability of preservative-free losartan potassium 0.8 mg/mL eye drops prepared with balanced salt solution (BSS), normal saline (NS), or glucose saline (GS), and stored in sterile bottles at different conditions: room temperature, refrigerated, and frozen.

Triplicate formulations were prepared and stored at –20 °C, 4 °C, and 25 °C. Concentration of losartan was analysed on days 0, 7, 15, 22 and 30 by validated HPLC-DAD, supported by UV–visible spectrophotometry and high-resolution mass spectrometry (HRMS). Visual clarity, pH, osmolality, and refractive index were monitored. Sterility was assessed using the BACT/ALERT system on days 0, 10, 20 and 30. FTIR was used to investigate turbidity observed in GS samples.

Formulations in BSS and NS retained ≥96% of initial losartan concentration under all conditions, with no degradation products detected by HRMS. pH (6.5–7.3), osmolality (~300 mOsm/kg), and refractive index remained stable, and no changes in clarity were observed. GS based formulations remained stable only when refrigerated or frozen; but at 25 °C, turbidity developed by day 15 and concentration dropped below 50% by day 20. FTIR suggested reversible losartan-glucose aggregation. All tested samples remained sterile throughout the days of the study.

BSS and NS are suitable vehicles for extemporaneous losartan eye drops, supporting 30-day refrigerated or frozen storage. GS should be avoided at room temperature. These findings provide validated evidence to safely extend expiration dates and improve ophthalmic care delivery.

No conflict of interest

To establish the aseptic preparation process of a 5 mg/ml sterile amikacin formulation in polypropylene syringes for intrathecal use, and to conduct a stability study to confirm a 48-hour shelf life.

A systematic search was conducted in PubMed and PubChem with no data found regarding the stability of a sterile amikacin solution in polypropylene syringes. A preparation process was established, using AMIKACIN 5 mg/ml 100 ml, Luer Lock 10 ml sterile polypropylene syringes, 0.22 μm syringe filters and sterile female-to-female Luer Lock connectors.

A batch of two syringes (30 mg/6 ml) was prepared under aseptic conditions. Syringes were then stored in UV-Vis light-protective steribags and refrigerated (2–8 °C). Final product samples were obtained and analysed at 0, 2, 4, 24, and 48 hours.

The physicochemical stability was defined as the absence of organoleptic changes (no colour change and no precipitates), pH variation < 0.5 units, and osmolarity between 280–310 mOsm/L. Regarding chemical stability, the acceptance range was set at 90–110% recovery of the initial amikacin concentration by particle-enhanced turbidimetric inhibition immunoassay. For microbiological stability, sterility testing was performed according to the European Pharmacopoeia.

Solutions remained clear, without precipitation or colour changes. pH values remained within the acceptable range: 4.37 ± 0.05 (0 h), 4.28 ± 0.06 (2 h), 4.21 ± 0.08 (4 h), 4.27 ± 0.07 (24 h), and 4.08 ± 0.11 (48 h). Osmolarity values were 306 ± 16.97 mOsm/L (24 h) and 292.5 ± 3.54 mOsm/L (48 h), both within the target range.

Amikacin recovery percentages were 99.78 ± 0.99% (2 h), 100 ± 0.35% (4 h), 95.88 ± 0.28% (24 h), and 93.49 ± 0.49% (48 h), remaining within the 90–110% range.

Microbiological cultures were negative at all time points.

The 5 mg/ml amikacin formulation in polypropylene syringes met the stability requirements for intrathecal administration. It demonstrated physical, chemical, and microbiological stability for up to 48 hours when stored at 2–8 °C under light protection.

No conflict of interest

To evaluate the stability and environmental impact of hospital compounding of intravitreal injections of aflibercept Eylea (8 and 40 mg/mL), bevacizumab MVASI (25 mg/mL), ranibizumab Ranivisio (0.6 mg/mL) and faricimab Vabysmo (120 mg/mL) stored in silicone-free and oil-free polypropylene syringes (Henke-Ject, ) with low dead space.

Syringes were stored at 2-8°C under light protection and analysed after 0, 7, 28 and 90 days. Analyses, performed in triplicate, included VEGF-binding affinity and biophysical stability tests using dynamic light scattering (DLS) and thermal-ramp analysis (25-100°C) to assess particle size and thermal behaviour. For statistical analysis (p < 0.01) one-way ANOVA was used.

In 2025, 6015 injections were prepared for 991 patients, resulting in an estimated savings of EUR 1 494 584. No visual changes in colour, opalescence or particles were observed up to 90 days. Ranibizumab showed the best thermal stability (unfolding 75-79°C) with minimal particle variation (2.69-2.84 nm). Bevacizumab remained stable (7.75-7.86 nm; 64-70°C), and aflibercept 40 mg/mL showed better stability than 8 mg/mL (6.61-7.26 nm). Faricimab exhibited early aggregation (peak particle size at 187 nm after 1 week; 42-64°C) and progressive VEGF affinity loss after 7 days. The others showed ≤10% affinity variation within 28 days.

Except for faricimab, all anti-VEGF injections seem to maintain their physical, chemical and biological stability throughout the 28-day shelf life, supporting the reliability of the hospital compounding and storage process. The analytical sensitivity applied enabled early detection of aggregation risk, justifying the decision to shorten faricimab’s validity period to one week. Continuous validation after any production change ensures consistent safety and efficacy. The demonstrated cost savings highlight the pharmacist’s role in promoting quality, sustainability and rational use of hospital prepared intravitreal preparations.

No conflict of interest

To evaluate calibration discrepancies in 177Lu radiopharmaceutical doses between laboratory-reported and measured values.

We analysed doses of lutetium-based radiopharmaceuticals received by eight radiopharmacy between January and December 2024. For each vial, the measured activity (in MBq) was compared with the certificate reference activity. Parameters collected included date/time of calibration, date/time of measurement, day of delivery, date of production and production site.

A total of 1 040 deliveries of 177Lu-PSMA (n=754) and 177Lu-oxodotreotide (n=286) during this period were analysed. 32.3% of the vials came from Spain and 67.7% from Italy. The overall mean deviation between measured and reference values was –7.2%. Taking into account dose calibrator uncertainty (3%), 21.7% of vials (n=226) were under-calibrated beyond the ±10% tolerance, while 73.8% exceeded a -5% deviation. Doses from Spain showed >10% deviation in 16.4% of cases, representing 24.3% of all non-compliant vials. Italian vials accounted for 75.7% of >10% deviations, corresponding to 24.3% of batches from this origin. The deviation observed also varied according to logistical factors. Vials delivered on Mondays showed a greater average deviation (–7.9%) compared with those received on Fridays (–6.5%). No significant difference was observed according to the time elapsed between production and delivery (range: –6.7% to –7.3%).

Although most measured values remained within the ±10% tolerance required for clinical use, a significant proportion of 177Lu doses showed deviations greater than –5%, raising concerns about systematic under-calibration. Both the origin of vials and delivery schedules appeared to impact these discrepancies, with higher deviations for Italian batches and Monday deliveries. These findings highlight the need for improved harmonisation of calibration procedures, currently under discussion at the European level, to ensure consistent and reliable dosing in 177Lu radiopharmaceutical therapies.

No conflict of interest

To evaluate the concordance between final volumes obtained after reconstitution of oral powder medications and the theoretical volumes indicated in the package leaflet and Summary of Product Characteristics (SmPC).

The hospital formulary was reviewed to identify oral powder or granule formulations requiring reconstitution prior to administration.

Selection criteria included: preparations that must be compounded in the hospital pharmacy; drugs commonly used in paediatrics; and/or NTI drugs.

Each suspension or solution was reconstituted in triplicate, strictly following the instructions provided in the package leaflet and SmPC. The final volume was measured using graduated cylinders (100 ± 1 mL and 250 ± 1 mL). The measured volume was compared with the theoretical value, and the actual drug concentration and percentage error were calculated. An error margin of ±10% was considered acceptable according to the European Pharmacopoeia.

Seven out of 13 formulations were selected: Amoxicillin 250 mg/5 mL, Amoxicillin–clavulanic acid 100 mg/mL–12.5 mg/mL, Azithromycin 40 mg/mL, Erythromycin 100 mg/mL, Linezolid 100 mg/5 mL, Valganciclovir 50 mg/mL, and Mycophenolate mofetil 1g/5 mL.

Five of the 7 (71.4%) showed no significant deviation (error ≤ ±10%). Erythromycin and linezolid exceeded this margin, showing a mean final volume of 120.17±0.76 mL (83.22 mg/mL; mean error 20.17±0.76%) and 169.33±0.76 mL (17.72 mg/mL; mean error 12.89±0.51%), respectively.

The discrepancies observed highlight the importance of verifying the final volume and concentration after reconstitution, especially for paediatric and narrow therapeutic index drugs. Errors greater than ±10% may represent a significant quality deviation, potentially compromising treatment efficacy and safety. Increasing the number of oral powder formulations analysed would help confirm the clinical significance of these findings and support the need to update leaflet and SmPC information regarding actual final volume and concentration.

No conflict of interest

To optimise unidose packaging (UP) for oral liquids, increasing production yield and reducing waste.

The study was conducted in the pharmacy department of an HCLPTH. We included systematic calculations from all production orders for oral liquid medications processed from 2022 to 2024, including the unit production cost. Yield was calculated using the formula: Percentage yield = (Actual yield/Theoretical yield) x 100%. Production cost and the value of losses were calculated, and all financial values were converted to euros (). An Ishikawa diagram (6M analysis) identified packaging with sealing failure as the root cause. In 2024, a market survey for new UP was conducted, followed by the acquisition of samples, pilot batch production, and evaluation of yield and cost. The saving was calculated by the difference between the values of the losses.

The intervention with the new UP resulted in a significant decrease in the average unit cost of critical UP products, decreasing from 0.33 (2022-2023) to 0.10 (2024). Consequently, the overall yield of the oral liquid line rose to 97.7% in 2024, surpassing the 97% target. This optimisation resulted in a 50.7% reduction in volume loss units from 2022 (4,443) to 2024 (2,191). In financial terms, the strategy reversed the waste trend, generating annual savings in losses of over 2,260.68, as the associated loss costs for the general line fell from 3,627.99 (2022) to 1,367.30 (2024), demonstrating an immediate and sustainable financial impact. The process was validated and incorporated into routine operations.

This strategy significantly enhanced efficiency and sustainability. It is simple, low-cost, and highly replicable in other hospital pharmacy compounding services.

No conflict of interest

To present the case of a 90-year-old female patient diagnosed in March 2024 with vaginal candidiasis after using oral antibiotics, in this case, amoxicillin-clavulanate 875 mg/125 mg every 8 hours for 10 days. She underwent treatment with vaginal miconazole and oral fluconazole 150 mg for 3 days without success. The vaginal swab culture revealed Candida krusei, which was resistant to fluconazole but sensitive to amphotericin B. The pharmacy service was asked to develop a 5% amphotericin B vaginal emulsion due to the lack of topical alternatives.

The galenic development and validation of the formula were achieved by following the procedures described in the National Formulary (PN/L/FF/002/00) and through quality control. Three samples were collected and analysed initially and again after 1 month. The validity period was determined by applying the risk matrix for non-sterile formulations outlined in the ‘Guide to Good Practice in the Preparation of Medicines in Hospital Pharmacy Services’. Formula design and clinical data of the patient was obtained from the software CPFarma and OrionClinic respectively.

Due to the hydrophobic nature of amphotericin B, an O/W emulsion was designed. The final formula included: amphotericin B 1.5 g, glycerin 4 g, and Ginebase (emulsion o/w for vaginal application) as vehicle up to 30 g. The galenic validation of the preparation—organoleptic characteristics (colour, odour, occlusiveness, extensibility, and consistency), homogeneity of particles, and exudation—was adequate and remained stable. The shelf life was set at 30 days under refrigerated conditions (2-8°C).

After 14 days of self-application of the vaginal emulsion once daily, the patient experienced a complete resolution of symptoms with no reported adverse effects.

The 5% amphotericin B vaginal emulsion resolved the drug-resistant infection. This case demonstrates the critical role of the hospital pharmacist in managing fungal-resistant infections, such as Candida krusei. The successful treatment with the compounded amphotericin B preparation underscores the importance of microbiological cultures in guiding antifungal therapy.

No conflict of interest

The aim of this work was to evaluate the impact of two new communication tools –an updated leaflet and a short educational film¹ explaining the chemotherapy preparation process from prescription to administration –on patients’ understanding and satisfaction, compared with the 2022 survey.

In 2025, a cross-sectional survey was conducted among outpatients receiving injectable chemotherapy in four day-hospital departments (medical oncology, haematology, neuro-oncology, and hepato-gastroenterology).

Patients were invited to read the updated leaflet and watch the educational film before completing a questionnaire administered by the pharmaceutical team.

The survey assessed knowledge of the chemotherapy preparation process, perceived adequacy of the information received, satisfaction with the new communication tools, and overall satisfaction rated on a 1–10 scale. Responses were collected using a 4-point satisfaction scale (1 = very dissatisfied; 4 = very satisfied) or yes/no questions and were compared with data from the 2022 survey.

Ninety-four patients participated in 2025 compared with 93 in 2022. Mean overall satisfaction remained high (9.1/10 vs 8.9, p=0.88). Over 90% of respondents were satisfied with both the chemotherapy process and the information provided. The proportion of patients who considered the information sufficient significantly increased from 55% in 2022 to 86% in 2025 (p<0.001) following the introduction of the video and updated leaflet.

Patient satisfaction with chemotherapy management and the information provided by the UPCO team remains consistently high. The introduction of dedicated communication tools significantly improved patients’ understanding of the hospital pharmacy’s role in the chemotherapy preparation process. These results underline the relevance of pharmacist-led educational initiatives to strengthen patient engagement, transparency, and trust in cancer care.

1. https://www.youtube.com/watch?v=lk63LHje0pY

No conflict of interest

To quantify and characterise waste produced from sterile (SP) and non-sterile preparations (NSP) within a hospital compounding unit, in order to identify opportunities for more sustainable management.

An observational study was conducted over 30 working days (August–September 2025) in a hospital compounding unit producing both SP and NSP. Waste generated during compounding activities was collected and weighed daily using a Terraillon scale (sensitivity ±0.1 kg). Each item was then classified into one of five waste streams: non-hazardous recyclable waste (NHRW), paper (PAP), household-type waste (HTW), infectious healthcare waste (IHW), and toxic chemical waste (TCW). Sorting compliance and the number of daily preparations were recorded. Data analysis was performed using Microsoft Excel.

A total of 5,800 waste items (2,270 from SP and 3,530 from NSP) were generated over 30 days, with a cumulative weight of 61 kg. During this period, 418 preparations were produced (10 SP and 408 NSP), generating on average 14 items and 147 g of waste per preparation. SP produced considerably more waste (227 items per preparation) than NSP (9). Only two sorting streams were used among the five available: IHW (496 items; 11 kg) and HTW (5,304 items; 50 kg). When reclassified by nature, waste distribution was 72% HTW (4,194), 16% IHW (914), 8% PAP (483), 3% TCW (152), and 1% NHRW (57). A total of 1,128 non-compliances (NCs), representing 20% of all waste, were recorded, mainly in the HTW stream (1,114; 99%). Sorting errors mainly involved PAP (77%), followed by NHRW (11%), TCW (7%), and IHW (5%).

This study highlights the substantial waste generation associated with compounding activities, particularly during sterile preparations. Waste sorting compliance was only partial, with approximately 20% of items misclassified—mostly paper incorrectly discarded in the HTW stream. These findings emphasise the need to improve source sorting through clearer waste stream identification, provision of suitable containers, and staff awareness initiatives, to enhance sustainable waste management within the compounding unit.

No conflict of interest

Identify ongoing CTs in a Phase I Unit that require AS for the preparation and administration of an IP.

Check whether there are restrictions or not with the Unit’s AS, according to the CT requirements.

Analyse the causes of not being able to use local AS and the sponsor’s solution.

Observational, retrospective study, including ongoing CTs at 01 Oct 2025 with IPs that require parenteral route (iv, sc, it...).

Main data collected were type of AS (diluent bags, syringes, secondary sets, filters, administration sets and closed system transference devices for preparation and administration (CSTDs), permitted or non-permitted use of local AS and causes.

Data source: preparation sheets.

108 CTs were identified.

In 30% of them, the use of any local AS is not permitted; of which 90% are not allowed in at least two types of AS. Regarding the type of AS not permitted in relation to the CTs identified:

The high variability of AS, local or provided by sponsor, can lead a risk of mistakes due to use of incorrect AS, worker unsafety, lack of knowledge of how to use them, less storage space, and a greater complexity of the CT.

For later phases/commercialisation, the restriction on AS can be a limiting factor.

Therefore, sponsors should conduct as extensive testing of references and materials as possible in the early stages.

No conflict of interest

To assess the benefits of centralised compounding of faricimab syringes under sterile conditions compared to dispensing vials for direct administration in the ophthalmology department (OD), including associated cost savings.

A retrospective observational study was conducted in a tertiary hospital between October 2024 and July 2025. Data collected included: syringes prepared in the pharmacy department, those submitted to the microbiology department for microbiological quality control (mQC), and administrations recorded by the OD. Costs of syringes were compared with a hypothetical scenario using vials.

Syringes were prepared in a horizontal laminar-flow hood following GPP, using the basic ZeroResidual kit (bZRk), which includes sterile, silicone-free, low dead volume, single-use 0.2mL syringes, disposable hypodermic needles, latex-free protective caps, and auxiliary bubble adapters. They were stored in individual light-protective bags, at 2-8°C for up to 28 days.

Costs of faricimab vial and associated consumables were based on hospital’s official purchase price.

During the study period, 2,545 syringes were prepared from 802 vials, yielding 3.17 syringes from each vial. Given the unit cost of 465.35 for faricimab vials and 30 for bZRk, the estimated cost per syringe was 176.65, representing a 62% reduction per administration. Of the total, 162 syringes were used for mQC, leaving 2,383 available for clinical use.

In the hypothetical vial-based scenario, the total cost would have been 1,108,929.05, whereas centralised compounding lowered the cost to 449,560.70, achieving savings of 659,368.35.

