Luis Fernando Valladales-Restrepo

Purpose: A pharmacotherapeutic follow‐up service is attended by pharmacists who systematically identify drug‐related problems and work to resolve their associated negative outcomes. The aim was to describe the characteristics of a pharmacotherapeutic follow‐up service and the factors associated with the presentation of drug‐related problems in a group of patients affiliated to the Colombian Health System. Methods: This was a cross‐sectional study of patients who attended a DADER method‐based pharmacotherapeutic follow‐up service. The drug‐related problems and their associated negative outcomes as well as the interventions performed on the patients were identified. Descriptive analysis and binary logistic regression were performed considering the presence of drug‐related problems as a dependent variable ( p < 0.05). Results: A total of 18 563 patients were identified, with an average age of 64.8 ± 14.9 years, and 66.3% were women. The most common chronic diseases were hypertension (54.3%), diabetes mellitus (29.2%), and rheumatoid arthritis (25.9%). The average number of medications/patient was 5.0 ± 4.1. Drug‐related problems were documented for 60.8% of the patients (1.6 drug‐related problems/patient), mainly due to drug–drug interactions (25.4%). Negative outcomes associated with medication use were observed for 60.0% of the patients (42.0% predominantly related to safety). The most common intervention was patient education (50.9%), and the negative outcomes associated with Medication use were resolved for 31.1% of patients who had two or more consultations. Patients over 65 years of age (OR:1.20; 95% CI:1.06–1.36), those from Bogotá–Cundinamarca (OR:1.62; 95% CI:1.52–1.73), those treated with ≥ 10 drugs (OR:1.21; 95% CI:1.07–1.36) and those treated with anticoagulants (OR:1.91; 95% CI:1.70–2.14) were more likely to experience drug‐related problems. Conclusions: Drug‐related problems were frequently identified, with drug–drug interactions being the most prevalent problem. Drug‐related problems were associated with increased age, an increased number of prescribed medications and the use of anticoagulants. Safety‐related negative outcomes associated with medication use were common, education was the predominant intervention, and one‐third of the negative outcomes associated with medication use were resolved.

Background: The aim of this study was to determine the use and safety of triptans in a group of patients with migraine who had excessive dispensings of antimigraine drugs. Methods: This was a cross-sectional study of patients with excessive dispensings of triptans identified by a pharmaceutical manager. The DrugBank database was used to determine rational amounts of triptans. Results: A total of 9147 patients used triptans, 44.6% of whom received excessive dispensings. A sample of 355 patients was selected, 22.8% of whom received regular doses of triptans daily. Adverse events were common (41.1%), and some patients experienced chronic headache (32.4%) and medication-overuse headache (MOH) (8.2%). Increasing age [adjusted odds ratio (aOR): 1.042; 95% confidence interval (CI): 1.008–1.077], a history of migraine for more than 10 years (aOR: 3.73; 95% CI: 1.37–10.16), previous dispensings of simple analgesics (aOR: 2.463; 95% CI: 1.001–6.057), and concomitant psychiatric illnesses (aOR: 3.583; 95% CI: 1.452–8.844) were associated with a higher probability of MOH. Conclusions: In this study conducted in a middle- to low-income Latin American country, triptans were commonly dispensed for patients with migraine, and their dosage did not comply with the recommendations of clinical practice guidelines for some patients. Increasing age, history of migraine ≥10 years, previous use of simple analgesics, and the presence of concomitant psychiatric disorders were associated with a higher probability of MOH. These findings reflect prescribing and dispensing patterns within the studied health-care context and may not fully represent the use of over-the-counter triptans or practices in other settings.

The aim was to determine the use of Sodium - Glucose Cotransporter-2 Inhibitors (SGLT2i) in patients with heart failure with and without diabetes mellitus in Colombia. The use of SGLT2i in patients with heart failure, followed for one year was evaluated. The patterns of use, indications, adherence and persistence of SGLT2i were analyzed. Descriptive and multivariate analyses were performed. A total of 500 patients were selected, with a mean age of 70.8 ± 12.8 years and 53.0% men; 57.2% started management with dapagliflozin. SGLT2i were most frequently used for heart failure with a reduced ejection fraction (HFrEF) and New York Heart Association classification of II or III (41.0%). The drug adherence rate was 80.9 ± 16.4%, and 71.8% of the patients reported persistent SGLT2i use for one year. Hospitalizations were less common during SGLT2i treatment than in the previous year (12.2% vs. 24.4%; p < 0.001). Having a Charlson Comorbidity Index ≥3 increased the probability of persistence of SGLT2i use at one year (Odds Ratio:4.56; 95%-Confidence Interval:1.46-14.27). SGLT2i use predominates in patients with HFrEF and in those with a high comorbidity burden. Adherence and persistence were similar to or even better than those reported in other real-world evidence studies.

