Improve Patient Adherence Research Articles

Practical and Multidisciplinary Review on Wilson Disease: The Portuguese Perspective

Wilson disease (WD) is a genetic disorder of copper metabolism caused by mutations in the ATP7B gene resulting in toxic copper accumulation in several organs. WD can manifest as liver disease, a progressive neurological disorder, a psychiatric illness, or a combination of these. Other clinical manifestations can also occur. Diagnosis is challenging and typically requires a range of biochemical tests, imaging, genetic testing for ATP7B, and/or liver biopsy. WD is treatable with chelating agents, such as <sc>d</sc>-penicillamine and trientine, and/or zinc salts alongside with dietary copper restriction. Liver transplantation may be indicated in WD patients with severe hepatic disease, and cautiously considered in patients with neurological WD. Treatment success highly depends on patient adherence and treatment persistence. Therefore, effective interventions for improving patient adherence and close monitoring are key for preventing WD progression. In Portugal, there are no reference centers for WD, and patients are dispersed across numerous medical specialists. This review aimed to summarize the most recent and relevant information for the diagnosis, treatment, and monitoring of WD in Portugal, as well as possible interventions for stimulating adherence to treatment.

Utilisation en vie réelle d’une triple thérapie fixe dans la BPCO : étude Trilife. Triple association fixe béclometasone/formotérol/glycopyrronium en particules extra-fines

Introduction: The Trilife study describes the real-life use, in France, of the beclomethasone/formoterol/glycopyrronium triple fixed-dose combination in solution for inhalation, which is indicated as continuous treatment for moderate-to-severe chronic obstructive pulmonary disease.Methods: This prospective, non-interventional, multicentric study, involving hospital and office-based pulmonologists, evaluates the proportion of patients for whom the triple fixed combination was prescribed in compliance with the indication and dosage specified in the summary of product characteristics (SPC). Patients were followed for six months.Results: In a population of 346 patients, the prescription was compliant with the SPC for 75.1% of patients (95% confidence interval: [70.6; 79.7]). The only variable associated with compliance with SPC in multivariate analyses was smoking (p=0.019). The results also show improved patient adherence to treatment and improved clinical status in terms of moderate or severe exacerbations, dyspnea, quality of life and satisfaction with treatment.Conclusion: Three quarters of the fixed triple combination prescriptions by French pulmonologists comply with the indication and dosage specified in the summary of product characteristics.

Factors influencing dementia patients' participation in advance care planning: A meta-analysis

ObjectiveA meta-analysis was conducted based on the available evidence to determine the influencing factors associated with the participation of people with dementia in advance care planning. MethodsA keyword search was performed in seven databases, Web of Science, PubMed, Embase, Cochrane Library, CINAHL, Scopus, and Void, to search for eligible studies published from the time of library construction up to February 1, 2024, to examine the factors influencing the participation of dementia patients in advance care planning and its effects. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS) and the assessment criteria of the Agency for Healthcare Research and Quality (AHRQ). After literature search, data extraction and quality assessment were completed independently by two researchers, meta-analysis was performed using Stata software 15.0 to pool the odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity between studies was assessed using the Cochran chi-square test (Cochran 's Q) and I2 values. ResultsA total of 19 studies were included in this study, and Meta-analysis showed that 8 of the 16 influencing factors were statistically significant: Patients' gender (OR=1.17; 95%: 1.13–1.2), age (OR=1.07; 95%: 1.03–1.1), education (OR=1.98; 95%: 1.65–2.38), race (OR=2.61; 95%: 1.67–4.08), the severity of the dementia (OR=1.46; 95%: 1.34- 1.58), ability to perform activities of daily living (OR=0.99; 95%: 0.97–1.0), religious affiliation (OR=2.24; 95%: 1.23–4.06), and patient income(OR=2.10; 95%: 1.47–2.98) were associated with participation in advance care planning. ConclusionsThe participation of dementia patients in advance care planning is influenced by gender, age, education, race, dementia severity, ability to perform activities of daily living, religious affiliation and patient income. The results of the study can inform the development of targeted interventions for dementia patients, thereby reducing overtreatment of dementia patients at the end of life and improving patient adherence to hospice care.