The OD reported enhanced safety due to sterile compounding and mQC, greater ease of use, and reduced waiting times compared to on-site preparation.

Indirect costs arising from preparation by nursing staff were not included, representing a limitation of the study.

Centralised compounding of faricimab syringes led to substantial cost savings in public healthcare, while also enhancing patient safety through sterile preparation and rigorous mQC.

Additionally, it improved ophthalmologists’ satisfaction due to its ease of use and reduced patient waiting times.

No conflict of interest

To identify the most ergonomically demanding manual preparations by measuring withdrawal and dilution forces, supporting prioritisation for robotic compounding.

The study was conducted in three hospitals combining manual and automated compounding with the Kiro Oncology robot. Preparations were selected by drug, dose, density and final container.

Two manual movements were assessed: withdrawal (pulling the syringe plunger to aspirate drug from the vial) and insertion (pushing the plunger to transfer the solution into the final container).

Additional tests used saline (NS), water for injection (WFI), and 5% dextrose (D5W) with syringes from 1 to 50 mL, to assess force across sizes and solutions.

A dynamometer with a custom adapter on the syringe plunger was used. Reference force values and risk levels were defined according to UNE-EN1005-3:2002+A1. The maximum reduced isometric force for withdrawal and insertion was 1.83 kg with tasks over 0.92 kg considered ergonomic risks. Measurements were done by trained staff under standardised conditions (syringe with closed system transfer devices).

Nine technicians participated, three from each hospital, (67% women, mean age 43±13years), three repetitions/participant (27 measurements):

Vial Dose (mg) Volume (mL) Syringe (mL) Final container Withdrawal force (Kg) (SD) Insertion force (Kg) (SD) Oxaliplatin (100 mg/20 mL) 200 40 50 IV bag 4.22 (1.60) 5.80 (2.71) Oxaliplatin (100 mg/20 mL) 85 17 20 IV bag 1.81 (0.58) 3.22 (1.75) Paclitaxel (300 mg/50 mL) 300 50 50 IV bag 4.77 (1.55) 5.43 (1.21) Paclitaxel (300 mg/50 mL) 100 16.7 20 IV bag 2.62 (0.48) 3.64 (0.90) Fluorouracil (5000 mg/100 mL) 4000 80 50 Infuser 4.20 (1.68) 9.40 (1.96) Fluorouracil (5000 mg/100 mL) 4000 80 50 Cassette 4.20 (1.68) 6.77 (4.00)

All manual preparations exceeded the recommended force limit, with no significant differences between aqueous (oxaliplatin) and viscous (paclitaxel) drugs. Force differences were mostly related to syringe volume and final container, with the highest forces recorded during infuser insertion. For NS, WFI, and D5W, only syringes >10 mL exceeded risk thresholds.

Manual compounding frequently exceeds ergonomic limits, especially with large volumes (>20 mL) and infuser transfers. These data support prioritising such tasks for robotic compounding (if available) to reduce musculoskeletal risk.

Clàudia Sabaté Martinez (Kiro-Grifols)

No conflict of interest

Formulation, preparation, and stability testing of preservative-free losartan potassium 0.8 mg/mL eye drops in Novelia multidose eye drop containers.

For the preparation of a qualification batch, 130 mg losartan potassium (GMP compliant API) were exactly weighted and dissolved in 163 g of sterile 0.9% sodium chloride infusion solution under cleanroom conditions. 50 mL portions of the solution were drawn up into a 50 mL sterile plastic syringe, a 0.22 µm Minisart PES membrane filter connected and 10 mL portions of the solution filtered into sterile Novelia multidose eye drop containers (nominal volume 10 mL) each, sealed, and labelled. The content of one eye drop container was distributed into aerobic (8 mL) and anaerobic (2 mL) blood culture bottles for rapid sterility testing. 12 eye drop containers were stored at 2-8 °C and samples withdrawn at day 0, 14, 28, and 90 from three systems each. Physicochemical stability was determined in triplicate by quantitative HPLC analysis of intact losartan and by measuring pH and osmolality in parallel.

At day 28, the losartan concentration amounted to 99.3% ± 0.9% RSD of the initially measured concentration. pH 6.2 and osmolality 288 mOsmol/kg fulfilled the pharmacopoeia specification of eye drops and remained nearly unchanged over 28 days. Refrigerated storage was chosen because of microbiological reasons and unknown stability at room temperature. The phosphate buffer-free formulation mitigates the risk of corneal calcification.

The preparation of preservative-free losartan potassium 0.8 mg/mL eye drops was successfully implemented. The Novelia multidose eye drop container allows multiple administration of preservative-free solutions and efficient pharmacy preparation. Stability testing of the preparation is ongoing and shelf life proven for at least 1 month.

No conflict of interest

To collect feedback from pharmacy staff regarding ergonomic challenges, health concerns, and perceptions of automation in aseptic compounding.

A cross-sectional survey was conducted among KIRO-Oncology and Kiro-Isolator users. The questionnaire collected demographic data (age, gender), occupational information (professional category, time dedicated to manual compounding), and self-reported physical health aspects related to work. Additional compounding-related variables included syringe size, final container type, and medicines considered difficult to compound manually or preferred for robotic preparation.

We received 37 responses from hospital pharmacy professionals, all of them used to combine manual and automated compounding with KIRO-Oncology or Kiro-Isolator robots across six countries: Spain (15), France (11), Latvia (5), Finland (3), Ireland (2), and Poland (1).

Among respondents, 39.3% were aged 18–30 years and 46.4% were 31–41 years; nearly 80% were women; 65% were pharmacy technicians, 27% pharmacists, and the remainder nurses. 73% spent over half of their working time on manual compounding.

95% reported discomfort or pain during compounding, mainly in the hands, cervical region, and fingers (>15% each). 19% had taken sick leave due to musculoskeletal disorders, with half notifying to the occupational health service. In two-thirds of these cases, medical leave or reassignment exceeded 1 month.

Manual compounding frequently leads to musculoskeletal discomfort among pharmacy personnel. Implementing ergonomic strategies and expanding robotic compounding for high risk or physically demanding preparations could potentially enhance staff safety and well-being.

Clàudia Sabaté Martinez (Kiro-Grifols)

No conflict of interest

The objective of this study is to analyse deviations identified during PN bag compounding and to define a standardised clinical decision making procedure involving the hospital pharmacist (HP) and the prescribing physician (PP) for assessing bag suitability.

Data related to bag compounding performed at a hospital between January 2025 and July 2025 were extracted from the ACS software. Data were categorised by production date, clinical ward, patient population (adult/paediatric), compounding deviation type and percentage, and proportion of validated versus rejected bags. For deviations between 2-4%, the HP consulted with the PP to assess bag suitability based on the patient‘s laboratory parameters and clinical status. Bags with deviations exceeding 4% were systematically discarded and re-compounded.

During the study period, a total of 1898 nutritional bags were compounded. Of these, 91/1898 (4.8%) showed a filling deviation exceeding 2%. The magnitude of the detected deviation ranged between 2-25% in 79 bags, 25-50% in seven bags, and exceeded 50% in five bags. Following joint decision making between the HP and the PP, considering the patient‘s laboratory values and clinical conditions, 64/91 bags were deemed suitable for administration as the deviation was not considered clinically significant. The remaining 27/91 bags were rejected. The main reasons for discarded bags were significant variations in sodium quantity (15 bags), excessive concentration of disodium fructose diphosphate in bags for preterm neonates (three bags), and potassium overdosage in paediatric emergency bags (nine bags).

The analysis confirmed that a 2% threshold procedure with systematic multidisciplinary evaluation based on laboratory and clinical parameters effectively ensures safe nutritional therapy. This approach proved essential for vulnerable populations, highlighting the fundamental role of interprofessional collaboration in preventing clinically significant errors in ACS which could affect patient outcomes.

No conflict of interest

This study aimed to assess the stability of (⁶⁸Ga)Ga-PSMA in the injection syringe to determine the maximum allowable time for possible reassignment in case of unforeseen delays, provided that radioactivity remains sufficient.

Radiochemical purity (RCP) was used as the stability marker. RCP values from the multidose vial and from dispensed syringes were compared. Four quality controls (QC) were performed at 30-minute intervals: T0, T30, T60, and T90. The analytical method was thin-layer chromatography (TLC). A 1 µL aliquot was applied on glass microfiber chromatography paper impregnated with silica gel. The mobile phase consisted of methanol and ammonium acetate (50/50, v/v). RCP values obtained at T0 were compared with those at subsequent times using the non-parametric Wilcoxon paired test (α = 0.05).

Ten (⁶⁸Ga)Ga-PSMA syntheses were analysed. No significant differences in mean RCP were observed between T0 and T30 (p = 0.10) or T60 (p = 0.13). Only RCP at T90 (p = 0.0091) was significantly different from T0. Across all syntheses, RCP coefficients of variation remained below the 2% variability threshold (1.62, 0.14, 0.29, 0.29, 0.27, 0.23, 0.17, 0.66, 0.24, 0.16), confirming temporal stability.

No degradation of (⁶⁸Ga)Ga-PSMA radiochemical purity was observed up to 60 minutes after dispensation, suggesting sufficient stability for temporary storage in syringes and possible dose reassignment. The significant variation observed at 90 minutes may result from the limited number of syntheses analysed. Further studies on larger datasets are needed to confirm and refine these findings.

NA

No conflict of interest

To assess dose uniformity and stability in extemporaneously compounded oral suspensions prepared with SyrSpend SF PH4. By combining results from previously conducted studies, we aim to provide (hospital) pharmacists with a clearer understanding of the accuracy and reliability of these suspensions.

The analysis included 180 formulations containing 127 active pharmaceutical ingredients (APIs), with 5,700 samples stored at room temperature and under refrigeration. Formulations were prepared under controlled laboratory conditions using validated compounding procedures and analysed with stability indicating HPLC-UV methods. Method specificity was confirmed through forced degradation. To mimic routine patient use, samples were manually agitated before six aliquots were drawn from the centre of each container at day 0, 7, 14, 30, 60, and 90. Content uniformity was assessed using USP <905> acceptance criteria, adjusted to account for the available sample size. Chemical stability was determined by comparing recovery values to initial concentrations.

All formulations tested met the acceptance limits of both the United States Pharmacopeia (USP) and the British Pharmacopoeia (BP). Average recovery values were 99.81% at room temperature and 100.21% under refrigeration, with no samples exceeding USP maximum limits. Mean concentrations remained within 90.86% and 109.91% of label claim, indicating accurate and consistent dosing. These findings confirm that SyrSpend SF PH4 maintains content uniformity and chemical stability across a wide range of APIs under different storage conditions.

This study provides (hospital) pharmacists with a practical, evidence-based framework for dose accuracy in extemporaneous compounding. Demonstrating reliable content uniformity and stability across multiple APIs and storage conditions, it supports safer, more standardised preparation of oral suspensions. These results can strengthen internal quality assurance processes and reinforce confidence in everyday compounding decisions.

Corporate sponsored research or other substantive relationships:

Carolina Schettino Kegele, Hudson Polonini and Eli Dijkers are employees of Fagron Group. The University of Athens has been provided a financial compensation to cover the costs of executing part of the stability studies presented in this abstract.

This study aimed to evaluate and compare four commercially available CSTDs. Specific objectives were to assess the devices’ safety and usability, and to develop standardised preparation protocols tailored to each cytotoxic drug.

A comparative study using scientific literature and manufacturer data evaluated four CSTDs: Chemfort (Asept), Chemolock (ICU Medical), Qymono (Vygon), and PhaSeal (BD). Each device was assessed across seven criteria: Ergonomics, Safety, Compatibility (NIOSH hazardous drug list), Assembly process, Aseptic duration, Dead volume, and Cost. A global performance score was calculated as the average of all criteria.

Standardised methotrexate preparation protocols were implemented in the gynaecology unit. A summary table was created in the cytotoxic reconstitution unit (URC), listing cytotoxic agents, their key characteristics, and the corresponding preparation protocol to support safe and consistent practice.

The characteristics of the four CSTDs were consolidated into a comparative table and visualised using a radar chart.

Based on this multicriteria analysis, Chemfort (Asept) was identified as the most suitable device, offering the best balance of safety, ergonomics, and compatibility with hospital workflows.

Following this evaluation:

These resources enhance safety, consistency, and usability in cytotoxic drug preparation, improving operational reliability for hospital staff.

This study confirms that Chemfort is a suitable CSTD for safe cytotoxic drug preparation, with the best technical specifications aligned with the hospital’s operational requirements.

Implementation will be accompanied by close monitoring of user satisfaction, preparation times, economic impact, and long-term sustainability.

The outcomes of this follow-up will support wider deployment and contribute to continuous improvement in the safety, efficiency, and quality of cytotoxic drug preparation

No conflict of interest

To evaluate the usefulness of a dual (in-person and remote) telepharmacy follow-up system for severe asthma patients on biologics by assessing clinical response, biomarkers, and health-related quality of life (HRQoL).

A multicentre 24–month prospective follow–up was conducted in severe asthma patients receiving biologics from three hospitals. Sociodemographic data, comorbidities, and health habits were collected. Clinical and functional parameters included forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), fractional exhaled nitric oxide (FeNO), eosinophil count, and immunoglobulin E. HRQoL was assessed using validated questionnaires: Asthma Control Test (ACT), FACIT–Fatigue, PROMIS–29, SNOT–22, TSQM, miniAQLQ, and P3CEQ. Correlations between clinical variables and HRQoL outcomes were analysed.

Thirty–seven patients (83.3% women, 46–65 years: 43.3%) were included; 48.7% had comorbidities, mainly hypercholesterolaemia (35.1%). Questionnaire completion rate was 89%, and 37.8% used the telepharmacy chat for queries. Dupilumab was the most frequent biologic (45.2%). Pulmonary function improved: FEV1 increased from 80.1±21.0% to 85.3±16.4%, and FEV1/FVC from 71.0±13.6% to 77.0±11.5%. FeNO decreased significantly (55.8±46.7 to 27.8±21.7 ppb). ACT scores improved from 17.1±6.0 to 22.3±2.2 (p=0.019). HRQoL improved: mini AQLQ symptoms (4.8±1.6 to 6.3±0.6, p=0.031), activity limitation (5.2±1.6 to 6.8±0.2, p=0.030), and emotional function (4.2±1.9 to 6.6±0.5, p=0.014). FACIT–Fatigue increased (36.0±11.8 to 44.5±7.2, p=0.010), and SNOT–22 scores decreased markedly in patients with nasal polyposis. PROMIS–29 revealed reduced depression and fatigue, with improved physical functioning. Overall satisfaction with telepharmacy follow–up was 8.7/10.

Telepharmacy enables efficient dual follow–up for severe asthma patients on biologics, providing real–time query resolution and outcome monitoring. Significant improvements were observed in pulmonary function, asthma control, HRQoL, and fatigue, alongside high patient satisfaction. Telepharmacy represents a valuable strategy for value–based care in severe asthma.

The authors thank the Asthma Multidisciplinary Unit and the Hospital Pharmacy Department for their support in the implementation of the telepharmacy model. No external funding was received.

No conflict of interest

To estimate the population-based minimum plasma concentration (Cmin) of risankizumab at weeks 12 and 52 and to correlate the degree of attainment of the threshold associated with clinical remission.

Retrospective observational study including adult patients diagnosed with Crohn’s disease and treated with risankizumab. The two-compartment model described by Suleiman et al. was implemented using the PKS software by Abbott. Patients receiving risankizumab were selected, and the predicted Cmin at weeks 12 and 52 of treatment was calculated using Bayesian estimation. A threshold associated with clinical remission was set at >60 mcg/mL at week 12 and >10 mcg/mL at week 52, based on the literature reviewed from Suleiman et al., Sequier et al., and Robin et al., as there is no established consensus. The predicted Cmin at week 52 was evaluated using the efficacy data documented in the electronic health records of patients for whom this information was available. Demographic (sex and age), anthropometric (weight), and laboratory (creatinine, faecal calprotectin (FCP), albumin) data were collected from electronic medical records.

32 patients were included; 57.9% women, with a median age of 53 years (27–77). The median clinical variables were: weight 70 kg (48–138); FCP 131mg/kg (12–537); and albumin 45 g/L (39–48). At week 12, no patients reached the established threshold, with a median Cmin of 33.2 mcg/mL (25.7–47.7). At week 52, only three patients achieved an adequate maintenance Cmin, with a global median of 6.5 mcg/mL (3.9–11). Of the five patients with follow-up data at week 52, 100% required re-induction due to lack of efficacy. All had subtherapeutic levels at both week 12 and week 52 under the dosing regimen specified in the product label. They are currently on an intensified regimen of risankizumab 360 mg subcutaneously every 6 weeks.

The recommended dosing of risankizumab in patients with Crohn’s disease does not achieve the pharmacokinetic/pharmacodynamic targets established in our study and is associated with a lack of response to the drug.

No conflict of interest

To assess the clinical utility and diagnostic performance of piflufolastat in biochemically recurrent prostate cancer and its impact on disease detection and treatment strategies.

A retrospective, multicentre, descriptive study was conducted during 2023–2024, including prostate cancer patients previously treated with radical prostatectomy or curative radiotherapy. Eligible patients had biochemical progression, persistence, or recurrence and were candidates for piflufolastat PET per Central Pharmacy and Therapeutics Commission protocol. Variables included age, Gleason score, initial treatment, PSA prior to imaging, PET-choline and PET-PSMA results (negative, positive, or indeterminate), and post-imaging treatment. Data were obtained from electronic medical records.

Thirty-two patients (mean age: 68 years) were included. Gleason scores were 6 (19%), 7 (70%), 8 (4%), and 9 (7%). Most underwent radical prostatectomy (n=28), four received curative radiotherapy. Mean PSA before imaging: 1.62 ng/ml. Average interval between PET-choline and PET-PSMA: 2.7 months.

Discordance between the two imaging occurred in 66% of cases. PET-PSMA was positive in 12 patients with negative PET-choline, and indeterminate in three others. Among five indeterminate PET-choline cases, three were positive and two negative on PET-PSMA.