Background Semaglutide is an effective antidiabetic agent that is injected weekly to induce weight reduction, and the impact on cardiovascular outcomes is favorable. Objective The aim was to evaluate the persistence of the use of weekly injectable semaglutide in Colombia for 12 months among new users. Methods A retrospective longitudinal follow-up study of a cohort of patients with a new prescription of weekly injectable semaglutide between January and December 2022 and persistence for 365 days was evaluated. Kaplan‒Meier survival analyses were performed to evaluate the survival effect of semaglutide. Results In total, 9356 new users of semaglutide were identified. The average age of the users was 61.6 ± 12.9 years, the main diagnoses were type 2 diabetes mellitus (43.8%) and obesity (41.8%), and 90.8% of them received the 0.25/0.5-mg dose. The mean duration of use was 93.7 ± 76.3 days, but only 13.8% and 0.2% of patients continued the treatment at 6 and 12 months of follow-up, respectively. In total, 35.4% had a prescription for a single month. The other concomitant antidiabetic drugs used were metformin (43.5%), sodium glucose-2 cotransporter inhibitors (38.3%) and insulin (18.2%). Conclusions Most of the patients started semaglutide at the suggested doses to continue with staging; however, the persistence of use was low, which may be related to difficulties in access, education on application methods, drug tolerability, and lack of follow-up by the clinician.

Purpose: Valproic acid is a known teratogen. The aim was to identify contraceptive use in a group of women using valproic acid.Methods: Descriptive study. A total of 22 855 women of childbearing age (15–49 years) with at least 1 month of valproic acid use from January 2022 to December 2023 were selected from a Colombian drug‐dispensing database. Data on the dispensing of hormonal contraceptives were searched during the study period. The time and rate of coverage (% of the period during which women took contraceptives while using valproic acid/total period of valproic acid consumption) with contraceptives were calculated.Results: Among the women included, 71.4% (n = 16 308) used 250‐mg valproic acid tablets. The mean age was 32.7 (standard deviation [SD]: 9.9) years, and the most common related diagnosis was migraine and headache (n = 5163, 22.6%). Only 8.0% (n = 1832) of the women had at least 1 day of coverage with some contraceptive while using valproate. For the patients with at least 1 day of coverage, the average duration of coverage was 72.5 (SD: 84.7) days (median: 30 days; IQR: 30–86 days). This represents an overall coverage rate of 5.3% (SD: 20.4%) (median: 0.0) and a coverage rate of 65.7% (SD: 35.1%) (median: 75.8%, IQR: 33.3–100%) for those with at least 1 day of coverage.Conclusions: A significant proportion of women of childbearing age are likely at risk of becoming pregnant while taking valproic acid.

Introduction: Heart failure is a common condition associated with significant mortality. Objective: to determine the prescription patterns of medications for the treatment of heart failure in a cohort of patients from Colombia. Methods: This was a retrospective study based on the clinical records of patients diagnosed with heart failure between 2019 and 2020. Sociodemographic, clinical, paraclinical, and pharmacological variables and the specialty of the treating physician were identified. Patients were classified according to functional class, stage, and left ventricular ejection fraction (LVEF). Results: A total of 4742 patients were evaluated, with a mean age of 68.2 ± 13.8 years and a male predominance (61.3%). A total of 92.0% were classified as stage C and 54.8% as functional class I, the mean LVEF was 42.9 ± 14.8%, and 32.53% had reduced LVEF. 30.7% did not have LVEF data. The most common causes were ischemic heart disease (44.0%) and arterial hypertension (29.7%). A total of 5.2% had hospitalizations for heart failure in the last year, and 75.6% were attended by a general practitioner. These patients were treated with β-blockers (88.3%), renin-angiotensin-aldosterone system inhibitors (RAASis) (83.1%), loop diuretics (46.8%), and mineralocorticoid receptor antagonists (MRAs) (46.5%). Triple therapy with RAASis + β-blockers+MRAs was received by 56.4% of patients with reduced LVEF, 32.8% with mildly reduced LVEF and19.5% with preserved LVEF, while quadruple therapy adding a sodium-glucose cotransporter-2 inhibitor (SGLT2i) was given just to 4.6% with reduced LVEF. Conclusion: The treatment that patients with heart failure with preserved LVEF is relatively simpler and is closer to the recommendations, while the proportion of indicated therapies according to guidelines is lower among those with reduced LVEF.

Introduction: Pulmonary hypertension (PH) is a chronic disease characterized by a progressive rise in pulmonary artery blood pressure. The objective was to describe the treatment patterns among ambulatory patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in a real‐world setting.Methods: This is a longitudinal cohort follow‐up study characterizing the treatment patterns of patients diagnosed with PAH or CTEPH, with secondary data from a population‐based drug‐dispensing database between 2022 and 2023, which includes sociodemographic, diagnosis, prescribing specialty, and treatment (drugs, persistence of use, and concomitant medications).Results: In total, 1045 patients with a diagnosis of PH were identified, with mean age of 62.9 ± 18.2 years, and 72.3% of females; of which 947 (90.6%) received monotherapy, and 98 (9.4%) received combination therapy at the beginning of follow‐up. The most frequently used drugs for the treatment of PH were calcium channel blockers (58.1%), followed by phosphodiesterase 5 inhibitors (41.1%), endothelin receptor antagonist (32.5%), and guanylate cyclase stimulants (9.7%). The schemes used most frequently were monotherapy with amlodipine (31.0%), sildenafil (19.2%), or nifedipine (10.0%), but the main combination were sildenafil with nifedipine (2.5%). The mean of persistence of use was 161 ± 123 days during 1 year of follow‐up.Conclusions: This group of patients with PH from Colombia were treated predominantly with monotherapy of calcium channel blockers and phosphodiesterase 5 inhibitors. However, current clinical practice guidelines recommend the use of combined therapy. The average persistence of the use of drugs for treatment for less than 6 months may be associated with difficulties in follow‐up, adherence, effectiveness, tolerability, and access.