Enhancing HIV/AIDS and TB medication logistics: A comprehensive approach to global healthcare distribution

The distribution of HIV/AIDS and tuberculosis (TB) medications is critical to the success of global healthcare initiatives, particularly in regions with limited infrastructure and resources. This review examines the logistical challenges hindering the efficient delivery of these life-saving medications, including supply chain inefficiencies, poor infrastructure, and geographical barriers. It also explores innovative approaches to optimizing logistics, such as the use of blockchain, drones, and artificial intelligence (AI), alongside public-private partnerships (PPPs) and supportive policy frameworks. These emerging technologies have the potential to enhance the availability and effectiveness of HIV/AIDS and TB treatments by improving supply chain transparency, reducing stockouts, and overcoming transportation challenges in remote areas. The paper further assesses the impact of these logistical improvements on healthcare outcomes, demonstrating how they contribute to improved patient adherence, reduced disease transmission, and cost savings. Finally, recommendations are provided for policymakers, healthcare organizations, and stakeholders to adopt these innovations, and future research directions are proposed to expand these models to other medications and diseases.

The FLASHFIT Interactive Device in Healthcare: Revolutionizing Patient Engagement and Monitoring

The study investigates the effectiveness of the FLASHFIT interactive device in enhancing patient engagement and monitoring within healthcare settings. As digital health solutions become increasingly vital, FLASHFIT aims to bridge the gap between patients and healthcare providers by promoting active participation in health management. This research employs a mixed-methods approach, combining quantitative data from patient usage metrics with qualitative feedback from users and healthcare professionals. Preliminary findings indicate that FLASHFIT significantly improves patient adherence to treatment plans and fosters a sense of autonomy in health management. Moreover, real-time monitoring capabilities facilitate timely interventions, enhancing overall patient outcomes. The study concludes that integrating interactive devices like FLASHFIT into healthcare practices empowers patients and streamlines communication between patients and providers, suggesting a transformative potential for future healthcare delivery models. Keywords: FLASHFIT interactive device, patient engagement and monitoring

Icodec ONWARDS: A review of the first once-weekly diabetes treatment for nurse practitioners and physician assistants.

Diabetes management is challenged by the complexity of treatment regimens and the need for frequent injections, affecting patient adherence and quality of life. Insulin icodec, a once-weekly basal insulin analog, represents a significant innovation, potentially simplifying diabetes care and improving outcomes. This review aims to evaluate the safety, efficacy, and clinical implications of insulin icodec for individuals with type 1 and type 2 diabetes, highlighting its potential to affect current treatment paradigms. A review was conducted comparing once-weekly insulin icodec with daily basal insulin analogs using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to ensure transparent reporting of systematic reviews. A search was performed in the following databases: PubMed, Google Scholar, Embase, and ClinicalTrials.gov, focusing on efficacy and safety outcomes. Insulin icodec has demonstrated effective glycemic management and a safety profile comparable to daily basal insulins. Its extended half-life and steady-state glucose-lowering effect have the potential to reduce the burden of daily injections and improve patient adherence. The introduction of once-weekly insulin icodec represents an advancement in diabetes care. For front-line clinicians, this innovation aligns with the need for more straightforward medication regimens. Coupled with continuous glucose monitoring systems, it enables a more personalized and efficient approach to diabetes management, with the potential to improve patient satisfaction and clinical outcomes. This underscores the impact of integrating such advancements into practice, highlighting the role of nurse practitioners and physician assistants in adopting these innovations to optimize patient care.

Effect of Fluid Paraffin on the Formulation Properties of Pressure Sensitive Adhesive Formulations Containing Diclofenac Sodium.