Treatment decisions varied: among PET-PSMA positive patients, six received androgen deprivation therapy (ADT) with apalutamide or enzalutamide, two received the same plus radiotherapy, five underwent Stereotactic Body Radiation Therapy (SBRT), three received ADT and radiotherapy, and one underwent cryotherapy.

Among PET-PSMA negative patients, four were under active surveillance, one received SBRT, three received ADT and radiotherapy, and one received ADT plus enzalutamide. In indeterminate PET-PSMA cases, two received ADT and apalutamide, two received ADT and radiotherapy, and two were closely monitored.

Piflufolastat PET is a valuable diagnostic tool for assessing recurrence in prostate cancer, especially in patients with negative PET-choline. Its higher sensitivity may influence treatment decisions. However, this study did not show consistent correlation between PET-PSMA findings and therapeutic strategies. Further studies are needed to clarify its impact on clinical outcomes.

No conflict of interest

To determine the frequency and types of intravenous drug incompatibilities in the ICU of a university hospital and to assess their correlation with the nursing staff’s years of experience.

A clinical pharmacist conducted an observational study over a 3-month period in an intensive care unit to gather data on medication incompatibilities. Information on drug pairs, routes of administration, and observed incompatibilities was documented during the preparation of IV mixtures. The Stabilis 4.0 tool served as the primary reference for identifying incompatibilities, while SPSS 2.0 was utilised for statistical analysis and data processing.

A total of 217 IV preparation and distribution procedures were observed, with 111 Y-site medication mix-ups (51%). Among these, 38 (34%) were incompatible, 21 (19%) compatible, and 52 (47%) had unknown compatibility. Of the 38 incompatibilities, nine (23.7%) involved nurses with <1 year of experience, one (2.6%) with 1–4 years, six (15.8%) with 4–5 years, and 22 (57.9%) with >6 years, suggesting increased risk at both low and high experience levels. A Student’s t-test showed a significant association between age and error frequency (t = -2.617; p = 0.009), with younger nurses more prone to errors.

Incompatibilities can have serious clinical implications, such as altered therapeutic effects and heightened risk of adverse reactions. This study suggests that errors may resurface over time, potentially due to overconfidence and decreased vigilance, highlighting that both inexperience and excessive familiarity can contribute to incompatibility errors. These findings emphasise the need for staff to maintain focus during drug administration and underscore the importance of ongoing awareness and continuous training programmes.

No conflict of interest

This study aims to evaluate the potential clinical, economic and organisational impact of the validation tool for parenteral chemotherapy as part of a quality improvement programme.

A retrospective evaluation study of a quality improvement programme was conducted at the chemotherapy preparation unit (CPU) of UZ Brussel for all patients receiving parenteral chemotherapy. Parenteral chemotherapy prescriptions were screened for DRPs and with the resulting PIs were recorded in a register using the Be-CLIPSS classification system. This register was retrospectively reviewed by an expert panel, which assessed the clinical, economic, and organisational impact of each PI using the CLEO tool.

A total of 10.696 parenteral chemotherapy prescriptions were analysed with a significant increase in DRP detection (0.3% vs 1.4%; p <0.001). More clinically significant PIs (19.48%) were detected in the tool supported period. A notable economic benefit of 105.652,99 was observed in the tool supported period and the validation time for parenteral chemotherapy prescriptions decreased significantly, with a median time reduction from 16:11 (07:16-33:45) minutes to 14:50 (6:00-33:00) minutes (p < 0.001).

The validation tool is associated with a positive clinical, economic and organisational impact. The tool significantly improved the detection of drug-related problems and a reduction of validation time.

No conflict of interest

To describe and analyse the use of AT in oncology patients during their last phase of life.

An observational retrospective study was conducted including oncology patients who received AT in 2024 at our centre. Variables collected included demographics (age, sex, ECOG), diagnosis, treatment characteristics (type, intention, line, duration), and mortality-related data (initiation of AT within 30 days prior to death (30DPD), follow-up by the palliative care unit (PCU), emergency or hospital admissions within the 30DPD, cause and place of death, and ongoing AT within 30 or 14 days of death). Descriptive statistics were applied.

A total of 158 patients (62% male; median age 69 years, IQR 15) were included. The most common diagnoses were lung (29.8%), digestive (24%), and breast (12%) cancer. Treatments received were chemotherapy (70.2%), immunotherapy (22.2%), and targeted therapies (11.4%); 94.3% were administered with palliative intent. PCU follow-up occurred in 54.4% of patients.

AT was administered within 30DPD in 25.9% (41/158) and within 14 days in 9.5%. New treatments were initiated within 30DPD in 8.9% of cases, mostly as first-line therapy (65%). ECOG ≥2 was reported in 39% of patients. Median number of treatment cycles was two (IQR 3).

The main causes of death were disease progression (93.7%) and infectious complications (3.8%). Emergency visits occurred in 77.2% of patients within 30DPD, with 68.3% requiring hospital admission. Death occurred at home (36.2%), long-term care facilities (40.4%), or hospitals (23.4%).

The proportion of patients receiving AT within 14 days of death (9.5%) was below the 10% threshold described in the literature, but initiation of new treatment within 30DPD (8.9%) exceeded the recommended 2%. These findings highlight possible inappropriate resource use, with high rates of emergency care. PCU follow-up (54.4%) was near optimal (55%). ECOG status and limiting treatment lines may help refine decision making in end of life oncology care.

1. DOI: 10.1200/JCO.24.00542;

2. DOI: 10.1200/JCO.2004.08.136;

3. DOI: 10.1093/jjco/hyn031;

4. DOI: 10.3390/cancers15133349

No conflict of interest

To evaluate effectiveness and safety of ATZ-BVZ and to compare the results with those obtained with the pivotal trial.

An observational and retrospective study was conducted including all patients treated with ATZ-BVZ from May 2021 to April 2025 in a tertiary hospital.

The variables studied were demographic data, ECOG, number of cycles received, previous treatments, BCLC (Barcelona Clinic Liver Cancer) stage, treatment duration, reasons for discontinuation, and date of death.

To evaluate effectiveness, progression-free survival (PFS) and overall survival (OS) were analysed by Kaplan–Meier method. PFS and OS were expressed in median and 95% confidence interval (95% CI).

To evaluate safety, adverse reactions (AR) were recorded.

Data were collected using the electronic clinical records and the oncohaematological prescription program. Statistical analysis was performed with SPSS v.22.0.

We collected 45 patients, of whom 43 were included due to loss to follow-up. The median age was 69 years (56-82). At the start of ATZ-BVZ, 59% had an ECOG 0 (n=25), 41% ECOG 1 (n=18). Previous treatments were sorafenib (n=3) and lenvatinib (n=2).

The median number of cycles received was 10 (4-54). The reasons for treatment discontinuation were: progression (n=8), death (n=4) and toxicity (n=3): immune-mediated colitis. 58% had BCLC stage C, 28% stage B and 14% stage A.

PFS and OS in our study were 9.1 months (95% CI:4.46-19.7) and 12.8 months (95% CI 6.79-14.3), respectively. In pivotal trial IMbrave150, PFS was 6.8 months and OS was 19.2 months.

In our cohort, safety results were comparable to the pivotal study: hypertension 33% vs 29.8%; asthenia 28% vs 20.4%; proteinuria 12% vs 20.1%; bleeding 20% vs 14.9%; infusion reaction 14% vs 11.2%. 6.9% experienced an AR leading to withdrawal of ATZ-BVZ vs 7% in pivotal trial.

The PFS obtained in our study was superior to that reported in the pivotal trial, probably because only 58% of our patients had stage C compared with 85% in IMbrave150.

The AR identified showed a similar incidence to our study.

It would be necessary to continue with this study to extend the follow-up time in order to analyse more precisely the effectiveness of the treatment.

No conflict of interest

The objective was to assess the prevalence and evolution of OD use over a 14-year period and its economic impact on the hospital pharmacy budget (HPB).

This was a retrospective, observational, longitudinal study from January 2011 to December 2024, of adult and paediatric patients with RD treated with ODs, both oncologic (excluding CAR-T therapies) and non-oncologic. Data were extracted from the official inpatient and outpatient pharmacy software (Farmatools), using OD classifications validated by ORPHANET (last update: April 2024). Drug prices were based on those published by the national health authorities. Variables analysed included the number and type of ODs (ATC classification), the number of treated patients, drug utilisation, and OD-related costs (percentage of HPB).

141 patients received treatment with 36 different ODs (97% adults, 3% paediatric). The highest number of patients was recorded in 2015 (n=41). OD use peaked in 2015 and 2020 (15 drugs), with the lowest in 2023–2024 (five drugs). Overall, 53% of ODs were oncologic and 47% non-oncologic. The most commonly used ODs were daratumumab (14.8%), nintedanib (11.3%), ibrutinib (10%), azacitidine, and bosentan (7.8%). OD distribution by ATC group was dominated by L (n=19), followed by C and A (n=4 each).

The average economic impact of ODs on the hospital pharmacy budget was 7.93%, ranging from 3.42% (2011) to a peak of 12.90% (2022). Group L represented 64.7% of total OD expenditure, with daratumumab alone accounting for 21.1% of total spending. Paediatric patients represented 11.5% of OD expenditure despite being only 3% of the sample.

Oncologic ODs represented 53% of treatments and accounted for 64.7% of OD-related spending. Daratumumab was the most used and costliest OD, while bosentan was the most frequent non-oncologic OD. The average OD budget impact over 14 years was 7.8%. This long-term project reflects a strong commitment to improving care and visibility for rare diseases, while highlighting the financial challenges of ODs in small healthcare systems.

No conflict of interest

This study aimed to evaluate the impact of PCs on the management of patients receiving long-term (>14 days) antibiotic therapies.

A prospective monocentric study was conducted from May 2024 to April 2025. Patients prescribed high risk antibiotics, identified by the infectious diseases mobile team, were referred to hospital pharmacists for a PC. Each patient received an antibiotic information leaflet and the pharmacist’s contact details. A satisfaction questionnaire was completed after the consultation. Data were collected and analysed using Microsoft Excel.

A total of 40 PCs were conducted (70% male, median age: 76 years (Q1=59; Q3=79)). Most consultations occurred in surgical wards (45%) and emergency/post-emergency units (18%). The main infection sites were osteomyelitis (30%), endocarditis (18%), surgical site infections (15%), and abscesses (15%). The median antibiotic treatment duration was 39 days (Q1=21; Q3=42), with 65% monotherapies and 35% dual therapies, accounting for 54 prescribed antibiotics.

The most frequently used antibiotics were sulfamethoxazole/trimethoprim (24%), levofloxacin (20%), and amoxicillin (19%). A total of 21 pharmaceutical interventions (PIs) were performed during the PCs, with a 90% acceptance rate by prescribers. These interventions mainly addressed the prevention or correction of drug interactions (eg, rifampicin with apixaban, levofloxacin with iron), the management of adverse effects (eg, renal or hepatic toxicity under cotrimoxazole), the optimisation of administration schedules (eg, rifampicin taken on an empty stomach), and adjustments to treatment duration or dosage, including for antibiotics and anticoagulants.

Three patients contacted the hospital pharmacist after the PC: two for clarification on dosing or duration, and one to report a severe skin reaction to sulfamethoxazole/trimethoprim, leading to urgent rehospitalisation and treatment modification. Patient feedback indicated a high level of satisfaction.

Pharmaceutical consultations enhance the safety and effectiveness of long-term antibiotic therapies by improving patient understanding, supporting adherence, and enabling timely intervention when complications arise. They underscore the essential role of hospital pharmacists in multidisciplinary infectious disease management.

No conflict of interest

To evaluate the real-world effectiveness and safety of fenfluramine in paediatric patients with refractory epileptic syndromes.

A retrospective observational study was conducted including all paediatric patients treated with fenfluramine between January 2021 and July 2025 at a tertiary children’s hospital. Demographic, clinical, and treatment variables were collected. Effectiveness was assessed according to seizure frequency and duration at 14-week follow-up. Safety outcomes included adverse drug reactions (ADRs). A multivariable logistic regression was performed to explore predictors of response.

A total of 45 patients were included (62.2% male), with a median age of 8 years (IQR 5–11). Diagnoses were DS (26.7%), LGS (31.1%), and other epileptic syndromes (42.2%). Before fenfluramine initiation, 23 patients (51.1%) presented more than 10 daily seizures. Concomitant cannabidiol was used in 29% of cases.

The median fenfluramine dose was 0.44 mg/kg/day at initiation, increasing to 0.56 mg/kg/day at 14 weeks. Overall, 25 patients (55.6%) achieved a clinical response. Among responders, 40% had epileptic syndromes different from DS or LGS, and 40% had previously received cannabidiol. Treatment discontinuation occurred in 24.4% of patients, due to inefficacy (8/11,72.7%) and adverse drug reactions (1/11,9.1%). Logistic regression including age, sex, diagnosis, and cannabidiol co-treatment did not identify significant predictors of response. Reported ADRs were mainly somnolence (28.9%), anorexia (24.4%), diarrhoea (8.9%), and abdominal pain (4.4%), which were generally mild and resolved after dose adjustment.

Fenfluramine appears effective and safe in the treatment of Dravet and Lennox–Gastaut syndrome and shows promising results in other difficult-to-treat epileptic syndromes. No predictors of response were identified, highlighting the need for larger multicentre studies to better define patient profiles and optimise therapy.

No conflict of interest

To evaluate the efficacy, tolerability, and safety of add-on CBD in paediatric and young adult patients with DRE

Clinical and pharmacological data of patients treated with add-on CBD at the Regional Paediatric Epilepsy Centre, Salesi Hospital (Ancona, Italy) between September 2019 and December 2023 were analysed. Efficacy was defined as ≥50% reduction in seizure frequency. Adverse events (AEs) were classified as minor or major. Quality of life (QoL) was assessed through caregiver reports.

Thirty-six patients were included: four with DS, seven with TSC, nineteen with LGS, and six with other DRE. Mean age at add-on CBD initiation was 26 years and 4 months; at treatment onset, 50% of patients were in the paediatric age range (<18 years). The mean treatment duration was 15 months, with an average of 3.25 concomitant antiseizure drugs. Overall, 53% (n=19) achieved a clinically relevant seizure reduction, most of whom (n=13) had LGS. Discontinuation occurred in 47% (n=17), due to lack of efficacy (n=12) or AEs (n=5). Adverse events were reported in 58% of patients, predominantly minor and transient. QoL improvement was reported in 53% of patients, including better sleep quality in 30.5%.

In this real-world cohort, add-on CBD demonstrated clinically relevant efficacy with acceptable tolerability and safety in paediatric and young adult patients with DRE, particularly in LGS. These findings support its role as a valuable therapeutic option in refractory epilepsies.

1. www.aifa.gov.it/documents/20142/1540069/123_EPIDYOLEX_DS_pp_scheda_innovativita_GRADE.pdf

No conflict of interest

To describe the pharmacokinetic variability of azole antifungals in paediatric patients monitored in tertiary care hospitals, analysing the impact of therapeutic drug monitoring.

Descriptive, retrospective, multicentre study including paediatric patients treated with antifungal agents who had plasma concentrations measured between February 2020-August 2025.

Trough plasma concentrations were measured at steady state using high performance liquid chromatography with ultraviolet detection (HPLC-UV).

Therapeutic ranges: voriconazole=1.5-5.5µg/mL, isavuconazole=2-5 µg/mL.

Collected Data: Gender, age, underlying pathology, type of treatment (empirical, targeted, or prophylaxis), infection treated, presence of isolates (MIC), treatment toxicity, liver function, levels, pharmacist recommendations, physician acceptance.

Plasma concentrations were determined in 94 samples from 31 patients, 65.38% girls, median age 11 (6–12) years and mainly haematological underlying conditions (80.8%). Voriconazole accounted for 84.04% (N=79) of the samples and isavuconazole 15.96% (N=15). There were no posaconazole samples. Empirical treatments represented 74.5%, targeted 24.5%, and prophylaxis 1.1%. Type of infections: respiratory 81.9%, systemic 6.4%, neurological 5.3%, among others. Aspergillus was most frequently isolated (A.flavus N=3, A.fumigatus N=9, A.terreus N=5), followed by Candida (C.guillermondii N=4, C.krusei N=2), with all isolates being sensitive to treatment.

For voriconazole, median concentration was 1.28 (0.42-3.03) µg/mL, with 44.3% (35) being subtherapeutic, 44.3% (35) within range, and 11.4% (9) supratherapeutic levels. Of those out-of-range, levels were re-requested in 78.43%, and 73,68% were brought into range and 26,3% were discontinuation.

44% of supratherapeutic levels presented adverse effects (visual disturbances, hypertransaminasemia), which resolved upon reaching therapeutic range, except for one discontinuation.

For isavuconazole, median concentration was 2.08 (1.59-3.04) µg/mL, 86.7% (13) within range, 6.7% (1) subtherapeutic, and 6.7% (1) supratherapeutic. Both children with out-of-range levels had their dosing regimen adjusted, achieving adequate levels in next determination.

Voriconazole shows significant pharmacokinetic variability, with more than 50% of plasma levels outside the therapeutic range. This highlights the crucial importance of pharmacokinetic monitoring to reach therapeutic ranges and ensure the effectiveness and safety of treatments in severe paediatric conditions.

No conflict of interest

To evaluate the effectiveness and safety profile of NALIRI in patients with mPC under normal clinical practice conditions.

Observational, retrospective, single-centre study. All patients treated with NALIRI between December 2016 and April 2025 were included. Demographic data, location of metastases, previous treatments, functional status (ECOG) at the start of NALIRI, duration of treatment, follow-up time and tolerance were collected. Effectiveness was assessed using RECIST criteria, progression-free survival (PFS) and overall survival (OS), using Kaplan–Meier curves. Toxicities were classified according to CTCAE v5.0. Data were obtained from electronic medical records and analysed using R software (v4.2.2).

