Background and Importance In chronic diseases, concern about safety and economic implications of treatment with biological drugs have raised, the need to adapt, by reducing doses, the treatment used once reached the individualised therapeutic goal for each patient.
Aim and Objectives Implementation of a pharmaceutical care consultation for patients with Severe Uncontrolled Asthma (SUA).
To establish a collaboration with the Pneumology Service for the referral of candidate patients for pharmacotherapeutic optimisation.
Material and Methods Pharmaceutical care consultations were scheduled for all SUA patients.
Candidates for optimisation were those treated with any monoclonal antibody for more than 1 year, had no exacerbations in the last 12 months, ACT score >20, FEV1>80%, withdrawal of oral corticosteroids, had good adherence to treatment measured by the Test of Adherence to Inhalers and the pharmacy dispensing record.
If a patient met these requirements was referred to pneumologist with a treatment optimisation proposal (lengthening the interval between doses or reducing the dose). Pneumologists were able to accept the optimisation proposal or not. If there was worsening after dose optimisation, the initial prescription was returned.
Results During a 2-year period, from May 2020 to May 2022, 38 patients received Mepolizumab, 20 Benralizumab, 14 Reslizumab and 59 Omalizumab. 125 patients came to pharmacy consultation.
35 patients that met the criteria for optimising treatment and were proposed to pulmonologist, with acceptance of the proposal: 9 with mepolizumab every 5 weeks, 1 with benralizumab every 9 weeks, 5 with benralizumab every 5 weeks, and 20 with omalizumab at half initial dose.
In September 2022, 25 patients continue to be optimised, 10 patients have returned to the usual dose because they were not fully controlled with the optimised regimen, none of whom had asthma exacerbations.
Conclusion and Relevance Pharmacotherapy optimisation exposes patients with total control of asthma to less drug and less probability of developing adverse effects, while minimising costs in the health system.
The collaboration pneumology-pharmacy allows the identification of patient candidates for optimisation, managing to optimise almost 1 out of every 3 patients in treatment with monoclonal antibodies.
Conflict of Interest No conflict of interest
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