Understanding the relationship between the release characteristics of the active ingredient in the tape formulation and the pharmaceutical characteristics of the adhesive layer can optimize therapeutic efficacy and improve patient adherence. This study aimed to clarify the effect of liquid paraffine (LP)/styrene-isoprene-styrene (SIS) triblock copolymer ratio on pressure-sensitive adhesive (PSA) formulation properties, such as adhesive properties and drug release, with a certain amount of diclofenac sodium (DFS) and tackifier. The effects of changes in PSA composition in DFS-containing tape formulations on adhesive and drug release properties were evaluated. The viscoelasticity results showed rigid gel-like behavior at low angular frequencies regardless of the LP/SIS ratio, and deformable gel-like behavior at high angular frequencies, with a maximum plasticizing effect of LP up to an LP/SIS ratio of 3.7. The peel adhesion test results showed that peel adhesion was not affected, but indicated a decreasing trend by increasing the LP/SIS ratio in the presence of DFS. Drug release test results showed that DFS release increased up to 24h for LP/SIS ratios of up to 3.7, but decreased when the LP/SIS ratio was 6. The results of the drug permeation tests were similar to those of the drug release tests. In conclusion, it is possible to change the drug release properties by changing the amount of LP in the tape formulation; however, no definitive correlation was found between the adhesive and drug release properties.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Clinical evidence of low-calorie and ketogenic nutrological therapy before, during and after bariatric surgery: a systematic review

Introduction: Obesity is a multifactorial disease that causes serious comorbidities. There are more than 2.2 billion overweight and obese people in the world. Obese patients tend to be predisposed to micronutrient deficiency even before bariatric surgery, therefore, it is imperative to supplement nutrients orally, enterally, or parenterally, according to the indications of each patient. Objective: It was highlighted the importance of low-calorie and ketogenic nutritional therapy before, during, and after bariatric surgery through the systematic analysis of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 119 articles were found. A total of 40 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 27 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=76.5%>50%. It was concluded that nutrological therapy strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to following the prescribed diet before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects on reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology are useful to provide optimal care to patients, especially in nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures such as RYGB. Immediate administration of thiamine is essential. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and a multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. In addition, serum micronutrient levels should be monitored regularly and additional supplementation should be prescribed as indicated.

Preventive Effects of a CVD Polypill on Developing Diabetes Among Patients With Metabolic Syndrome: Results of the PolyIran-Liver Trial.

While cardiovascular disease (CVD) polypills have demonstrated significant benefits in preventing CVD events by managing CVD risk factors and improving patient adherence, their effects on blood glucose levels, an important risk factor for CVD, remain unknown. We analyzed data from the PolyIran-Liver trial, which involved 1,508 participants aged 50 and above. Of these, 787 were randomly assigned to receive a polypill (consisting of aspirin, atorvastatin, hydrochlorothiazide, and valsartan), while 721 received usual care as the control group over a five-year period. The aim was to determine whether there were any significant differences in fasting blood sugar (FBS) levels between the two groups at baseline, middle, and end of the study. The data analysis focused on three subgroups: participants with diabetes, those with metabolic syndrome (MetS) but without diabetes, and participants without diabetes or MetS. Of the total studied population, with a mean age of 59±6.7 years, 328(22%) were identified with diabetes, 371 (25%) with MetS but without diabetes, and 809 (54%) without diabetes or MetS. We observed a trend of rising FBS levels until month 30, followed by a subsequent decline at month 60. Participants in the polypill group exhibited lower FBS levels than the control group at both time points, with statistically significant differences in all three subgroups at month 30 and in the MetS-without diabetes at month 60 (mean difference: -9.3 mg/dl, 95% CI: 13.9 to -4.6). The polypill used in this study may have the potential to delay the onset of diabetes in patients with MetS more effectively than in the general population. However, its beneficial effects on the blood sugar levels of diabetic individuals require further investigation.

Wound Care at the Intersection of Race, Ethnicity, and Malnutrition.

Ensuring adequate nutrition is vital for maintaining skin health and promoting successful wound healing. Globally, the rise in malnutrition and diet-related diseases is contributing to increased rates of illness and disability. Populations in food deserts and those experiencing food insecurity are particularly at risk. Being at risk for or having malnutrition associated with chronic conditions such as diabetes and cardiovascular disease can increase the incidence of wounds. Healthcare disparities and varied clinical outcomes among ethnic minorities further contribute to these challenges. Research indicates that racial and ethnic minorities experience a higher prevalence and severity of wounds, including pressure injuries. Detecting early-stage wounds in individuals with darker skin tones can be difficult, adding to the disparities.Culturally appropriate nutrition interventions are essential in addressing these health inequities because tailored approaches tend to be more effective than uniform strategies. Understanding diverse dietary patterns and incorporating cultural food preferences into care plans can improve patient adherence and outcomes. Promoting equity in wound care through culturally sensitive practices helps to foster respect, dignity, and trust within healthcare settings, particularly for minority populations.In this review, the authors highlight the need for inclusive interventions that provide culturally aligned nutrition, supporting patients' clinical and holistic well-being.