Forty-six patients with a median age of 65.5 years (range:45–80) were included; 52% were women. Twenty-two percent had undergone surgery. The most common metastases were hepatic (44%), peritoneal (30%), pulmonary (26%), adrenal (11%) and lymph node (9%). In metastatic disease, 40 patients received gemcitabine-nabpaclitaxel as first-line treatment. Seventy-two percent of patients received NALIRI as second-line treatment. The ECOG at the start of treatment with NALIRI was 0 (13%), 1 (65%) and 2 (20%).

The median follow-up was 5 months (range: 1-19) and the median duration of treatment was 2.5 months (range: 0.5-17). At the end of the study, 35 patients had died. The PFS and OS data were 3.5 months (95% CI:2-5) and 6 months (95% CI:4.4-8), respectively.

Ninety-four percent of patients experienced some adverse reaction. The most common toxicities were gastrointestinal (67%; five grade 3 cases), haematological (59%; one grade 4 and three grade 3) and asthenia (63%; one grade 4 and five grade 3). Other toxicities included abdominal discomfort (11%), neurotoxicity (15%), stomatitis (17%; two grade 3) and hand-foot syndrome (9%). Dose reductions were performed in 17 patients, treatment delays in 19 and suspensions due to toxicity in 12 cases.

The effectiveness of NALIRI was comparable to that of the NAPOLI-1 trial. NALIRI showed a high incidence of adverse effects, which in many cases required dose adjustments or treatment discontinuation.

No conflict of interest

The primary objective of this study was to assess quality of life in patients receiving intravenous IFX or subcutaneous ADA. Secondary objectives included comparing quality of life between both therapies and evaluating treatment adherence.

We conducted a single-centre, prospective, observational study between April and June 2025. Adult patients with a confirmed diagnosis of moderate-to-severe IBD treated with IFX or ADA for at least 1 year were included. Exclusion criteria comprised severe comorbidities, cognitive impairment, or inability to complete questionnaires.

Quality of life was assessed using the validated IBDQ-9, while adherence was measured through the Morisky 4-item scale for ADA and infusion attendance for IFX. The study was approved by the Institutional Research Ethics Committee, and all participants provided informed consent. Statistical analysis included measures of central tendency and dispersion for quantitative variables, and absolute frequencies for categorical variables. Independent samples t-test was used for mean comparisons, with significance set at p<0.05. Analyses were performed with SPSS v.24. Data sources included electronic medical records and the outpatient dispensing module.

A total of 70 patients were included: 36/70 (51.4%) treated with IFX and 34/70 (48.5%) with ADA. The mean age was 50.9 years (SD=13.4), with Crohn’s disease predominating (78.6%). Overall IBDQ-9 scores indicated good quality of life (69.5%, SD=22.1%). No significant differences were observed between therapies (p=0.92), although IFX showed a higher proportion of patients with very good quality of life. Adherence was 100% in IFX versus 85.3% in ADA. Notably, non-adherent ADA patients reported nearly 30% lower quality of life compared to adherent patients.

Patients with IBD treated with IFX or ADA demonstrated overall good quality of life, with no significant differences between therapies. However, treatment adherence emerged as a key determinant, particularly in patients receiving ADA.

No conflict of interest

To evaluate pharmaceutical interventions in patients with hypercholesterolaemia treated with PCSK9i (alirocumab or evolocumab).

To assess the acceptance rate of the interventions.

Retrospective observational study of pharmaceutical interventions performed in patients with hypercholesterolaemia treated with PCSK9i since the inclusion of these drugs in the hospital guidelines (August 2016–February 2025) at a tertiary care hospital. Data collected: age, sex, lipid-lowering treatment, adherence, pharmaceutical interventions, treatment changes.

During the study period, 52 patients receiving PCSK9i treatment were included (28 men) with a median age of 64 years (IQR: 16–84). The median duration of treatment was 39 months (IQR: 4–100). In addition to monoclonal antibodies, 62% of patients were on concomitant treatment (statins, ezetimibe, and/or bempedoic acid). Sixty-five percent were statin-intolerant. Adherence to hospital medication collection was 95.4% compared to 78.9% in primary care. Nineteen interventions were carried out in 17 different patients, with an acceptance rate of 89.5%. The most common intervention was an increase in alirocumab dose (68.4%). Other interventions included switching and addition of oral treatments.

Close monitoring by the pharmacy department benefits:

No conflict of interest

To evaluate the potential carbon footprint savings achieved by delivering outpatient medications from a hospital pharmacy to patients’ nearest community pharmacies through a cooperative distribution programme.

This was a retrospective observational study that included outpatient medication deliveries between a tertiary hospital and community pharmacies that are part of a cooperative distribution programme according to the Official Association of Pharmacists of Barcelona (COFB). The study period ranged from March 2020, when the programme started, to mid-August 2025. Carbon footprints were assessed using the tool ‘Carbon Footprint Calculator’¹ and expressed in tonnes of CO₂ (tCO₂). The potential carbon footprint savings were evaluated by quantifying the difference between patient travel from home to the hospital and back and the one-way deliveries to community pharmacies, as these deliveries followed the usual routes of wholesaler couriers. Data were obtained from the hospital clinical registry and the COFB online portal.

A total of 26,136 medication deliveries from the hospital to community pharmacies were included: 976 in 2020, 3,013 in 2021, 4,705 in 2022, 6,219 in 2023, 6,738 in 2024, and 4,485 in the first 7.5 months of 2025. These deliveries resulted in progressively increasing annual carbon footprint savings (figure 1), from 34.4 tCO₂ in 2020 to 239.2 tCO₂ in 2024, with 158.6 tCO₂ achieved during the first 7.5 months of 2025 (projected to reach 253.8 tCO₂ for the full year). The total savings over the study period were 918.5 tCO₂.

Abstract 4CPS-016 Figure 1

Carbon footprint savings achieved by delivering outpatient medications to community pharmacies

Delivering outpatient medications from a hospital pharmacy to patients’ nearest community pharmacies is associated with substantial carbon footprint savings and supports a more sustainable, environmentally friendly dispensing model.

1. Carbon Footprint. Carbon Footprint Calculator. https://www.carbonfootprint.com/calculator.aspx

No conflict of interest

To assess the evolution of disease activity, quality of life, fatigue, and work functioning in CD patients treated with biologics or JAK inhibitors (JAKi) over 12 months using ePROMs.

A retrospective observational study was conducted in three Spanish hospitals (Jan 2021–Sept 2024). Adult CD patients receiving biologics/JAKi were included. Clinical data (Harvey-Bradshaw Index (HBI), CRP, faecal calprotectin) and ePROMs (MIBDI, IBDQ-32, IBD-Control, FACIT-Fatigue, WRFQ) were collected at baseline and 12 months. Descriptive and comparative statistics (ANOVA, t-tests, non-parametric tests) were applied with Bonferroni correction.

Results 118 patients were included (53.0% male, mean age 43.5 ± 13.0). Most were on anti-TNF therapy (81.0%) and first-line treatment (53.4%). At baseline, 35.3% had moderate-severe disease (HBI), with mean CRP 2.4 ± 14.3 mg/L and calprotectin 435.5 ± 460.2 µg/g. After 12 months, improvements were observed across all PROMs. The proportion of patients with inactive disease (MIBDI) increased from 7.6% to 39.1%, and those with great disease control (IBD-Control) rose from 64.6% to 93.6%. Quality of life improved (IBDQ-32: high QoL from 60.3% to 83.3%), and fatigue decreased (FACIT-Fatigue: mild fatigue from 70.2% to 91.4%). Work performance also improved (WRFQ: high performance from 70.0% to 76.8%). However, 43.5% still reported active disease (MIBDI), and 6.4% had poor disease control. Importantly, patients rated their satisfaction with the dual follow-up model (in-person and telematic) at 8.15 out of 10, highlighting its acceptability and perceived value.

Our telepharmacy value-based health project demonstrates the utility of ePROMs in monitoring CD patients. Despite overall improvements, a significant proportion of patients continue to experience disease burden, highlighting the need for individualised care strategies. The high satisfaction with the hybrid care model supports its continued implementation.

The authors thank the Inflammatory Bowel Disease Multidisciplinary Unit and the Hospital Pharmacy Department for their support in the implementation of the telepharmacy model. No external funding was received.

No conflict of interest

To evaluate changes in PK parameters, clinical outcomes and cost during the first year after PK-guided switch from SHL to EHL FIX in patients with severe/moderate HB on prophylaxis.

Multicentre, observational, retrospective, and multidisciplinary study conducted from December 2024 to May 2025 comparing pharmacokinetic and clinical outcome variables 1 year before and after the switch, including associated costs. Clinical data – annualised total bleeding rate (ABR), annualised joint bleeding rate (AJBR), weekly dose (IU/kg^{– 1}), infusion frequency – were extracted from OrionClinic. PK profiles and PK variables – half-life, area under the curve (AUC), trough levels – were obtained using WAPPS-Hemo, whereas economic data (Laboratory Purchase Price without Value-Added Tax) were obtained from Orion-Logis. Quantitative variables were expressed as median (IQR) and qualitative as n (%). Statistical analysis was performed with R.v.4.4.3.

Twenty-one patients (nine paediatric, 12 adults) were included in the study. All PK parameters showed significant improvement, with median improvement ratios for t1/2 and AUC of 4.1 (3.4–4.8) and 4.2 (2.6–5.0), respectively, with no age group differences (p>0.05). ABR was significantly reduced (p = 0.009), with resolution of 5 out of 6 (83.3%) target joints. Infusion frequency and weekly dose were reduced by 50.0% (50–65%; p = 0.0001) and 56.3% (40.0–65.8%; p = 0.0001), respectively, with a median reduction of 52.1 (26.1–67.8) injections and 130,357.3 (5,142.9–203,357.3) IU of FIX per patient per year. Despite lower consumption, the median annual drug cost increased to 28,254.9 (4,432.1–44,060.8) per patient per year.

PK-guided switching to EHL FIX prophylaxis markedly improved all PK parameters while reducing treatment burden and improving both efficacy and quality of life in patients with HB. Although our analysis did not demonstrate direct cost savings—as only drug-related expenses were considered—this contrasts with haemophilia A, where switching to EHL factors has shown significant economic benefits. Comprehensive real-world studies including indirect costs are warranted to better define the full health-economic impact of EHL FIX therapy.

No conflict of interest

To evaluate the persistence of anti-CGRP mAbs used in migraine prophylaxis and to identify the main reasons for treatment discontinuation.

A retrospective observational study was conducted including all treatment episodes defined as unique patient–consultation pairs with initiation of galcanezumab, fremanezumab or erenumab between 2020 and 2024. Data were collected from nine hospitals. Persistence was analysed using Kaplan–Meier survival curves, censored at maximum follow-up. Treatment discontinuation was defined as a documented end date. Reasons for suspension were classified into lack of efficacy, adverse events, or clinical improvement. Log-rank tests were applied to compare persistence curves.

A total of 302 treatment episodes from 259 unique patients were included: galcanezumab (n=126), fremanezumab (n=115) and erenumab (n=61). The mean age was 46.3 years (median 48; range 22–75; IQR 16.5), and 84.4% were women. Regarding treatment line, 75.9% of episodes corresponded to first-line use, 18.2% to second-line, 4.8% to third-line and 1.1% to later lines. Global persistence was 98.1% at 3 months, 91.9% at 6 months, 84.3% at 12 months, 79.1% at 2 years, 74.4% at 3 years and 68.2% at 4 years. By drug, persistence at 12 months was 85.4% for galcanezumab, 81.3% for fremanezumab and 84.2% for erenumab; at 4 years it was 69.2%, 73.5% and 63.9% respectively. Among 65 discontinuations, the main reasons were lack of efficacy (60.0%), adverse events (18.5%) and clinical improvement (3.1%). When stratified by treatment line, naïve patients showed persistence of 78.6% at 12 months and 64.9% at 36 months, compared with 72.5% and 59.1% in switch patients. Differences were not statistically significant (p=0.78).

In real-world practice, long-term persistence to anti-CGRP mAbs is high, with galcanezumab and fremanezumab showing favourable persistence up to 4 years, while erenumab demonstrated slightly lower rates. Lack of efficacy was the leading cause of discontinuation. Importantly, no significant differences were found between drugs or between naïve and switch patients.

No conflict of interest

This retrospective study was conducted to analyse the use of drugs from ATC group C07 (beta blocking agents) in both ambulatory and hospital patients treated at the Division of Paediatrics in a tertiary hospital during 2022 and 2023. Patients were included in the study if they received at least one beta blocking medicine during this time period of the study.

Data were collected from the hospital information system. They included patient age, duration of beta blocking therapy, the specific drug from ATC group C07, prescribed dose, dosing interval and the main diagnosis classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Descriptive variables were reported as proportions or frequencies; numerical variables were summarised using the median, minimum, and maximum values.

During the study period, 205 patients received at least one beta blocking agent, most frequently bisoprolol (36.9%) and propranolol (37.3%). Propranolol was more commonly administered to younger patients (≤11 years of age), whereas bisoprolol was predominantly prescribed to older children (>11 years of age). Beta blocking agents were most often administered in the form of an oral suspension (49%) or tablet (34%). Approximately 60% of the medications were prepared by the hospital’s galenic laboratory. The primary treatment indications included congenital malformations of the circulatory system (17.6%) and tachycardia (17.1%). Overall, 80.6% of beta blocker use was off-label.

Beta blocker use in the paediatric population was characterised by frequent off-label prescribing, with clear age-related preferences in medicine selection (propranolol in younger children and bisoprolol in older ones). Most formulations required individualised preparation, often by the hospital’s galenic laboratory, reflecting the limited availability of paediatric-appropriate dosage forms.

No conflict of interest

To describe real-world use of oritavancin regarding indications, dosage, effectiveness and safety in clinical practice, and to assess its economic impact when administered at hospital discharge.

A retrospective observational study was conducted including all patients treated with oritavancin from September 2023 (date of inclusion in the hospital formulary) to July 2025 in a tertiary hospital. Variables evaluated: age, sex, type of infection, isolated microorganism, treatment indication, dosage, clinical cure (absence of clinical signs of infection), results of microbiological cultures, 30-day mortality, adverse events, hospital stay and economic cost.

Twenty-eight infection cases in 25 patients were analysed. Most were male (80%, n=20) with a median age of 54 (43–67) years. Main indications were skin and soft tissue infections (SSTIs) (64.30%, n=18) and osteoarticular infections (OAI) (28.60%, n=8). Targeted therapy based on antibiogram was used in 46.4% (n=13) of cases. The most frequent pathogens were Enterococcus faecalis (14.29%, n=4), Enterococcus faecium (14.29%, n=4), Staphylococcus epidermidis (14.29%, n=4), Methicillin-resistant Staphylococcus aureus (14.29%, n=4) and Methicillin-susceptible Staphylococcus aureus (10.71%, n=3). 85.71% (n=24) of the cases received a single 1200 mg dose, while 14.30% (n=4) received a second 800 mg dose 8-12 days later. 46.43% (n=13) received treatment immediately before discharge.

Regarding effectiveness, 71.43% (n=20) achieved complete clinical cure, 14.29% (n=4) relapsed, and no 30-day mortality was observed. Post-cure cultures were performed in 21.4% (n=6), all negative. Regarding safety, only one patient developed adverse events in two cases. One case involved general malaise post-infusion, and another a severe infusion-related reaction.

The treatment cost per patient ranged 1,342–2,237, whereas avoided hospitalisation costs ranged 4,550–27,300 from one to six weeks, depending on the diagnosis. Estimated savings for patients receiving oritavancin at discharge ranged 30,074–337,459.

Oritavancin demonstrated an adequate effectiveness and safety profile with high clinical cure rates and few adverse events, although vigilance is warranted due to potential infusion-related reactions. Beyond its approved indication in SSTIs, it proved effective in OAI. Its administration at discharge enabled substantial cost savings by avoiding prolonged inpatient care. Further studies are needed to confirm its role in antibiotic stewardship and resource optimisation.

No conflict of interest

To explore the mechanism of curcumin in treating constipation through network pharmacology combined with molecular docking technology.

The method is based on collecting curcumin and constipation targets from multiple databases, establishing a target prediction network for curcumin treatment of constipation, submitting common targets to the STRING database, analysing connectivity using Cytoscape software, conducting gene ontology (GO) functional analysis and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment analysis on the top 20 ranked genes, and molecular docking of the obtained targets to study the mechanism of curcumin treatment of constipation.

As a result, 232 targets related to curcumin, 563 targets related to constipation, and 54 common targets between curcumin and constipation were obtained from the database. GO functional analysis shows that these targets are associated with 635 pathways; KEGG pathway enrichment analysis showed 134 related pathways. The molecular docking results showed that curcumin has good binding ability to targets such as mitogen activated protein kinase 3 (MAPK3), interleukin (IL) 6, serine/threonine kinase 1 (AKT1), vascular endothelial growth factor A (VEGFA), signal transduction and transcription activator 3, albumin, Jun oncogene, tumour necrosis factor (TNF), IL1B, tumour protein p53, C-C motif chemokine ligand 2, and fibronectin 1.

The therapeutic effect of curcumin on constipation is achieved through multiple targets and pathways; Specifically, curcumin may regulate MAPK by binding to core targets MAPK3, IL6, AKT1, VEGFA, and TNF IL6, TNF. Phosphatidylinositol 3-kinase/protein kinase B and VEGF signalling pathways play a role in treating constipation.

No conflict of interest

To describe paediatric patients treated with vancomycin who required switching to another antibiotic, and to assess whether these modifications were justified.

A descriptive, observational, retrospective study was conducted in hospitalised paediatric patients treated with intravenous vancomycin between 01 January 2022 and 31 July 2024, who later switched to another antibiotic for the same indication. Data were obtained from medical records and the prescribing program. Changes were considered justified if vancomycin doses exceeded 75 mg/kg/day without achieving trough levels of 10–15 mg/mL, in central nervous system infections, or in clinically unstable patients. The protocol was approved by the local ethics committee.

A total of 836 vancomycin treatments were administered to 582 patients. Treatment was changed in 69 cases (62 patients). Median age was 4.4 years (1 month–19.5 years); 61% were male and 82% had underlying diseases (51 patients), mostly oncohaematological (30). The most frequent indications were bacteraemia (32%), febrile neutropenia (12%), prophylaxis (7%), fever of unknown origin (6%), and pneumonia (6%).

