Therapeutic innovation and sustainability in immune-mediated pathologies

Abstract

For a few years now, we have been experiencing a disruptive therapeutic innovation in immune-mediated pathologies with the incorporation of biological and targeted therapies that have significantly improved efficacy, safety and convenience for patients. The objective of the Pharmacy Services is to achieve the best health results with the rational use of the drug, that is, it is effective, safe and efficient. Pharmacy Services behave as a strategic element in hospitals and have four main axes: technology, logistics, scientific advice and direct clinical activity. In clinical activity, from the Pharmacy Services we promote greater patient adherence to their treatments, information about them to patients, review of drug interactions and effective monitoring to achieve the best health results. We use the CMO model (Capacity / Motivation / Opportunity), and we have implemented telepharmacy programs to facilitate collaborative dispensing with the community pharmacy. Thus, we gain comfort for patients and improvement of the comprehensive approach to patient needs. The levels of adherence are lower in chronic diseases as time passes from the start of treatment and with the disease controlled; pathologies such as chronic obstructive pulmonary disease, diabetes, or depression have mean adherence values of less than 50%. In the case of immune-mediated diseases the values are 70-90%, but we still need to improve them to achieve maximum effectiveness. From the Pharmacy Service we promote the maximum individualization of therapy, and we believe that no two patients are the same, not even the same patient is the same after the diagnosis and when he has been treatment for several years. For this reason, we have incorporated the determination of levels of biological drugs in the blood to be able to adjust the dosage to the individual needs of the patient. This allows us to optimize the dose when the pathology is controlled, maintaining the target serum levels, or to intensify the dose when control of the disease is not achieved, due to low levels of the drug or high levels of the antibodies that the patient may have generated. Currently, in the Pharmacy Service of University Hospital Virgen Macarena we monitor the levels of Infliximab, Adalimumab, Vedolizumab and Ustekinumab, with optimal results for the patients. It is vital to implement these strategies in a multidisciplinary way with the services involved, in this case mainly Digestive, Rheumatology and Dermatology. We have a pharmacist who is an expert in these pathologies who streamlines and catalyzes all activities in this area.