Novel Carbohydrate Polymer-Based Systems for Precise Drug Delivery in Colon Cancer: Improving Treatment Effectiveness With Intelligent Biodegradable Materials.

Due to their biocompatibility, biodegradability, and controlled release, carbohydrates polymers are crucial to targeted drug delivery systems, notably for colon cancer treatment. This article examines how carbohydrate polymers like chitosan, pectin, guar gum, alginate, hyaluronic acid, dextran, and chondroitin sulfate are used in improved drug delivery. Modifying these polymers improves drug loading, stability, and release patterns, enhancing chemotherapeutic drugs' therapeutic index. Chitosan nanoparticles are pH-responsive, making them perfect for cancer treatment. Pectin's resistance to gastric enzymes and colonic bacteria makes it a promising colon-specific medication delivery agent. The combination of these polymers with nanotechnology, 3D printing, and AI allows the creation of stimuli-responsive systems that release drugs precisely in response to environmental signals like pH, redox potential, or colon enzymatic activity. The review highlights intelligent delivery system design advances that reduce systemic toxicity, improve treatment efficacy, and improve patient adherence. Carbohydrate polymers will revolutionize colon cancer treatment with personalized and accurate alternatives.

Evaluating the impact of pharmacy-led telemedicine services on access to oncology care in rural areas

This review paper explores the impact of pharmacy-led telemedicine services on enhancing access to oncology care in rural areas. With the increasing prevalence of cancer and the challenges associated with delivering specialized oncology services in remote locations, telemedicine has emerged as a vital tool for bridging the healthcare gap. The paper highlights the significant role of pharmacists in managing complex medication regimens, improving patient adherence, and providing essential support through telemedicine platforms. Key findings indicate that telemedicine improves patient access to care and enhances patient and provider satisfaction, leading to better treatment outcomes. The review also discusses the implications for healthcare policy and practice, emphasizing the need for investment in telemedicine infrastructure and pharmacists' integration into this care model. Future research directions are proposed to evaluate the long-term effectiveness of these services and explore advanced telemedicine technologies. The potential of telemedicine to transform rural healthcare access and outcomes is vast, offering a promising solution to address the disparities in oncology care. Keywords: Telemedicine, Oncology Care, Rural Healthcare, Pharmacy-Led Services, Patient Access, Healthcare Disparities.

Formulation and Evaluation of Sustained Release Dosage Form of Venlafaxine Hydrochloride for Enhanced Treatment of Neurodisorders

In the present study, we have designed and developed a sustained-release tablet formulation of Venlafaxine Hydrochloride. The optimized formulation was then subjected to various evaluation parameters. The formulation of venlafaxine hydrochloride sustained release tablets with a dosage of 500 mg included the utilization of several hydrophilic polymers, including jackfruit mucilage, HPMC K4, and PVPK30, as release retardants. This was done to extend the duration of drug release to 12 hours. The formulation features, including pre-compression and post-compression investigations, were conducted individually according to established protocols. The tablets were determined to be compliant in terms of weight uniformity, hardness, thickness, diameter, friability, and drug content. Separate in-vitro dissolution studies were done for both tablets. The venlafaxine hydrochloride SR formulation F18 was optimized to provide the desired release profile for up to 12 hours. The Venlafaxine Hydrochloride SR formulation was optimized and exhibited zero-order release kinetics. The stability studies conducted under accelerated conditions at a temperature of 40 ± 2°C and a relative humidity of 75 ± 5% yielded good results. The study indicated that the sustained release administration of Venlafaxine HCl is potentially efficacious. It reduces the frequency at which the patient has to take medication and improves patient adherence. Our objective is to conduct in-vivo pharmacokinetic studies of the formulation to verify the drug’s entry into the systemic circulation.

Advancements in Metacarpal Fracture Management: A Narrative Review of Rehabilitative Strategies.