Vancomycin was switched to linezolid in 40 treatments (58%), daptomycin in 24 (35%), clindamycin in 4 (6%), and ceftaroline in 1. The main reason for switching was failure to reach therapeutic levels (52%, 36 treatments), although 14 were deemed unjustified since maximal dosing had not been attempted (mean dose 62 mg/kg/day). Fifteen treatments (22%) were switched due to sequential step-down to oral therapy, although in three cases a more suitable antibiotic could have been chosen. 14 treatments (20%) were changed due to the patient’s clinical condition, although in two cases doses could have been increased. In one case, antibiogram-guided selection was preferable. Four treatments (6%) were changed due to allergy or adverse effects.

Vancomycin is mainly used in preschool children with oncohaematological diseases. Most changes were justified, but serum level monitoring and dose optimisation are crucial before switching. Antibiotic choice should be guided by susceptibility results to ensure appropriate management in paediatric patients.

No conflict of interest

To evaluate the performance of a hospital pharmacy-led CMM program from 2020 to 2025, with emphasis on adherence support, pharmacovigilance, and patient engagement.

This observational descriptive study analysed the hospital pharmacy CMM database (January 2020–June 2025). Variables included diagnoses, pharmacotherapy, type of service delivered, and care plan status (completed, suspended, presumed active). Outcomes assessed were enrolment trends, diagnosis distribution, services provided, pharmacotherapy coverage, and patient retention.

A total of 1,344 patients were enrolled between 2020 and 2025, with steady growth: 2020 (6%), 2021 (13%), 2022 (18%), 2023 (17%), 2024 (30%), and 2025 to date (16%). The most frequent diagnoses were osteoporosis (18%), prostate cancer (6%), chronic kidney disease (6%), and rheumatoid arthritis (5%), with other autoimmune diseases accounting for ~7%. About one-third of records lacked a coded diagnosis, reflecting a documentation limitation. The majority of interventions were recorded as control of dispensing (56%), which included pharmacist verification and counselling, complemented by structured follow-up (2%) and SPD support (1%). Care plan outcomes showed 38% completed, 35% suspended, and the remainder (27%, n=356) presumed active. Among these active patients, the median follow-up was 3 months (IQR: 0.5–6 months), with some exceeding 1 year, demonstrating sustained pharmacist engagement. Pharmacotherapy included 177 unique medicines, frequently high-cost biologics such as denosumab (12%), secukinumab (8%), and epoetin beta (6%).

The hospital pharmacy-led CMM program demonstrated sustained growth, broad therapeutic coverage, and contributions to adherence support and pharmacovigilance. While missing diagnoses and the predominance of dispensing records highlight opportunities to expand structured follow-up, the active cohort analysis confirms meaningful patient retention over time. This model strengthens patient safety and quality of care and may be adapted across healthcare systems to optimise pharmacotherapy outcomes.

No conflict of interest

To assess the level of agreement in the classification of interactions between herbal or food products and DOACs across four drug interaction databases.

A descriptive cross-sectional study was performed to identify potential interactions between herbal or food products and DOACs (apixaban, rivaroxaban, edoxaban, dabigatran) listed in four drug interaction databases (Lexicomp, Medinteract, Micromedex, Drugs.com). Interaction severity was standardised into four categories: Severe, moderate, minor and undetermined.

Abstract 4CPS-026 Table 1

Statistical analyses were performed with STATA BE/17.0. Overall agreement among the four databases was assessed using Gwet’s AC with quadratic weights, while Fleiss’ Kappa with quadratic weights was applied for sensitivity analysis. Agreement levels were interpreted according to Altman’s thresholds: ≤0.20 poor, 0.21–0.40 fair, 0.41–0.60 moderate, 0.61–0.80 good, ≥0.81 excellent.

A total of 1992 potential interactions between DOACs and molecules were identified, of which 149 (7.5%) involved herbal or food products: apixaban 42 (28.2%), dabigatran 42 (28.2%), edoxaban 23 (15.4%), rivaroxaban 42 (28.2%).

Overall agreement between the four databases was moderate with Gwet’s AC (range 0.55–0.57) but poor with Fleiss’ Kappa (range 0.05–0.10).

Drug interaction databases showed inconsistent classification of DOAC–herbal product interactions, with overall agreement ranging from poor to moderate depending on the statistical method applied. These discrepancies highlight the absence of harmonised criteria and limit the reliability of database alerts. Pharmacists should critically appraise interaction information before making clinical recommendations. Standardisation of classification systems and further research on DOAC–herbal interactions are needed to strengthen clinical decision support.

No conflict of interest

Calculate risankizumab treatment persistence in its different indications: PsO, PsA, CD and UC.

Observational, retrospective and descriptive study including patients with PsO, PsA, CD and UC treated with risankizumab in a tertiary care hospital from March 2021 to July 2025.

The variables collected were: sex, age, diagnosis, previous treatments, start and end date of risankizumab and reason for discontinuation (primary, secondary failure, adverse reaction, loss to follow-up).

Drug persistence was assessed at 6, 12, and 24 months, both overall and by indication and line of treatment (early vs later lines (>3 lines)). Excel was used for data analysis.

A total of 113 patients were studied, the median age was 50 (16-84) years, 53.1% of whom were women. Risankizumab prescriptions were for: PsO (58.4%), CD (30.1%), PsA (10.6%), and UC (0.9%). 44.2% of patients were in the fourth-line or beyond.

During the study 17.6% (n=20) discontinued treatment, with a median duration of 15 (2-28) months. Causes of discontinuation were: loss to follow-up (45%), secondary failure (35%), and primary failure (20%). No patients discontinued treatment due to intolerance.

Results of drug persistence according to indication and line of treatment are shown in the following table (data UC are not shown because there is only one patient in the study and remains on treatment):

Indication Treatment lines Drug Persistence 6 months 12 months 24 months PsO Earlier-lines 90% 75% 40% Later lines 96% 92% 58% PsA Earlier-lines 80% 60% 0% Later lines 71% 43% 29% CD Earlier-lines 77% 56% 0% Later lines 77% 47% 0% All indications Earlier-lines 84% 65% 25% Later lines 84% 70% 32%

The greatest treatment persistence was observed in patients with psoriasis, whereas results regarding initiation in early or late treatment lines were contradictory. Further studies are needed to confirm these findings.

No conflict of interest

Evaluate the use of cladribine in a tertiary care hospital.

A retrospective analysis was conducted with patients who completed treatment with cladribine between January 2020-August 2025. Baseline patient characteristics, the number of cladribine cycles received, and the need for subsequent disease-modifying treatment (DMT) were recorded.

A total of 103 patients with the described characteristics were included. Baseline characteristics were: 70.87% female, median age 39 years (interquartile range (IQR): 32–46), and median time from diagnosis to initiation of cladribine of 4.75 years (IQR: 2–11.75). Information on baseline Expanded Disability Status Scale (EDSS) scores was available for 47 patients (median 2, IQR: 1–2.63). Previous DMTs were also recorded (14.56% of patients were naïve, 56.31% had received one prior DMT). Of the 103 patients, 27.18% required subsequent DMT. Among them, six patients had received only one cycle, most of these cases due to disease progression. 79 patients received two cycles of cladribine; of these, 13 did not require further DMT from the fourth year after treatment initiation, maintaining persistence of the therapeutic effect, while 22 patients did receive subsequent DMT, most commonly (nine patients) due to disease progression. Regarding the time from the start of cladribine treatment to subsequent DMT, eight patients received it at 3 years, nine at 2 years, and five at 1 year. Additionally, 18 patients received three cycles of cladribine, most of them (10 patients) in the fifth year after treatment initiation (mean 4.49 years, standard deviation 0.66). The main reason for the administration of the third cycle was disease progression.

Many patients treated with cladribine maintained long-lasting therapeutic effects, with some continuing without the need for further DMT from the fourth year after treatment initiation. However, a significant proportion of patients required a third cycle or subsequent DMT due to disease progression. These results suggest that cladribine is an effective option for the treatment of RRMS, although continuous monitoring and individualised treatment adjustment are necessary to evaluate and optimise long-term outcomes.

No conflict of interest

Provide real-world data on the long-term use of cladribine.

A retrospective analysis was carried out at a tertiary hospital, including patients treated with cladribine between January 2020-August 2025. Patients who received a third cycle of cladribine or who remained without disease-modifying therapy (DMT) from the fourth year after starting treatment were included.

A total of 31 patients met the inclusion criteria, of whom 18 (58.06%) had received a third cycle. Baseline Expanded Disability Status Scale (EDSS) was available for 14 patients, with a median of 2.5 (interquartile range-IQR-: 1–3.38). The median age at treatment initiation was 41 years (IQR: 35.5–50), and 74.19% of the patients were women. The median time from diagnosis to starting cladribine was 9 years (IQR: 3–14). Of the total patients, three were naïve, and most of the rest (13 patients) had received one prior DMT. Regarding relapses, only two patients experienced a relapse in the first year of treatment, with complete resolution, which allowed continuation with the second cycle; in the second year, one patient presented a relapse. Currently, 13 patients remain without DMT, five of whom have reached 5 years and eight have reached 4 years since starting cladribine treatment. Of the 18 patients who received a third cycle, most did so in the fifth year (10 patients), while the rest did so in the fourth (six patients) and third year (two patients), with a mean of 4.39 years (standard deviation: 0.70). The most common reason for prescribing the third cycle was clinical progression (seven patients).

Most patients had received at least one prior DMT. More than half of the patients required a third cycle after a maintenance period of effect, most frequently in the fifth year from treatment initiation. However, larger studies are needed to better evaluate the effect and long-term use of cladribine.

No conflict of interest

To assess the proportion of patients achieving clinically meaningful improvements in HIT-6 (≥3 points) and MIDAS (≥4.5 points) over 24 months in a real-world migraine cohort, and to characterise patient demographics and treatment exposure.

Prospective observational stud in patients with preventive treatments targeting the CGRP pathway were included . PROMs were collected remotely via a telepharmacy platform at baseline and follow-up (1, 3, 6, 12 and 24 months). . Responder analysis was conducted in patients with paired baseline–follow-up data. Responders were defined as ≥3-point reduction in HIT-6 or ≥4.5-point reduction in MIDAS. Proportions of responders were calculated at each timepoint; Chi-squared tests assessed differences across visits.

A cohort of 244 patients with migraine from 10 centres was followed Mean age was 45.2 years (SD 12.3; range 18.0–75.0; IQR 37.0–54.0); 82.1% were women. 55% of ePROMs were completed.

Patients received the following CGRP pathway-targeted preventive treatments: 32.4% galcanezumab, 28.1% erenumab, 24.3% fremanezumab, 8.2% atogepant, 2.5% eptinezumab, 4.5% others.

The overall response rate to ePROMs was 54.8%.

HIT-6 responders: 1m 54.8% , 3m 63.6%, 6m 70.7% , 12m 66.7% , 24m 70.4%.

MIDAS responders: 1m 62.1% , 3m 66.0% (68/103), 6m 71.0% , 12m 68.3% , 24m 68.0%.

Responder rates remained stable over time, with no statistically significant differences across visits (HIT-6: ²=6.36, p=0.174; MIDAS: ²=6.54, p=0.162).

In this real-world migraine cohort of patients, preventive therapies targeting the CGRP pathway led to sustained clinical improvements, with ~55–70% of patients achieving MCID in HIT-6 and MIDAS at all follow-up points up to 24 months. These findings support the effectiveness and durability of anti-CGRP therapies in routine clinical practice and underline the value of PROM-based longitudinal monitoring through telepharmacy platforms.

No conflict of interest

The aim of this study is to evaluate the efficacy and safety of TAS+BEV in adults with mCRC in routine clinical practice.

This retrospective, observational, and multicentre study included patients with mCRC treated with TAS+BEV in four hospitals between January 2023 and July 2025.

Patient data (age, sex, Eastern Cooperative Oncology Group (ECOG) performance status, KRAS mutation status, prior treatments) were sourced from electronic medical records.

Efficacy was assessed in terms of progression-free survival (PFS) and OS, using the Kaplan–Meier method.

Safety was evaluated through the collection of adverse events (AEs) according to Common Terminology Criteria for Adverse Events v5.0, documentation of dose reductions, treatment interruptions, and discontinuations due to toxicity.

Fifty patients were included (74% male; median age 68 years (43-86)). All had ECOG 0-1 at baseline and median prior treatment lines was 2 (2-5). KRAS mutations were present in 60%.

At cut-off date, 24% remained on treatment. Median PFS was 3.9 months (0.27–27.17), median OS 12.4 months (0.27–23.6), and 6-month OS was 68.7%.

Grade ≥3 adverse events (AEs) occurred in 30% of patients, including neutropenia, anaemia, thrombocytopenia, and asthenia. Two patients developed febrile neutropenia.

Most frequent AEs of any grade were neutropenia (36%), asthenia (30%), thrombocytopenia (20%) and diarrhoea (16%).

TAS dose reductions to 30 mg/m² were required in 30%, with two requiring a further reduction to 25 mg/m² and 30% experienced treatment delays or discontinuations due to AEs.

The findings are clinically relevant but must be interpreted with caution. The median OS (12.4 months) exceeds the results of the pivotal trial (10.8 months), while median PFS (3.9 months) is slightly lower than in SUNLIGHT (5.6 months).

Safety outcomes were consistent with previous evidence.

Our findings support and extend existing evidence, although larger studies with longer follow-up are warranted.

No conflict of interest

To evaluate the effectiveness and safety of off-label verteporfin PDT in patients with cCSC treated in a tertiary university hospital.

A retrospective observational study was conducted among patients with cCSC who received verteporfin PDT (3 mg/m²) between January 2021 and March 2024. Demographic variables (age, sex) and clinical parameters (best-corrected visual acuity (BCVA), neurosensory retinal detachment (NRD), pigment epithelium detachment (PED), and subretinal fluid (SRF)) were collected. Clinical outcomes were assessed using optical coherence tomography (OCT), fundus examination, and BCVA (decimal scale) at baseline and 2 months post-PDT. Safety was evaluated by the occurrence of adverse reactions (ARs).

A total of 50 eyes from 41 patients (71% men, average age 58 ± 11.6 years) were analysed. Median BCVA improved from 0.5 (IQR 0.2–0.7) at baseline to 0.65 (IQR 0.3–0.9) at follow-up (Wilcoxon signed-rank test, p <0,001), indicating a significant improvement in visual acuity. After verteporfin PDT, BCVA improved in 56.0% (n = 28; 95% CI: 42.3%–68.8%) of eyes, while 44.0% (n = 22; 95% CI: 31.2%–57.7%) remained without clinical change. Of the 27 eyes with baseline NRD, 70.4% (n = 19; 95% CI: 51.3%–84.2%) showed improvement, and 29.6% (n =8; 95% CI: 15.8%–48.7%) remained unchanged. Of the 13 eyes with PED, 69.2% (n = 9; 95% CI: 42.0%–87.4%) showed improvement. Of the 21 eyes with SRF, 71.4% (n = 15; 95% CI: 49.7%–86.3%) achieved fluid reduction following verteporfin PDT. ARs occurred in three patients (6%), with secondary choroidal neovascularisation.

Off-label verteporfin PDT demonstrated statistically significant effectiveness in patients with cCSC, leading to significant improvements in BCVA and anatomical outcomes. A majority of eyes with neurosensory retinal detachment, pigment epithelium detachment, or subretinal fluid showed clinical improvement, with few reported ARs and good tolerability. These results support verteporfin PDT as a valuable therapeutic option to stabilise and improve vision in patients with cCSC.

No conflict of interest

This study aimed to evaluate the rational use of inhaled aminoglycosides in hospitalised patients with respiratory infections, and to examine the association between pharmacist assessment of prescribing appropriateness and clinical outcomes.

We performed a retrospective review of adult inpatients receiving inhaled aminoglycosides between 2017 and 2023. Demographics, infection details, concomitant IV antibiotics, culture results, resistance profiles, and treatment duration were collected. Pharmacists assessed prescribing rationality based on evidence-based criteria. The primary outcome was bacterial eradication within 28 days. Logistic regression identified predictors of success.

74 patients received inhaled aminoglycosides, of whom 53 met inclusion criteria. The mean age was 75 years, and amikacin was prescribed in 98% of cases. The average duration of inhaled therapy was 10.5 days, with 66% receiving concomitant intravenous antibiotics and 28% requiring mechanical ventilation. Pseudomonas aeruginosa was isolated in 54.7% of patients, and MDR organisms in 81.1%. At 28 days, bacterial eradication was significantly higher when prescriptions were assessed as rational by pharmacists (92.6% vs 7.4%, p = 0.024). Logistic regression confirmed rational prescribing as an independent predictor of eradication success (AOR 9.36, 95% CI: 1.67–52.46), while mechanical ventilation was negatively associated (AOR 0.17, 95% CI: 0.04–0.70). Eradication also showed a significant association with favourable clinical outcomes (78.6% vs 21.4%, p = 0.001).

Inhaled aminoglycosides should be reserved as adjunctive therapy rather than monotherapy, particularly for MDR infections. This study demonstrates that pharmacist assessment of rational prescribing is significantly associated with microbiological and clinical success. Bacterial eradication at 28 days may serve as a practical, reliable endpoint for evaluating antibiotic effectiveness in hospital practice, and supports the integration of structured pharmacist evaluation into antimicrobial stewardship programmes.

No conflict of interest

To evaluate the use of faricimab and its economic impact from the hospital pharmacy perspective.

Observational, descriptive, retrospective study. We included all patients who initiated faricimab between January 2024 and June 2024, and followed them through March 2025. Variables: age, sex, diagnosis, dosing schedule, treatment-naïve vs pretreated status, and (for pretreated) last prior therapy. We assessed treatment persistence and cost savings from vial sharing under a laminar-flow hood in the Pharmacy. Data were extracted from the SAVAC e-prescribing system and the SELENE electronic health record and analysed in Access.

