Introduction - Several medications are available for the treatment of cancer, and monoclonal antibodies that target PD-1 and PD-L1 represent first-line options for cancer. PD-1 promotes the ability of the immune system to recognize and attack cancer cells by activating T cells. PD-1 also activates the autoimmune system. This activation causes healthy cells in the body to be attacked by the immune system, resulting in immune-related adverse events (irAE). The objective of this study was to comprehensively evaluate the adverse events of rejection reactions in real-world solid organ transplant patients using monoclonal antibodies that target PD-1/PD-L1. Methods. - Data from 2016-2021 were extracted from the U.S. Food and Drug Administration(FDA) Adverse Reporting System (FAERS) to describe the rejection reaction in patients with solid organ transplantation cases after using PD-1/PD-L1 inhibitors approved by the FDA. The reporting odds ratio (ROR) with 95% confidence interval (CI) for rejection reaction was calculated for each PD-1/PD-L1 inhibitor. A disproportionality signal was defined when the lower limit of 95% CI > 1. Results. - The FAERS database recorded 11,935 adverse events related to solid organ transplantation. Among these reports, 117 showed that various PD-1/PD-L1 inhibitors exhibited a strong correlation with solid organ transplantation rejection. The 3 medicines with the incidence of rejection reaction include avelumab (1), nivolumab (79) and pembrolizumab (37). The average time of solid organ transplantation rejection associated with PD1 / PD-L1 inhibitors was 40.64 days. Of those patients who experienced solid organ transplant rejection, a total of 24.79% died. Conclusion. - This study found that PD-1/PD-L1 inhibitor use in patients with solid organ transplantation was associated with donor organ rejection. This information serves as a pharmacovigilance signal that we need to continue to track in the real world. (c) 2022 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved.

Abstract Background Generic medicines substitution is an important means to control rapid growth of pharmaceutical expenditures for the healthcare system in China. Acceptance and utilization of generic medicines is highly influenced by healthcare providers’ perceptions. This study aimed to compare the knowledge, awareness and perceptions of generic medicines between physicians and pharmacists in China. Methods We used an online, cross-sectional survey across China. The questionnaire explored four sections: demographic characteristics, assessment of the participants’ knowledge and awareness of generic medicines, perceptions of generic medicines and generic substitution practices. Chi-square or Mann–Whitney-U tests were applied to compare differences between physicians and pharmacists. P-values < 0.05 were considered significant. Results A total of 1644 physicians and 4187 pharmacists participated. Most physicians (82.8%, n = 1362) and pharmacists (89.8%, n = 3760) correctly identified the definition of generic medicines. A similar percentage of physicians and pharmacists agreed that approved generic medicines are as effective (64.1% vs 68.2%) or safe (63.8% vs 69.1%) as brand-name medicines. Most physicians and pharmacists (67.6% vs 71.0%) supported the policy of generic substitution. In practice, 79.4% (n = 1305) of physicians reported that they had prescribed generic medicines. More than 78% of respondents reported an obvious increase in the number of generic medicines prescribed in their medical institutions. The majority of physicians and pharmacists identified lack of trust regarding efficacy and safety of generic medicines and the difficulty of changing patients’ preference as top challenges in generic substitution. Conclusions Both physicians and pharmacists surveyed had adequate knowledge of generic medicines, and hold positive attitude towards generics and generic substitution. Efficacy and safety are key factors related to prescribing or dispensing generic medicines. Various policies and regulations should be taken to encourage successful generic substitution.

Objective To evaluate pharmacists’ knowledge, perceptions and practices towards generic substitution in the 11 pilot locations in China. Design An online cross-sectional survey using questionnaires was conducted. A convenience sampling technique was implemented to recruit pharmacists. Setting and participants The study took place in medical institutions of 11 pilot locations that participated in the pilot national centralised procurement programme in 2019. Two thousand two hundred and ninety-one pharmacists including hospital pharmacists or community pharmacists based on health-systems or clinics participated in the study. Results Most of the participants had the good knowledge of requirements for evaluating the quality and efficacy of generic drugs (n=2118; 92.4%), and the definition of generic drugs (n=2078; 90.7%). In terms of perceptions, 67.3% of respondents were of the opinion that generic drugs are equally as effective as the brand-name drugs, and 69.0% of respondents were of the opinion that generic drugs are as safe as brand equivalents. A high percentage of participants supported the policy of generic substitution (n=1634; 71.4%). A significant positive correlation was demonstrated between total knowledge score and total perception score (ρ=0.267; p<0.001). Efficacy, safety and the direction of national policies and hospital regulations were the main factors affecting pharmacists’ willingness to dispense generic drugs. Conclusions The study identified gaps in respondents’ knowledge and perceptions of generic substitution. Pharmacists who are more knowledgeable in generic drugs tend to hold a more supportive attitude towards generic substitution. Although it appeared that pharmacists in China have largely accepted generic substitution, they still have concerns regarding the reliability and quality of generic drugs. The current issues need to be addressed for the realisation of the true value of generic drugs as part of the country’s healthcare cost-containment strategy as well as the implementation of generic substitution policy in China.

Background and purpose: An advanced pharmacy practice experience (APPE) in a community pharmacy setting is required in all accredited doctor of pharmacy program curricula in the United States. This setting often presents unique challenges to precepting students that may hinder the development and availability of robust learning experiences. This qualitative review discusses perceived challenges and potential solutions to maintaining a meaningful community rotation experience for students based on published literature and reported preceptor experiences. It also explores the clinical impact of APPE students in community pharmacy. Educational activity and setting: St. Louis College of Pharmacy (STLCOP) provides a systematic approach to student orientation and evaluation for community pharmacy APPEs. This allows all pharmacy students to be held to the same educational outcome standard. Site preceptors are responsible for communicating site-specific expectations and providing frequent formative feedback to students throughout the five-week rotation. Findings: Community rotation students spent approximately 6400 hours providing almost 30,000 patient interventions over two years, indicating a potential benefit in quality of care at student-hosted sites. Despite evidenced benefits of the presence of pharmacy students in community pharmacies, some pharmacists hesitate to precept students due to anticipated obstacles of this additional responsibility. Summary: This review explored the community practice APPE structure offered at STLCOP and describes the patient impact that students have made during this clinical rotation. Data seem to indicate a positive return on investment for having APPE students in community pharmacy.

Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients' medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs.

Since the approval of the first dipeptidyl peptidase-4 (DPP-4) inhibitor in the United States in 2006, the use of these agents as second-line oral antihyperglycemic therapy in type 2 diabetes management has been established. Several clinical trials and meta-analyses have been conducted to identify potential additional benefits and risks associated with each DPP-4 inhibitor. In general, DPP-4 inhibitors are effective at promoting moderate lowering of A1C and are associated with few adverse events. Although there is evidence that DPP-4 inhibitors confer cardiovascular safety and renoprotection, the potential risks of hospitalization for heart failure and acute pancreatitis are disadvantages to their use as add-on therapy.