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APhA Staff
Oseltamivir seems to shorten hospital stays for kids with flu
Influenza is common among children and as many as 45,000 of those patients end up in the hospital. Oseltamivir was first approved by FDA in 1999, and outpatient use has shown that treatment with oseltamivir can reduce the time to alleviation of symptoms by 17 hours in adults and 29 hours in children, compared with placebo.
A group of researchers led by Patrick S. Walsh, MD, MS, from the Medical College of Wisconsin conducted a multicenter study to determine if early use of oseltamivir can improve outcomes of hospitalized in pediatric patients.
The multicenter retrospective study, published online on September 19 in JAMA Pediatrics, involved over 55,000 children aged 18 and younger who were hospitalized with the flu from October 1, 2007, to March 31, 2020, in 36 tertiary care pediatric hospitals and received either early oseltamivir treatment, defined as use of oseltamivir on hospital day 0 or 1, or no oseltamivir treatment.
The primary outcome was length of hospital stay in days. Secondary outcomes included 7-day hospital readmission, hospital day 2 or later transfer to the ICU, and a composite outcome of in-hospital death or use of extracorporeal membrane oxygenation (ECMO).
Results of the study showed that the children who received early oseltamivir treatment had shorter hospital stays (median 3 vs. 4 days) and lower odds of all-cause 7-day hospital readmission, ICU transfer, and death or ECMO use. The authors concluded that their findings support the early use of oseltamivir to treat hospitalized pediatric patients. ■
Does treatment with enteral glutamine help patients with severe burns?
Patients with severe burns (deep second- or third-degree burns affecting ≥ 10% of the body) are known to suffer from depletion of plasma and muscle glutamine, which can contribute to muscle wasting, weight loss, and infection.
Although enteral glutamine is recommended for treatment of patients with severe burns, limited evidence supports this approach. Members of the global RE-ENERGIZE trial team conducted a multicenter, double-blind, randomized trial to investigate the benefits and risks of glutamine supplementation.
Patients were assigned to receive 0.5 g/kg body weight per day of enterally delivered glutamine or placebo. Trial agents were given every 4 hours through a feeding tube or 3 or 4 times a day by mouth until 7 days after the last skin grafting procedure, discharge from the acute care unit, or 3 months after admission, whichever came first. The primary outcome was the time to discharge, with data censored at 90 days.
Results of the study, published on September 15, 2022, in the New England Journal of Medicine, showed that supplemental glutamine did not reduce the time to discharge.
The median time to discharge was 40 days in the glutamine group and 38 days in the placebo group. Mortality at 6 months was 17.2% in the glutamine group and 16.2% in the placebo group.
The authors note that no substantial between-group differences in serious adverse events were observed. They also note that their results were unexpected given the results from previous single-center trials of supplemental glutamine in burn-injured patients and suggest that the practice of translating the results of single-center trials into clinical-practice recommendations, as with enteral glutamine supplementation, should be re-examined. ■
Full-dose anticoagulation could be better than prophylaxes for patients with COVID-19
COVID-19 is known to create risk for venous and arterial thrombotic complications, but optimal dosing of anticoagulants is uncertain. To determine the efficacy and safety of prophylactic full-dose versus standard-dose anticoagulation therapy in critically ill patients with COVID-19, researchers with the TIMI study group at Brigham and Women’s Hospital and
Harvard Medical School conducted a multicenter, open-label, randomized-controlled trial with blinded endpoint adjudication in ICU-level patients with COVID-19.
Patients were randomized to full-dose or standard-dose prophylactic anticoagulation. Patients without an indication for antiplatelet therapy were also randomized to either clopidogrel or no antiplatelet therapy. The primary efficacy outcome was the hierarchical composite of death due to venous or arterial thrombosis, pulmonary embolism, deep venous thrombosis, type 1 myocardial infarction, ischemic stroke, systemic embolic event, or acute limb ischemia through hospital discharge or 28 days. The primary safety outcome was fatal or life-threatening bleeding.
Results of the study, published on August 29, 2022, in Circulation, showed that full-dose anticoagulation was more effective at reducing thrombotic complications compared with standard-dose prophylactic treatment. No difference in all-cause mortality was observed and no differences in the primary efficacy or safety endpoints of clopidogrel treatment versus no antiplatelet therapy were seen.
The authors concluded that full-dose anticoagulation should be considered to prevent thrombotic complications in selected critically ill patients with COVID-19 after weighing an individual patient’s risk for both thrombotic events and bleeding. ■
Determining the optimal medication for heart failure
Significant progress has been made in the treatment of heart failure with reduced ejection fraction (HFrEF), but questions remain regarding medication therapy for HF with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF).
To compare the outcomes associated with different medication combinations for the treatment of HFpEF and HFmrEF, researchers from the Second Affiliated Hospital of Soochow University (China) conducted a network meta-analysis of 19 randomized clinical trials enrolling over 20,000 patients with symptomatic HF and left ventricle ejection fraction (LVEF) of 40% or more, assessing any of the following interventions: ARNIs, MRAs, ACE inhibitors, ARBs, SGLT-2 inhibitors, and β-blockers.
The main outcomes were first hospitalization for HF, all-cause mortality, and cardiovascular mortality. The study was published on September 20, 2022, in JAMA Network Open.
Compared with placebo, none of the included drug classes were associated with a reduced risk of death, but SGLT-2 inhibitors, ARNIs, and MRAs were associated with a significant decrease in hospital admission for HF. SGLT-2 inhibitors were shown to be optimal for decreasing the risk of admission for HF.
The authors note that their results are consistent with the latest guideline recommendations and suggest that the increasing use of medication combinations may be associated with accumulative benefits in terms of HF hospitalization rather than all-cause death for patients with HF and an LVEF of 40% or more. They conclude that more studies that explore the phenotypic classification and the LVEF cutoff for the efficacy of drug therapies for patients with HFpEF or HFmrEF are needed. ■