We included 116 patients; 53.45% were women, mean age 72.99 ± 11.22 years. The most frequent diagnosis was age-related macular degeneration (AMD) (68.97%), followed by diabetic macular oedema (DME) (30.17%) and retinal vein occlusion (RVO) (0.86%). Most patients were prescribed monthly dosing (44.83%), then every 2 months (42.24%) and every 3 months (12.93%). Overall, 79.31% (n=92) were pretreated; prior therapies were aflibercept in 71.74% and ranibizumab in 28.26%. At analysis, 72% of patients remained on treatment. Probability of continuing treatment was 78% at 6 months and 70% at 12 months. By diagnosis, persistence differed significantly (p=0.028): for DME, 65% and 60% at 6 and 12 months; for AMD, 82% and 78% at 6 and 12 months. No significant differences were observed between naïve and pretreated subgroups. Vial sharing during 2024 and Q1-2025 yielded 221,535 in savings (consumables included).

In our cohort, AMD was the predominant indication, with monthly and bimonthly schedules used most often—contrasting with pivotal trials where 4-monthly dosing predominated. Most patients had been previously treated, mainly with aflibercept. Persistence at 6 and 12 months was similar overall, with higher persistence in AMD than DME, and more than 70% of patients were still on treatment at data cut-off. Vial sharing in the pharmacy generated substantial cost savings for the health system.

No conflict of interest

This study aimed to design, implement, and evaluate a no-code digital system supporting pharmacists in patient counselling and side effect monitoring among adults receiving chemotherapy.

The system was developed using AppSheet (no-code platform) and implemented in a hospital chemotherapy unit from July to December 2024. Pharmacists contributed throughout the development process, defining clinical workflows, structuring the knowledge assessment, and determining ADR documentation standards. The system included modules for patient education, a 15-item quiz to assess knowledge, and ADR reporting with severity grading (1–4). Pharmacists provided three structured counselling sessions per patient, reinforcing knowledge and capturing ADRs across treatment cycles. Patients with grade 2 ADRs were monitored closely by ward pharmacists, while grade 3 cases prompted collaborative management with physicians. The digital platform reduced repetitive paperwork, enabled systematic follow-up, and allowed pharmacists to devote more time to direct patient care.

A total of 196 patients were enrolled. Knowledge scores improved significantly from 45.6% before counselling to 72.0% after the second session and 91.8% after the third (p < 0.01). Over 80% of patients receiving three sessions achieved scores above 80%. Fatigue (92.9%), anorexia (76.0%), and nausea (60.2%) were the most common ADRs, while hand-foot syndrome (22.2%) was the most frequent severe ADR. Pharmacists’ structured interventions ensured that all patients with grade ≥2 ADRs received timely follow-up. Pharmacists reported enhanced efficiency, better communication with physicians, and improved continuity of care.

The digital system reinforced the central role of pharmacists in oncology care. It improved patient knowledge, standardised ADR monitoring, and optimised pharmacy workflows. Wider adoption could advance safe, coordinated, and pharmacist-led supportive care for chemotherapy patients.

No conflict of interest

To evaluate longitudinal changes in quality of life, disease control, activity, work role functioning and treatment satisfaction using CU-Q2oL, Urticaria Control Test (UCT), Urticaria Activity Score 7 (UAS7), PROMIS-29, Work Role Functioning Questionnaire (WRFQ) and TSQM in patients with chronic urticaria treated with biologics.

Observational prospective multicentre study including 37 patients with chronic urticaria. Mean age was 46 years; 67% were women. Most patients received omalizumab (92.3%), PROMs were collected at baseline, 1 month, 6 months and 12 months. Paired and mixed-effects analyses were applied where feasible.

At baseline, CU-Q2oL scores indicated substantial burden (pruritus 41.7, daily activities 19.4, sleep 33.2, global impact 24.4). At 1 year, improvements were observed (15.9, 8.7, 25.9 and 17.2, respectively). UCT increased from 8.8 to 12.1, with significant gains from month 1 (p<0.01). UAS7 decreased from 15.6 to 7.3, showing clinically relevant reduction.

PROMIS-29 showed a significant reduction in fatigue (54.5 -> 48.6, p=0.001), with favourable trends in anxiety (58.8 -> 53.7), depression (52.4 -> 49.0) and physical function (51.0 -> 57.0). Pain interference increased slightly (51.6 -> 55.6).

WRFQ global score improved from 88.8 at baseline to 98.9 at 12 months, with all domains (work scheduling, output, physical, mental, social demands) approaching maximal functioning, although without statistical significance due to small, paired samples and ceiling effect.

TSQM at 12 months reflected high treatment satisfaction: convenience 66.7, effectiveness 72.2, side effects 100, global satisfaction 78.6, total 79.4.

In this real-world multicentre cohort, biologic therapy for chronic urticaria was associated with sustained improvements across multiple PROMs. CU-Q2oL, UAS7 and PROMIS-29 confirmed clinically meaningful benefits, with fatigue showing statistically significant improvement. WRFQ demonstrated near-complete work role functioning and TSQM highlighted high treatment satisfaction. These findings support the effectiveness of biologics in routine care and underscore the importance of PROMs for patient-centred monitoring and therapeutic decisions.

No conflict of interest

This study aimed to develop an electronic point-based tool for pharmacists to use when selecting relevant patients for medication review. Furthermore, the tool was implemented, and the number of pharmaceutical interventions were evaluated.

First, pharmacists decided parameters for graduating the patients: kidney function, number of medical treatments, risk-situation-drugs (opioids, blood thinners and antidiabetics), triple-whammy-interaction and anticholinergic burden. These five parameters were based on previous conclusions from medication reviews. Each parameter was given a score and built into an electronic patient journal system (EPJ) for automatic screening. Second, the digital point-based tool was presented and implemented in an emergency department. The pharmacists developed a new workflow prioritising patients with the highest score. Implementation and efficacy were evaluated by the number of pharmaceutical interventions before and after presenting the digital point-based tool.

In 2024 the group of pharmacists in the emergency department made 3635 medication reviews. Of these the pharmacists found reason for a pharmaceutical intervention in 2046 (56%) cases. After implementation of the digital point-based tool (13 May –19 September 2025) the pharmacists made 726 medication reviews. Of these the pharmacist found reason for a pharmaceutical intervention in 552 (76%) cases, corresponding to a 20% increase.

Incorporation of the digital point-based tool in EPJ makes it easy to see every patient’s point-score and thereby makes patient-prioritisation user-friendly. The increase in rate of interventions (56% to 76%), indicates that the pharmacists are spending more time on pharmacist-relevant patients.

No conflict of interest

To assess the effectiveness of subcutaneous secukinumab 300 mg in HS.

Single-centre, retrospective observational study conducted in a secondary-level hospital (January 2021–February 2025). Adult patients with HS treated with secukinumab 300 mg as maintenance therapy for ≥3 months were included.

Variables: sex, age, body mass index (BMI), smoking status, Hurley stage (clinical severity: I mild, II moderate, III severe), prior biologics, treatment duration, dosing regimen, International HS Severity Score System (IHS4, severity index: <4 mild, 4–11 moderate, >11 severe), and patient-reported outcomes.

20 patients were included (12 men, 8 women), mean age 41±16 years, BMI 31 kg/m2. Smoking status: 45% (9/20) active, 20% (4/20) former, 35% (7/20) non-smokers. All had moderate-to-severe disease (Hurley II–III) and previous adalimumab exposure.

Overall, 40% (8/20) discontinued secukinumab due to lack of efficacy after a median of 10 months (range 4–35). The remaining 60% (12/20) continued treatment: 10 required dose intensification, ie, shortened interval (seven every 2 weeks, three every 3 weeks) and two maintained monthly dosing. Among patients persisting on treatment, 66% (8/12) reported subjective improvement, predominantly under intensified regimens (6/8), with reduced inflammation, drainage, and mean IHS4 reduction of 2.3 points. 33% (4/12) reported no benefit after a median of 11 months (range 6–33). Median time to dose intensification was 8.6 months (range 0–31.5; N=14).

IHS4 evolution (subgroup with available data): baseline 9.3 (range 1–20; N=10), first follow-up 14 (range 1–40; N=10) after 7.9 months, and second follow-up 17 (range 1–40; N=3) after 13.6 months. Median follow-up was 11 months (range 4–49). Eight patients (40%) required surgery during treatment.

Secukinumab may represent a therapeutic alternative for HS after adalimumab failure. A subgroup of patients, mainly under intensified dosing, experienced clinical improvement and IHS4 reduction. However, high discontinuation rates and worsening severity scores were observed. Standardised and systematic assessment of objective measures, such as IHS4, in routine practice is essential to accurately evaluate effectiveness and optimise treatment decisions.

No conflict of interest

To compare the effectiveness and safety of gepants (atogepant and rimegepant) in patients diagnosed with CM and HFEM naive versus those previously treated with anti-CGRP monoclonal antibodies.

Retrospective observational study on patients treated with gepants, comparing naive patients to those pre-treated with anti-CGRP antibodies. The main effectiveness variables included changes in the mean monthly migraine days (MMD) and the percentages of patients achieving ≥50% or 30-49% reduction in MMD after at least 12 weeks of treatment. Safety variables were treatment discontinuation rates and the main adverse events reported in patients who received at least one dose of gepant. Clinical and treatment data were collected from electronic health records (Selene ) and the external prescription module (Farmatools). Statistical analysis involved descriptive measures and t-tests to evaluate differences in RStudio (v. 2023.09.1).

Between March 2024 and June 2025, 192 patients were selected. The 92.7% were women (178/192) and the mean age was 47 years (SD=12.6). Effectiveness was evaluated in 181 patients: 72.4% (131/181) naive and 27.6% (50/181) pre-treated, with 13 and 17 baseline MMD, respectively. After 12 weeks, MMD decreased to 7 for naive and 8 for pre-treated patients, with a non-statistically significant difference of 1 day (p=0.42). In the naive-group MMD≥50% was 58.8% (77/131) and MMD30-49% was 14.5% (19/131). Pre-treated-group MMD≥50% was 64% (32/50) and MMD30-49% was 10% (5/50). Safety analysis included 192 patients. The 3.7% (5/135) naive and 15.8% (9/57) pre-treated patients discontinued the treatment. The reasons were: lack of response (60% (3/5) naive; 88.9% (8/9) pre-treated), adverse effects (40% (2/5) naive; 66.7% ( 6/9) pre-treated) and both reasons (55.6% (5/9) pre-treated). The most common side effects were constipation, nausea, and weight loss.

Gepants used in the treatment of migraine appear to reduce migraine days similarly in naive and pre-treated patients. Regarding safety, both groups demonstrate an adequate safety profile, despite a higher rate of treatment discontinuation observed in pretreated patients.

No conflict of interest

The aim was to develop and validate a multi-factor model for predicting renal function decline in patients initiating dolutegravir, and to design a prototype application for real-time patient risk classification.

A retrospective cohort of adults initiating dolutegravir-based therapy between 2021 and 2023 was analysed. Patients were randomly divided into a training dataset (n=880) and a validation dataset (n=220). Logistic regression was used to identify predictors of a ≥25% decline in eGFR, calculated by the CKD-EPI equation. Model performance was compared with a model based on baseline eGFR alone using area under the receiver operating characteristic curve (AUC). A prototype application was developed to embed the validated model for clinical use.

In total, 1,100 patients were included; 17.8% experienced a ≥25% reduction in eGFR. Five independent predictors were identified: age >40 years, body mass index >23 kg/m², CD4 count <400 cells/µL, baseline eGFR <90 mL/min/1.73m², and alanine aminotransferase >40 U/L. The five-factor model demonstrated superior predictive performance compared with baseline eGFR alone (AUC 0.780; 95% CI 0.716–0.844 vs AUC 0.651; 95% CI 0.571–0.730). The application prototype enabled rapid patient-level classification and displayed tailored monitoring recommendations.

The validated five-factor model improved renal risk prediction compared with eGFR alone. Its translation into a prototype application demonstrates a feasible approach to support hospital pharmacists and clinicians in proactive surveillance of patients receiving dolutegravir. Prospective validation and workflow integration will be required to confirm clinical impact and promote adoption in practice.

The authors thank the leadership team, Department of Pharmacy, HIV/AIDS clinic, and medical staff of Pakchongnana Hospital for their support, as well as the Faculty of Pharmacy, Thammasat University.

No conflict of interest

The purpose of this study was to evaluate the impact of a proactive prescription screening system by pharmacists on the detection of drug-related problems (DRPs) and on the clinical impact of pharmacist interventions in hospitalised patients.

A prospective research and development study was conducted in the ICU, internal medicine and surgery and orthopaedics wards from 1 October 2024, to 30 April 2025. DRPs were categorised according to the Pharmaceutical Care Network Europe classification (PCNE) classification. The impact of pharmacist intervention (PIs) based on standard pharmacist assessments, was evaluated using the clinical, economic, and organisational (CLEO) tool.

During the study period, 1,838 patients were screened. 135 DRPs were detected and managed, representing 7.34% of all cases. The types of DRPs were treatment effectiveness (65.19%), other (23.70%), and treatment safety (11.11%). The top three possible causes of DRPs were drug selection (46.67%), dose selection (32.59%), and patient transfer-related issues (12.59%). The severity of the problems was categorised as C and D in 68.89% and 14.07% of cases, respectively. The overall acceptance rate by physicians was 97.39%. Eighteen pharmacist interventions (PIs, 13.33%) had major clinical impact and 74 PIs (54.81%) had moderate clinical impact. A positive economic impact was observed in 57.78% of cases, leading to savings in drug costs.

The proactive prescription screening system implemented by pharmacists effectively detected and managed DRPs in hospitalised patients. Pharmacist interventions had high physician acceptance, significant clinical impact, and contributed to drug cost savings. These findings highlight the important role of pharmacists in improving patient safety and optimising therapy.

No conflict of interest

To analyse the relationship between baseline CR stratification according to the HFA-ICOS algorithm and the occurrence of cardiovascular events in patients treated with trastuzumab, as well as to describe the measures taken.

Retrospective observational study in HER2-positive cancer patients treated with trastuzumab as the only cardiotoxic anti-HER2 agent in a tertiary hospital between January2024-June2025.

Prior to treatment, demographic, clinical, and cardiac imaging variables were recorded, as well as comorbidities, lifestyle risk factors, and history of cardiotoxicity from previous or concomitant treatments. Baseline CR was stratified into low, moderate, high, or very high.

A cardiovascular event was defined as a decrease in LVEF ≥10 points from baseline and/or a drop below 50%. After the event, management included cycle delay, initiation of cardiological treatment, or intensification of follow-up.

The cohort included 81 patents (70 women, 11 men) whose mean age at baseline was 65 years (range: 29-89), in whom trastuzumab was used as treatment for breast cancer (82%) and gastroesophageal cancer (18%).

Baseline risk distribution, clinical factors, and comorbidities, together with the relationship with previous and current treatments and cardiological evaluation, were analysed, and specific risk subgroups were identified. The results are summarised in table 1.

During follow-up, 21% of patients experienced cardiovascular events, with a higher prevalence in those with high or very high baseline risk (73%). After the event occurred, different measures were taken according to clinical need: one-third of patients began cardiological treatment, almost half postponed the cycle, and all were reevaluated with LVEF before the next cycle.

Abstract 4CPS-042 Table 1

The fact that 40% of patients were classified as high or very high risk, together with the occurrence of a significant number of cardiovascular events, reinforces the need to link baseline stratification with clinical management. These findings demonstrate the usefulness of the HFA-ICOS algorithm in identifying risk profiles, prioritising cardiological surveillance, and guiding clinical decisions that ensure the continuity of cancer treatment.

No conflict of interest

To evaluate the accuracy of self-reported medication allergy histories guided by ChaRM-A compared to pharmacy technicians.

A prospective, observational study was conducted from February-May 2025. Outpatients ≥18 years, scheduled for a visit to the outpatient medication reconciliation department, were randomly selected for participation. Patients performed medication allergy history taking in an online standalone environment with ChaRM-A support. Subsequently, a pharmacy technician conducted medication reconciliation including medication allergy history taking (usual care). The primary outcome was the proportion of patients with a discrepancy between the two composed medication allergy lists. Secondary outcomes were the nature and prevalence of the discrepancies, their clinical relevance and potential risk factors. Data were analysed through descriptive statistics and regression analysis.

Forty-five patients (median age 66 years (IQR 57-76), range 19-88 years) documented their medication allergy history with support of ChaRM-A. The median time they needed was 2 minutes and 27 seconds (IQR 01:33-04:39). Sixteen (35.6%) patients did not have any allergies. The other 29 patients documented ≥1 allergy and 28 (96.6%) of them had ≥1 discrepancy (median 1 discrepancy per patient (IQR 1-4), range 1-10). In total, 70 discrepancies were found: 37.1% documentation deviations, 35.7% omissions and 27.1% additions. Most discrepancies (n=61, 87.1%) were classified as unharmful. The number of discrepancies per patient was significantly associated with the number of allergies per patient (p=0.03 (95% CI: 1.03-1.94)).

Although numerous discrepancies were found between medication allergy histories self-reported by patients with a DA and pharmacy technicians, their clinical relevance was low, indicating that a DA may safely support patients. Optimisation of the DA and additional research is needed to fully support patients in self-reporting medication allergies.

No conflict of interest

To compare the effectiveness of botulinum toxin plus atogepant (BTX-ATO) versus atogepant monotherapy (ATOm) in patients with CM.

Observational, retrospective, multicentre study conducted in two tertiary hospitals in patients with CM treated with atogepant for at least 3 months. The cohorts compared were patients treated with BTX-ATO versus ATOm. The main variable was the difference in the change in mean monthly migraine days (MMD) at 3 months compared with baseline between the two cohorts. Secondary variables included the proportion of patients achieving ≥50% reduction in MMD at 3 months (MMD ≥50%), as well as 30–49% and 0–29% reductions, between cohorts.

Demographic, clinical, and treatment data were obtained from the Electronic Health Record (Selene) and the electronic prescribing programme (Farmatools). Statistical analysis included descriptive measures, the Mann–Whitney U test and the Chi-squared test to compare differences, using Python (3.12.7) for data processing and analysis.