Metacarpal fractures are prevalent injuries that can significantly impact hand functionality if not managed effectively. This narrative review examines recent advancements in treatment strategies, comparing conservative and surgical interventions, and evaluates the role of early mobilization and innovative rehabilitation techniques. We analyze evidence showing that surgical treatment with low-profile titanium plates provides superior stabilization, enabling earlier mobilization and better functional outcomes compared to conservative methods or K-wire fixation. Early mobilization, facilitated by metacarpal braces or controlled active exercises, enhances recovery and reduces the need for extended physical therapy. We also explore the integration of technology in rehabilitation, which has improved patient adherence and satisfaction. The review highlights the importance of personalized treatment plans and discusses the potential of novel rehabilitation approaches to optimize metacarpal fracture management. Future research should focus on refining these strategies and developing standardized protocols to enhance hand function and patient satisfaction.

Pulsatile Drug Delivery System: A Review

As modern technologies advance, new methods of drug delivery systems are constantly being developed. Pulsatile drug delivery system is becoming increasingly popular because it can deliver the drug at the correct location, time, and dosage, improving patient adherence. These technologies are designed to align with the body's inherent circadian rhythm. Pulsatile drug release is mainly preferred when continuous drug release is not needed. Understanding the circadian clock's design, illness rhythm pathophysiology, and chrono pharmacology’s medication knowledge helps create and utilize chronotherapeutic dosage forms for effective disease treatment, reducing side effects, improving targeted drug delivery, and maintaining consistent dosing. Proper design of pulsatile drug delivery enhances patient adherence, targets drug distribution, and decreases side effects. Like many other medical conditions, the outlook for chronotherapy using pulsatile drug delivery seems very optimistic. Pulsatile drug delivery systems can utilize either one or multiple mechanisms to administer medication at a specific time and location. Formulation of pulsatile flow is achieved by incorporating different polymers, with the thickness of the coating layer dictating the speed of release of the active medicinal ingredient.

Formulation and Evaluation of Acyclovir Loaded Transferosomal Gel for Transdermal Drug Delivery

Background: A carrying structure for targeted transdermal drug delivery is a transferosome. These unique liposomes are made of an edge activator and phosphatidylcholine. The most common antiviral drug is acyclovir, a synthetic nucleotide nucleoside analog derived from guanine. It works well to cure the varicella-zoster virus and the virus that causes herpes simplex (HSV), primarily HSV-1 and HSV-2. But its skin permeability is minimal. Therefore, this work aimed to use transferosomes to prepare acyclovir so that it could pass through the skin's barrier function. Objective: This study uses a 32-factorial factorial design to develop a transferosomal gel containing acyclovir through thin-film hydration method for painless acyclovir delivery services for skin disease treatment. Material and Methods: The independent variables are the amount of phospholipid (X1) and tween 80 (X2), while the dependent variables are particle size (Y1) and percentage entrapment efficiency (Y2). To create an ideal formulation, the produced transferosomes were assessed for particle size, in vitro drug release amount, and entrapment efficiency (EE%). A Carbopol 934 gel basis was prepared using the optimized acyclovir transferosome formulation, and its drug concentration, pH, spreadability, viscosity, and stability were assessed. Results: With small particles ranging from 176.6 to 324.4 nm, the produced acyclovir transferosomes had a high EE% range from 66.34 to 76.42 %. According to the in vitro release study, there is a negative correlation between in vitro release and EE%. The formulation TF5, including 1%w/w of carbopol 940, provides a superior profile of drug absorption in vitro. Consequently, acyclovir can enter the skin as transferosomes and cross the stratum corneum barrier. Conclusion: Acyclovir can be transformed into a transfersomal gel, which will improve antiviral efficacy, get over the skin's protective layer, prevent adverse oral reactions, and eventually improve patient adherence. Keywords: Transferosome, Transdermal drug delivery system, Acyclovir, 32 Fractional factorial design, Carbopol 934

Evaluating Patient Perceptions of Pharmacist-Led Medication Therapy Management in Hypertension Management