A total of 45 patients were included, 91.11% (41/45) were women with a mean age of 47.42 years(SD = 11.0). The BTX-ATO cohort included 29 patients (64.4%) and the ATOm cohort 16 patients (35.6%), with baseline MMD of 20 and 21 days, respectively. After 3 months, MMD decreased to 13 days in the BTX-ATO cohort and 14 days in the ATOm cohort, with an absolute difference of 1 day between cohorts (p = 0.329). The proportion of patients achieving MMD≥50% was 41.4% (12/29) with BTX-ATO and 25.0% (4/16) with ATOm. MMD 30–49% was achieved by 6.9% (2/29) with BTX-ATO and 12.5% (2/16) with ATOm, while MMD 0–29% was 51.7% (15/29) and 62.5% (10/16), respectively. No statistically significant differences were found in secondary variables (p = 0.507).

Results suggest that the effectiveness of atogepant in chronic migraine, in terms of reducing monthly migraine days, is comparable between patients receiving combination therapy with botulinum toxin and those receiving atogepant monotherapy. Further prospective studies are needed to determine the potential added value of combination therapy.

No conflict of interest

To describe the pharmacist-led follow-up and optimisation of antiemetic therapy in colorectal cancer patients receiving moderately emetogenic chemotherapy, quantifying adjustments and their impact on symptom control.

A prospective study was conducted between January and June 2024 in a regional hospital. Patients with colorectal cancer who received at least three cycles of moderately emetogenic chemotherapy were included.

Follow-up was carried out in the Oncohaematology Pharmaceutical Care Clinic through structured clinical interviews after each cycle. Clinical and therapeutic information was obtained from the electronic medical record (Diraya) and the prescribing and validation system (Farmis-Oncofarm).

All patients initially received the full NCCN-recommended regimen on day 1 of chemotherapy. From subsequent cycles, treatment was personalised, simplifying regimens and mainly using corticosteroids as maintenance, leading to less medication than international guidelines recommend.

Efficacy was assessed as complete response (CR), defined as no vomiting and no rescue, and total control (TC), defined as absence of nausea, vomiting, and rescue.

A total of 52 colorectal cancer patients were included, with a median age of 63.5 years (41–82); 59.6% were male and 3.8% had diabetes. The most frequent regimens were XELOX (28.8%), FOLFOX ± Bevacizumab (28.8%), FOLFIRI ± aflibercept/bevacizumab/cetuximab (30.8%), and Irinotecan ± Cetuximab (7.7%). At study closure, 67.3% were off antiemetic therapy.

Regarding treatment adjustments, 88.5% (46) reduced the regimen, while 5.8% (3) required intensification with palonosetron/netupitant. Nausea occurred in 7.7% (4) and vomiting in 3.8% (2). Overall, CR was achieved in 94.2% (49) and TC in 92.3% (48). After intensification, all patients achieved CR and TC. Notably, no patient receiving XELOX required rescue antiemetics.

Individualised antiemetic optimisation in colorectal cancer patients treated with moderately emetogenic chemotherapy enabled substantial regimen reduction while maintaining high rates of symptom control. Although all patients began with full NCCN protocols, later cycles were managed with simplified, corticosteroid-based approaches, resulting in markedly less medication without loss of efficacy. That all patients with reduction achieved CR and nearly all TC, while others required intensification to reach these outcomes, highlights the value of structured pharmacist-led follow-up. The excellent tolerability of XELOX, with no need for rescue therapy, suggests this subgroup could benefit from simplified initial antiemetic protocols.

No conflict of interest

This retrospective before-after study aimed to appraise the impact of local ASP (written guidelines and antibiotic restriction) on antibiotic (AB) use and clinical outcomes in patients requiring intensive care due to pneumonia and sepsis.

This study was conducted as a single-centre retrospective observational study in the ICU of a pulmonology department of a tertiary care centre. Data collection for the pre-intervention period occurred from 1 January 2018 to 31 May 2022, while the ASP period data was collected from 1 June to 28 March 2024.

The patients admitted to the ICU with pneumonia and sepsis were mainly men (58/101, 57.4% and 84/128, 65.6%), the need for intensive care increased with age, and most of the patients belonged to 65+ age group in both study phases (68.3% and 58.6%). The majority of the patients had four or more comorbidities (57.4% and 40.6%). In-hospital mortality was relatively high (42.6% and 41.4%), most of the patients losing their lives already in the ICU (33/43, 76.7% and 37/53, 69.8%). Significant increase in guideline-adherent agent selection (34.5%) and use of combination therapy (35.0%) was observed, while the use of fluoroquinolones decreased significantly (-31.1%). Despite the significant decrease in the number of patients using restricted ABs (-53.3%), a significant increase was observed in the average AB exposure (form median 2.0 to 2.7 DDD/patient/day) and direct AB costs (10.5%) in the ICU. The inappropriate AB therapy was relatively low in the presence of MDRs in both phases (5.9% and 15%). However, the decrease in the use of restricted ABs and the increase in AB exposure/patient/day in the ICU were not associated with worse clinical outcomes.

ASP implementation in the ICU resulted in a significant improvement in the appropriate use of ABs, but a significant increase in the AB exposure/patient/day. Although, all these have not been accompanied by better clinical outcomes, ASP may hold the promise to improve AMR with a sustained long-term effect.

Supported by the University of Debrecen Program for Scientific Publication.

No conflict of interest

This retrospective observational study aimed to evaluate the empiric antibiotic prescription pattern and clinical outcomes in patients with pneumonia and sepsis with different respiratory support.

The study was conducted between June 2018 and February 2024 at the Intensive Care Unit (ICU) of a Pulmonology Department of a tertiary care medical centre in Hungary. During the intensive care therapy were used different types of respiratory support. In the group I of patients was used high flow nasal oxygen (HFNO), or low flow nasal oxygen (LFNO), or non-rebreather mask (NRM) and classic non-invasive ventilation (NIV), while patients in the group II required invasive mechanical ventilation. Guideline-adherence (agent selection, dosage), presence of multidrug-resistant (MDR) pathogens, antibiotic exposure, and clinical outcomes (LOS-length of stay, 30-day mortality) were compared between the two groups of patients. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. p<0.05 was considered to be significant.

Comparing the two groups we have not found significant differences in empiric guideline-adherent agent selection (51/115, 44.3% and 52/114, 45.6%). However, overall guideline-adherence was significantly higher in case of invasive ventilation (11.1% vs 1.7%, p<0.05). Guideline-adherent agents have not result in significantly better 30-day mortality rate in either of the groups. Group I has shown significantly lower antibiotic exposure and better clinical outcomes than Group II. Significant difference was found between groups (I vs II) in the presence of MDR pathogens (14.3% vs 49.6%, p<0.001), antibiotic exposure (ICU: median 11.5 vs 21 DDD/patient, p<0.001 and total: median 19 vs 27 DDD/patient p<0.05), ICU-LOS (median 5 vs 11 days,%, p<0.001), total LOS (median 11 vs 15 days,%, p<0.001), and 30-day mortality (14.8% vs 68.4%, p<0.001). Moreover, the presence of MDR pathogens significantly increased ICU-LOS, antibiotic exposure, and 30-day mortality rate.

Among invasively ventilated patients MDR pathogens occurred more frequently increasing significantly antibiotic exposure, length of stay, and 30-day mortality rate. However, guideline-adherent antibiotic therapy has not resulted in better clinical outcomes at ICU.

No conflict of interest

To evaluate the impact of IDPN on nutritional and biochemical parameters at baseline, 3 months, and 6 months.

Observational, retrospective, multidisciplinary study conducted in a tertiary hospital including adult patients receiving IDPN for >6months (2021-January 2025)

Data collected: demographics and anthropometric parameters, Charlson Comorbidity Index (CCI), calories and protein intake at baseline, and nutritional and biochemical parameters: glucose, total protein (TP), serum albumin (Alb), C-reactive protein (CRP), CRP/Alb ratio, creatinine, glomerular filtration rate (GFR), triglycerides, cholesterol, and urea.

Qualitative variables were expressed as absolute and relative frequencies, and quantitative variables as median and interquartile range. The Wilcoxon signed-rank test was used for comparisons between related samples.

Seven patients were included: 4 (57.1%) female; median age of 67 years (63-65). The median weight was 54.6kg (45.5-62.3), BMI 19.3kg/m² (16.7-22.9) and CCI 5 (5-8). Patients received IDPN three times per week, with a median of 16.5kcal/kg/day (14.6-18.8) and 1.2g of protein/kg/day (1-1.3).

Serum albumin increased during follow-up, reaching statistical significance between months 3 and 6 (p=0.043). BMI, TP, and cholesterol increased, while CRP and CRP/Alb ratio decreased, indicating favourable but non-significant trends.

Other parameters remained stable without significant changes.

Abstract 4CPS-048 Table 1 Parameter Month 0 Month 3 Month 6 P (0- 3) P (0- 6) P (3-6) Weight (kg) 54.6 (45.5-62.3) 50.5 (43-60) 57.3 (46-68.8) 0.686 0.345 0.144 BMI (kg/m²) 19.3 (16.7-22.9) 17.0 (16-25.5) 20.8 (16.9-26.5) 0.686 0.345 0.144 Glucose (mg/dL) 92 (86-121) 128 (85-181) 136 (119-347) 0.345 0.144 0.225 TP (g/L) 50.4 (46.5-74) 53.8 (52.5-55) 70 (53.9-86.1) 0.180 1.000 1.000 Albumin (g/dL) 2.74 (2.56-3.64) 3.30 (3.21-3.37) 3.41 (3.39-3.65) 0.237 0.116 0.043 CRP (mg/L) 26.3 (4.9-44.8) 15.5 (5.3-117.5) 6 (2.5-279) 0.500 1.000 0.655 CRP/Alb ratio 8.41 (1.35-18.9) 4.13 (1.5-39.9) 1.75 (0.7-82.2) 0.500 1.000 0.655 Urea (mg/dL) 92 (60-174) 105 (75-153) 101.8 (63-107) 0.753 0.686 0.500 Creatinine (mg/dL) 6.38 (3.8-11.5) 6.06 (5.7-9.4) 5.59 (1.6-7.1) 0.345 0.593 0.225 GFR (ml/min) 8.5 (6-11.5) 6.0 (4-12) 7 (5-13) 0.092 0.593 1.000 Triglycerides (mg/dL) 117 (86-143) 116 (98-213) 115 (97-574) 0.465 0.465 0.225 Cholesterol (mg/dL) 115 (84-133) 143.5 (83-265) 175 (115-245) 0.225 0.068 0.500

Consistent with previous evidence and limited by a small cohort, our findings suggest progressive nutritional improvement.

However, further studies with larger cohorts are warranted to confirm these results

No conflict of interest

To estimate adherence to Ca/VitD supplementation in adults and to identify patient, treatment, and formulation factors associated with adherence.

A cross-sectional study was conducted in adults with at least one Ca/VitD dispensation in the health area of a tertiary hospital in Madrid (2022–2025) and >3 months of treatment. A random sample of at least 350 patients was estimated. Demographic, therapeutic, and formulation-related variables were collected, along with Likert scales (1–5) for taste, texture, and overall organoleptic assessment. Adherence was defined as fulfilment of three criteria: self-reported adherence >90%, positive Morinsky-Green test, and >90% of estimated dispensations done. Univariable logistic regressions and a stepwise multivariable analysis were performed.

A total of 360 patients were included: 65% women, median age 71.9 years (IQR=58.6–83.1), with 8.5 chronic medications (IQR=4–13). Formulations were 50% chewable, 38.9% orodispersible, and 11.1% effervescent. Adverse events occurred in 15.3% of patients, all gastrointestinal. Overall adherence was 34.7% (95% CI=30–39.8%), compared with 70.8% self-reported (95% CI=65.9–75.3%).

In univariable analysis, adherence increased with a higher number of chronic medications (OR=1.08; 95% CI=1.04–1.12), higher overall organoleptic assessment (OR per 1-point increase=1.43; 95% CI=1.17–1.76), formulations with polyols versus other sweeteners (OR=6.05; 95% CI=3.36–10.87), chewable tablets (OR=2.38; 95% CI=1.48–3.89), and female sex (OR=3.16; 95% CI=1.99–5.00). Negative predictors were longer treatment duration in months (OR=0.99; 95% CI=0.98–0.99), Ca dose >500 mg (OR=0.20; 95% CI=0.12–0.35), adverse events (OR=0.15; 95% CI=0.06–0.40), and concomitant antiresorptives (OR=0.56; 95% CI=0.34–0.91).

The best multivariable model (AUC=0.83) identified the following significant predictors (p<0.05): ≥10 chronic medications, polyol-containing formulations, female sex, and maximum overall assessment as positive factors; occurrence of adverse events as a negative factor.

Adherence to Ca/VitD supplementation was low. Organoleptic acceptability emerged as a critical determinant; an early interview after treatment initiation may facilitate formulation switching and prevent discontinuation. Chewable formulations with polyols appeared better tolerated. Patients on antiresorptives or long-term therapy may require targeted reinforcement strategies to maintain adherence.

No conflict of interest

To evaluate the impact of clinical pharmacist-led IV to PO medication switch interventions on medication cost reduction in postoperative patients.

A retrospective cross-sectional study was conducted at the Surgery Floor in an Oncology care hospital low- and- middle income country, covering the period from July 2023 to June 2025. All documented IV to PO switch interventions for adult elective surgical patients were included. Exclusion criteria were outpatient cases, non-surgical admissions, and undocumented or unanswered interventions. Data were extracted from the hospital information system and analysed using descriptive statistics to summarise intervention frequency, physician acceptance, medication types, and cost savings.

A total of 641 interventions were recorded in 401 patients (65.1% female; mean age 43.2 years). Of these, 441 (68.8%) were accepted, 134 (20.9%) were unanswered, and 66 (10.3%) were rejected. The most frequently switched medications were paracetamol (53.7%), metoclopramide (17.6%), and omeprazole (13.7%). Common surgical procedures included colectomy/colorectal surgery (10.7%) and mastectomy (9.1%). The interventions resulted in an estimated cost saving of Rs. 92,035.45 (~287.61) during the study period. No adverse clinical outcomes were reported.

Clinical pharmacist-led IV to PO interventions achieved substantial cost savings without compromising patient safety. These findings underscore the importance of integrating pharmacists into surgical care teams to timely optimise postoperative IV to PO switch for per oral medication use and resource allocation, particularly in resource-limited settings.

The authors acknowledge the contributions of the clinical pharmacy team and Management Information System team at Shaukat Khanum Memorial Cancer Hospital and Research Centre for their support in data collection and intervention documentation.

No conflict of interest

To analyse drug utilisation and to evaluate clinical effectiveness of intravitreal dexamethasone implants in our Hospital from 2023 to 2024.

Patients’ data were obtained from healthcare information systems: we created a database including eye identification, age, gender, diagnosis and date of administration.

We excluded patients managed outside the hospital or with overlapping diagnoses.

For hospital-managed patients with multiple dexamethasone administrations, the final visual acuity was compared to baseline.

The visual acuity was measured using the Best-Corrected Visual Acuity (BCVA) scale.

We recorded the therapeutic switches during the study period.

Data were stratified by diagnosis.

We analysed 59 eyes: 40 with DME (mean age 72 years, 50% female) and 19 with RVO (mean age 74 years, 70% male).

In the DME group, 16 eyes received dexamethasone monotherapy, 23 received combination therapy with anti-VEGF agents (aflibercept, bevacizumab or faricimab) and one eye received three treatments.

The average number of administrations over 2 years was 4.8 (range 2-10).

Mean visual acuity change was +0.08 (p>0.05), 75% of eyes showed improvement.

Monotherapy eyes improved by +0.27 with 1.6 administrations per year, while multiple-treatment eyes showed a -0.05 change with three administrations per year.

In the RVO group, most eyes received combination treatment: three eyes received monotherapy, 13 eyes (68%) received combination therapy with antiproliferative drugs and three eyes received three treatments, with an average of seven administrations (range 2-16) and a mean visual acuity change of -0.03.

The intravitreal dexamethasone implant demonstrates effectiveness in stabilising or modestly improving visual acuity, particularly in DME patients, with a low number of treatments required.

Although variability limits statistical significance, even small gains or stabilisation can meaningfully improve patients’ quality of life by slowing disease progression and preserving vision.

No conflict of interest

To assess the effect of a multifaceted intervention at patient-, nurse- and prescriber-level on postoperative prescribing and use of oxycodone after discharge in TKA and THA patients.

A prospective monocentre pre-post intervention study was conducted. Patients ≥18 years scheduled for TKA or THA between 17/03/2025-04/04/2025 (pre-intervention) and 06/05/2025-23/05/2025 (post-intervention) were included. The multifaceted intervention combined (i) intensifying patient education on opiate use by pharmacy assistants, (ii) extending postoperative pain-assessment by nurses and (iii) tailoring oxycodone-prescribing by physicians. Primary outcomes were postoperative opioid prescribing and -use (percentage of patients discharged with an oxycodone prescription and percentage of patients using oxycodone on the day of discharge, and on day 1-3-7-14 post-discharge). Secondary outcomes were postoperative pain (Numeric Rating Scale pain scores) on the prespecified days, prescription/refill requests, and leftover medication after discharge. Differences between pre- and post-intervention groups were analysed using an unpaired t-test or Chi-squared test. Changes in pain scores over time and differences in these changes between groups were analysed using Mixed Repeated Measures ANOVA.

Pre-intervention 34 patients were included, post-intervention 32 patients. Pre-intervention, 34/34 patients (100%) were discharged with oxycodone (immediate-release, IR), compared to 16/32 post-intervention patients (50%) (p<0.0001). This reduction remained significant for THA and TKA patients separately (p<0.0001 resp. p<0.005). No significant reduction in opioid use after discharge was observed among those patients discharged with oxycodone. Pain scores did not significantly differ between the pre- and post-intervention groups. Among patients who were not discharged with oxycodone IR, only one requested a prescription, which was ultimately not used. Pre-intervention, 28/34 (82.4%) patients had surplus oxycodone tablets, post-intervention less, but still 14/34 (41.2%), patients reported having oxycodone tablets left.

The multifaceted intervention significantly reduced the proportion of THA and TKA patients postoperatively discharged with oxycodone IR without increasing postoperative pain after discharge. Nonetheless, post-intervention, 40% of patients had excess oxycodone tablets, indicating that there is room for further decrease of the availability of oxycodone and consequent risks of long-term use.

No conflict of interest

To assess the effectiveness and safety of inclisiran at 12 months in patients with hypercholesterolaemia in real-world clinical practice.

A retrospective observational study was conducted at a tertiary hospital. Adults with hypercholesterolaemia who initiated inclisiran in 2024 were followed for 12 months. Demographics, prior lipid-lowering therapy, and treatment indications were collected. LDL-C was measured at baseline, 3 and 12 months, and percentage change from baseline was calculated. Categorical variables are presented as number and percentage (n (%)), and continuous variables as mean±standard deviation.

Fifteen patients were included (40% women; 60±7 years), all in secondary prevention. Inclisiran was indicated for failure to reach LDL-C targets despite optimal lipid-lowering therapy in 11 (73%) patients, and for statin intolerance in 4 (27%).

At baseline, 11 (73%) received statins (three monotherapy, five with ezetimibe, two with ezetimibe+omega-3, one with omega-3), two (13%) ezetimibe monotherapy, and one (7%) was untreated. Mean LDL-C at baseline was 119±27mg/dL and after 3 months, it decreased to 54±44mg/dL; 12 showed a reduction of 61% while in two patients increased by 9%, and one was undetermined due to hypertriglyceridemia (>400mg/dL).

At 12 months, mean LDL-C was 64±45mg/dL: nine maintained reduction (–54%), one patient had a 32% LDL-C increase after temporary discontinuation of statin, two had missing follow-up laboratory data and one discontinued treatment by own decision.

Adverse effects were reported in three (20%) patients: fatigue (1 (7%)), arthralgia (1(7%)), and headache (1 (7)).

Inclisiran was associated with sustained LDL-C reductions at 12 months and a favourable tolerability profile in real-world practice, as demonstrated in clinical trials. These findings support its efficacy in patients not achieving LDL-C targets with statins or with statin intolerance, although interpretation is limited by the small sample size and descriptive nature of the study. Prospective studies with larger cohorts are needed to confirm long-term effectiveness and safety.

No conflict of interest

The aim of this study was to evaluate DRPs and pharmacists’ interventions in renal inpatients, and to assess the perceived severity of DRPs identified.

A 2-week prospective observational study was conducted on the nephrology ward in a university teaching hospital. Inpatients with renal disease, admitted under a nephrologist were included. Renal pharmacists recorded DRPs identified and resultant interventions made using Microsoft Forms. DRPs were categorised by type and source of intervention, renal disease and drug class. Collected data were extracted to Microsoft Excel and analysed using descriptive statistics. The severity of DRPs was assessed using the Dean and Barber method. The Intraclass correlation coefficient (ICC) was calculated using SPSS version 29.0.1.0, to assess inter-rater reliability.

80% (n=42) of eligible patients had DRPs recorded, with a mean of 3.2 (SD ±2.97) per patient. Mean DRP was highest among kidney transplant recipients and haemodialysis patients (5 (SD±3.65) and 4.8 (SD ±2.59) respectively). ‘Commence medication’ was the most frequent PI recorded (27%, n=44). 92% (n=154) of DRPs were identified by reviewing patients’ medicines and prescription record (MPAR) or medicines reconciliation. Cardiovascular drugs were most frequent drug class involved in DRPs (26%, n=43). 99% (n=163) of DRPs were classified as moderate or severe. 92% (n=152) of DRPs were resolved following PIs.

This study highlights the pivotal role of renal pharmacists in the identification and resolution of DRPS in renal inpatients, with the majority of DRPs classified as moderate or severe and successfully resolved following pharmacist intervention. Future work should consider the economic benefits of the renal/specialist renal clinical pharmacy service and cost of administration errors.

No conflict of interest

To evaluate the effectiveness and safety of inclisiran in patients with primary hypercholesterolaemia or mixed dyslipidaemia in real-world clinical practice.

A retrospective multicentre observational study including all patients who initiated treatment with inclisiran up to September 2025. Data collected in Excel included demographic variables, cardiovascular diagnosis, reason for initiation, previous use of PCSK9 inhibitors, statin intolerance, concomitant lipid-lowering therapies and adherence. The primary variables were the median and interquartile range (IQR) of percentage reduction from baseline in LDL cholesterol, total cholesterol, non-HDL cholesterol, HDL cholesterol and triglycerides at 90 and 270 days after treatment initiation. Safety was assessed through reported adverse events and treatment discontinuations. Adherence to concomitant lipid-lowering therapies was evaluated according to dispensing records. Data were obtained from electronic medical records and hospital pharmacy databases.

A total of 63 patients were included (mean age 64 ± 11 years; 63% male). At 90 days, the reduction in LDL cholesterol was 36% (IQR 6–62) and at 270 days 39% (IQR 26–51). Total cholesterol decreased by 23% (IQR 0–42) and 24% (IQR 17–34), respectively. Non-HDL cholesterol was reduced by 33% (IQR 1–56) at 90 days and 36% (IQR 19–50) at 270 days. HDL cholesterol remained stable with minimal changes (3% (IQR 0–11) and 0% (IQR 0–9)). Triglycerides showed median reductions of 12% (IQR 0–29) at 90 days and 7% (IQR 0–22) at 270 days. No serious adverse events were reported; however, 8% (5/63) experienced local injection site reactions and 3% (2/63) discontinued treatment due to lack of effectiveness. Adherence to concomitant lipid-lowering therapies was >80% in 82% (52/63) of patients.

Inclisiran was associated with reductions in LDL cholesterol and total cholesterol in real-world clinical practice, with an acceptable safety profile. Nevertheless, the magnitude of LDL cholesterol reduction was lower than that reported in pivotal clinical trials.

No conflict of interest

This study aimed to evaluate the impact of organ dysfunction and extracorporeal support on argatroban dosing requirements in critically ill patients.

We performed a retrospective, single-centre study of ICU patients treated with argatroban for ≥24 hours between January 2015 and December 2024. Data included demographics, organ dysfunction, extracorporeal support, argatroban dosing, aPTT monitoring, and bleeding or thrombotic events. Argatroban doses were compared by organ dysfunction and extracorporeal support using the Mann–Whitney test. Independent predictors of mean argatroban dose were assessed by multiple linear regression.

A total of 46 patients were included. The mean initial dose was 0.19±0.28 mcg/kg/min, and the therapeutic dose (dose achieving two consecutive target aPTTs) was 0.38±0.42 mcg/kg/min. Patients with hepatic dysfunction (n=28) required significantly lower therapeutic and mean doses than those without (p=0.023 and p=0.032, respectively). Renal dysfunction, ECMO, and CRRT did not significantly influence dosing, although higher aPTT values were observed in CRRT patients. Multivariate analysis confirmed the Child-Pugh score as an independent predictor of mean dose (p=0.018).

In critically ill patients, argatroban should generally be initiated at ≤0.5 mcg/kg/min, with further reductions in hepatic dysfunction. Extracorporeal support did not significantly alter dosing requirements, reinforcing hepatic function as the key determinant for adjustment. These findings support individualised argatroban therapy and provide practical guidance for HIT management in the ICU.

No conflict of interest

To analyse the evolution of intravitreal anti-VEGF drugs in clinical practice in a secondary-level hospital over the last 5 years.

Retrospective observational study including all dispensations of aflibercept, brolucizumab, faricimab, and ranibizumab from 2020 to 2024. The number of patients and dispensations for each drug were analysed globally and by diagnosis, as well as the treatment cost per patient per year. Data were obtained from the outpatient dispensing record Farmatools and analysed in an Excel database.

Over the last 5 years, 18,735 intravitreal anti-VEGF doses were dispensed: 2020: 1,264; 2021: 3,637; 2022: 4,202; 2023: 4,710 and 2024: 4,922. The number of patients treated was 567, 716, 807, 860, and 929, respectively.

Classified by drug and year:

Annual treatment cost per patient was 854.6, 927.7, 1,204.7, 1,338.5, and 1,225.2 in 2020, 2021, 2022, 2023, and 2024, respectively.

The number of patients has gradually increased, while the number of doses has almost quadrupled. By drug, aflibercept use has increased, ranibizumab use has declined, brolucizumab has shown only occasional use, and faricimab use cannot yet be assessed due to its recent introduction. It is necessary to evaluate real-world data and position the use of these drugs due to the ageing of the population, their chronic administration and the economic impact involve.

No conflict of interest

To describe and assess the meetings of the ASP team conducted in a district hospital during 2024, focusing on antibiotic use, clinical cases discussed, and recommendations provided to prescribers.

A retrospective descriptive study was conducted using the official records of the weekly meetings of the Antimicrobial Stewardship Program, held every Friday during 2024. Prescriptions registered in the hospital pharmacy program and microbiology data from the clinical history were reviewed, and the frequency of each variable was manually counted. Totals were then calculated and summarised monthly. Data included the number of meetings, antibiotics reviewed, clinical indications, and proposed interventions: reduction, continuation, duration adjustment, discontinuation, or coverage recommendations.

A total of 35 meetings were conducted in 2024, addressing 101 cases of bacteraemia. The most frequently reviewed antibiotics were ertapenem (96), meropenem (77), and linezolid (27). The most common interventions were continuation according to clinical evolution (159), de-escalation (74), and treatment discontinuation or completion (41). Duration adjustment was recommended in 23 cases, while coverage recommendations were less frequent (6). Five deaths were recorded during follow-up. Broad-spectrum carbapenems represented a substantial proportion of discussions (173), underlining their clinical relevance and the importance of ASP supervision.

Microbiological cultures with antibiograms were also analysed, highlighting the presence of extended-spectrum beta-lactamase producing E. coli (20 isolates) and Klebsiella pneumoniae (17), multidrug-resistant Pseudomonas aeruginosa (10), K. pneumoniae KPC (4), Proteus mirabilis (4), E. coli AmpC (5), and methicillin-resistant Staphylococcus aureus (7). These findings emphasise the value of microbiological surveillance and its direct impact on therapeutic decision making during the meetings.

ASP meetings provided a structured and systematic framework to optimise antibiotic use in hospitalised patients, particularly in severe infections. The frequent interventions demonstrate the active role of the team in guiding prescription practices. These results support the continuity of multidisciplinary ASP initiatives in hospitals and align with international recommendations.

No conflict of interest

The objective of this study was to evaluate 12 months of implementation, focusing on the number of pharmaceutical interventions and the types of iatrogenic risks identified.

The fall risk score integrates several clinical and therapeutic criteria: history of falls, balance disorders, assistance with hygiene, cognitive impairment, sedative or neuroleptic use, post-anaesthesia status, and environmental factors. Each item contributes a weighted score, with ≥4 indicating high risk. This alert is included in the patient’s medical record, allowing automatic extraction by the algorithm. Data were collected for all patients with a score ≥ 4, between April 2024 and April 2025, including age, sex, score, number of chronic medications, inappropriate prescriptions (based on institutional and international guidelines) and pharmaceutical actions taken.

A total of 1149 patients were included (median age: 84 years; 50% men/50% women; median score: 6), with a median of 10 prescribed drugs. Overall, 37% had at least one inappropriate prescription. The most frequent issues were unnecessary proton pump inhibitors (74%), inappropriate doses of hypnotics (18%), and harmful drug associations (17%). Patients with inappropriate prescriptions were mainly hospitalised medical wards (73%), surgical/ambulatory units (19%), cardiac intensive care (6%), and intensive care (2%). Overall, 309 pharmaceutical interventions were made on prescriptions.

Future prospects include strengthening collaboration with prescribers through targeted training and evaluating the clinical outcomes of interventions. In addition, physicians are now required to justify the prescription of proton pump inhibitors upon hospital admission. Discharge letters will also include a dedicated section to alert community physicians to potential iatrogenic risks, ensuring continuity of care and supporting deprescribing strategies.

1. https://academic.oup.com/ageing/article/50/4/1189/6043386

2. https://pubmed.ncbi.nlm.nih.gov/33568364/

No conflict of interest

To evaluate differences in the effectiveness and persistence of secukinumab according to prior biologic exposure (naïve vs previously treated) and initial dosage.

A retrospective, observational study (January 2017-February 2025) was conducted including all PsA patients treated with secukinumab monotherapy.

Data were collected from electronic records and the pharmacy program, including the secukinumab treatment line (first-line to fourth-line), start/end dates, initial dosage, and prior biological treatments. One patient was excluded for missing data.

Effectiveness was assessed at 24 weeks, classifying patients as responders (clinical improvement) or non-responders (worsening), based on physician documentation. Persistence was estimated with Kaplan–Meier, defined as months from treatment initiation to discontinuation for any reason; patients still on treatment were censored. Differences in persistence by initial dosage (150 mg vs 300 mg every 4 weeks) and treatment line were compared using log-rank test. Statistical analysis was performed with R (v4.4.1).

Of the 61 patients, 6.6% received secukinumab as first-line therapy, 57.4% as second-line, 31.1% as third-line, and 4.9% as fourth-line. Overall, 74% achieved a clinical response at 24 weeks: 100% in first-line, 83% in second-line, 58% in third-line, and 3.3% in fourth-line.

The median overall persistence was 36.4 months (95% CI:20.3–NA); in naïve patients, 36.8 months (range 10.5–53). No statistically significant differences in persistence were observed (95% CI:0.69–1.91; p=0.59) among patients previously exposed to one (40 months, range 1.5–98), two (27.7 months, range 0.9–93), or three biologics (31 months, range 4–31).

The 300 mg every 4 weeks regimen showed a trend towards higher persistence versus 150 mg (HR=0.76), although this was not statistically significant (95% CI: 0.4–1.5; p=0.44).

Secukinumab showed high overall effectiveness (74% response rate).

Treatment-naïve patients had better outcomes, declining in later lines.

Treatment line and initial dose did not significantly affect persistence.

The position of secukinumab within the therapeutic sequence may be related to these outcomes, although larger prospective studies are needed to confirm this finding.

No conflict of interest

To determine clinical risk factors and determinants associated with CVE in patients with severe asthma with a T2 inflammatory phenotype, and to assess whether asthma treatments act as protective or risk markers for these events.

We conducted a retrospective cohort study of adults with severe T2 asthma managed at a hospital severe asthma care unit. All patients were receiving biologic therapy and high-dose inhaled corticosteroids (ICS). Additional therapies analysed included oral corticosteroids (OCS), montelukast, and long-acting β2-agonists (LABA). Patients with prior CVE before asthma diagnosis were excluded. Demographics, comorbidities, lung function, biomarkers (blood eosinophils, IgE), and treatments were collected from electronic medical records. CVE considered were myocardial infarction, angina requiring revascularisation, heart failure, supraventricular arrhythmia, stroke, or pulmonary embolism. Statistical analysis was performed using SAS 9.1.

A total of 164 patients were included (135 women; mean age 57±18 years). Sixteen patients (9.7%) experienced a CVE during follow-up. The most frequent comorbidities were obesity and allergic asthma. Significant associations with CVE were observed for eosinophilic asthma (OR=8.25, 95% CI 3.45–19.74; p<0.001), nasal polyposis (OR=5.17, 95% CI 2.06–12.95; p<0.001), and frequent exacerbations (OR=14.14, 95% CI 4.54–44.14; p<0.001). Higher CVE risk was also found in patients treated with OCS (OR=38.89, 95% CI 13.31–113.63; p<0.001), ICS (OR=32.50, 95% CI 6.70–157.44; p<0.001), montelukast (OR=16.60, 95% CI 6.35–43.38; p<0.001), and LABA (OR=5.65, 95% CI 2.15–14.80; p<0.001). These associations likely reflect disease severity and treatment intensity rather than a direct causal effect of the medications.

In severe T2 asthma, eosinophilic phenotype, nasal polyposis, and frequent exacerbations were strong clinical determinants of CVE. The association of CVE with asthma treatments underscores the importance of considering underlying disease severity when assessing cardiovascular risk in this population.

No conflict of interest

To describe the clinical management of a paediatric patient with late-onset OTCD and highlight the therapeutic role of hospital pharmacists in metabolic decompensations.

An 11-year-old male was admitted with vomiting, somnolence, and hyperammonaemia (480 µmol/L), alongside hyperlactacidaemia and hepatic dysfunction, with no relevant family history. On admission, he received hydroxocobalamin, biotin, and cerebral oedema management. Continuous veno-venous haemodiafiltration (CVVHDF) was initiated as an extracorporeal technique to achieve a rapid decrease in ammonia levels. Initial pharmacological therapy included sodium benzoate with sodium phenylacetate (alternated with phenylbutyrate), arginine, carnitine, carglumic acid, L-citrulline, paromomycin, and lactulose. Phenylbutyrate was discontinued due to nasogastric tube obstruction and replaced by sodium benzoate with phenylacetate. The hospital pharmacist adjusted and validated parenteral nutrition with protein restriction, compensated by higher carbohydrate intake to promote anabolism and protein synthesis, and provided basal fat to meet energy needs without overloading metabolism or causing acidosis/stress.

CVVHDF rapidly reduced ammonia levels with clinical improvement, and pharmacological therapy helped maintain stable ammonia levels. Although genetic results were not yet available, diagnosis was supported by metabolic findings: marked elevation of urinary orotic acid, elevated glutamine, and decreased citrulline, leading to clinical suspicion of OTCD. Genetic testing later confirmed a hemizygote OTC gene mutation. Maternal testing revealed mutation G4A1V3, despite an uncomplicated pregnancy and delivery. Therapy was adjusted for outpatient management, maintaining phenylbutyrate, citrulline, and strict protein control. Regular monitoring of ammonia, amino acids, and liver enzymes was implemented. The patient remained stable, with no further metabolic decompensations and good adherence to treatment.

OTCD can occur beyond the neonatal period with subtle or non-specific symptoms, delaying diagnosis. Early multidisciplinary intervention, including metabolic specialists and hospital pharmacists–who play a key role in the rapid initiation and adjustment of therapy and parenteral nutrition–is essential to secure favourable outcomes and avoid irreversible neurological damage.

No conflict of interest