Background: Hypertension is the primary contributor to cardiovascular diseases worldwide, it affects millions and needs effective management strategies. Pharmacist-led Medication Therapy Management (MTM) is essential in improving medication adherence and optimizing the treatment outcomes for patients suffering from hypertension. Objective: This study aims to evaluate patient perceptions of pharmacist-provided Medication Therapy Management (MTM) services for managing hypertension. Moreover, it evaluates to examine how these perceptions influence patient`s adherence to their prescribed treatment regimens. Methods: This cross-sectional observational study aimed at determining the patients' perceptions on the Medication Therapy Management (MTM) services they receive to control their hypertension. Data from 114 patients was obtained and their perceptions were recorded using the survey instruments. Patients below 20 years were excluded. The data was assessed using the SPSS 24th version. The p-value was ascertained by using the Chi-square test. Results: The study analyzed 114 hypertensive patients predominantly females (63.2%) aged 50 years or above (51.8%). The selection of patients was based on a convenience-stratified strategy. The p-value was ascertained by using the Chi-square test. The majority had been managing hypertension for over a year (88.8%), with 45.6% managing it for 1-5 years. Educational levels varied, and most participants resided in urban areas (75.4%). Awareness of hypertension management was high with 86% of patients recognizing MTM's positive influence on medication adherence. Despite these favorable outcomes, challenges such as medication costs and lifestyle changes were noted, highlighting the need for tailored interventions to improve patient adherence and health outcomes. Conclusion: In conclusion, most hypertensive patients understood how to manage their condition and found Medication Therapy Management (MTM) helpful. MTM improved their medication adherence, reduced side effects, and enhanced their understanding of the treatment, leading to better health outcomes. However, challenges such as medication costs, lifestyle changes, and scheduling conflicts made it harder for patients to fully follow MTM advice. Despite these challenges, MTM played an important role in effectively managing hypertension.

Dosage by design – 3D printing individualized cabozantinib tablets with immediate release

Production of patient-specific dosage forms is important to improve patient adherence and effectiveness while reducing the prevalence and severity of adverse effects. Due to its possibility of rapid prototyping 3D printing can be used to produce individual dosages while utilizing techniques such as hot melt extrusion to increase the bioavailability of poorly soluble drugs. In this work, Parteck MXP and Kollicoat IR were used as water-soluble polymer bases for formulation development for 3D printing of various dosages incorporating cabozantinib while enabling immediate release. The effect of tablet design and the excipients sorbitol, croscarmellose sodium, and sodium starch glycolate was investigated for this goal. A way to calculate the size of tablets for predetermined dosages is proposed to enable the printing of individual strengths from one formulation. Rheological data were collected to deepen the understanding of the role of melt viscosity in 3D printing and hot melt extrusion processes. The production of immediate-release cabozantinib tablets containing every therapeutically relevant dosage in a single unit produced by two-step 3D printing was realized.

The patient-reported outcomes for the new brand-generic teriflunomide in relapsing-remitting multiple sclerosis

BackgroundPatient-reported outcomes (PROs) provide valuable insights into the impact of disease-modifying therapies (DMTs) on patients' daily lives and disease progression. This study evaluates treatment satisfaction and tolerability among patients using a brand-generic Teriflunomide (Tebazio®, 14 mg tablet) manufactured by Zistdaru Danesh Biopharmaceuticals. Materials and MethodsA Phase IV observational study was conducted on patients with Relapsing-Remitting Multiple Sclerosis (RRMS) who were either initiated on or switched to Teriflunomide 14 mg. The primary focus was on the medication's safety. Patient satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication [Version 1.4] (TSQM-14). Additionally, medication adherence and discontinuation rates were monitored. ResultsOf the 235 RRMS patients enrolled, participated in this study, all received the Teriflunomide treatment orally on a daily basis. Over the 18-month follow-up period, 25.96 % of patients discontinued the treatment. Discontinuation was mainly due to adverse events (11 %), lack of patient willingness to continue (12.7 %), and disease progression (4.2 %). The most commonly reported adverse events included dermatologic disorders, elevated liver enzymes, and gastrointestinal issues. TSQM-14 scores demonstrated significant improvements over the 18-month period. A high medication adherence rate of 98.1 % was also recorded. ConclusionPatients reported notable satisfaction with Teriflunomide, as reflected in their TSQM scores, which suggests a likelihood of improved patient adherence. The 14 mg brand-generic Teriflunomide was well-accepted by Iranian RRMS patients, with no significant concerns arising during the study. These findings also highlight the significance of patient-reported outcomes in DMTs, with potential benefits for adherence and clinical practice.