Antiretroviral prescription profile and adherence to guidelines

• Published in: European journal of hospital pharmacy. Science and practice Vol. 19; no. 2; pp. 158 - 159
• Main Authors: Sánchez, A. Hernández, Jiménez, M. Arteta, García, T. Molina, González, P. Tejada
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.04.2012
• Subjects: Drug therapy
• ISSN: 2047-9956; 2047-9964
• DOI: 10.1136/ejhpharm-2012-000074.193

Background A national HIV study group publishes yearly recommendations for antiretroviral therapy (GESIDA) in Spain. Purpose To describe the differences between GESIDA in 2010 and 2011 (GESIDA-2010; GESIDA-2011). To analyse the antiretroviral therapy (ART) prescription profile (PP) in treatment-naïve patients for 2010 and 2011(PP-2010; PP-2011) and evaluate the adherence to GESIDA. DSL010 table 1 PP-2010 (GESIDA-2010) PP-2011 (GESIDA-2011) *PP-2010 (GESIDA-2011) WITHIN GUIDELINES PREFERRED 43 88% 28 83% 40 81% ALTERNATIVE 5 10% 0 0% 3 6% OUTSIDE GUIDELINES OUTSIDE 1 2% 8 17% 6 13% - – * Adherence of PP-2010 to GESIDA-2011. - In 2010 98% of treatments adhered to GESIDA-2010; however in 2011 adherence to GESIDA-2011 fell to 83% (α<0.003). - It seemed as though some doctors were still following the 2010 guidelines in 2011, since 88% of treatments were in line with PP-2010 and only 83% were in line with PP-2011. Furthermore, PP-2010 preferred therapies (recommended by GESIDA-2010) were used more than GESIDA-2011 recommended treatments in 2011, verging upon significance (α=0.05). Materials and methods Eighty-five treatment-naïve patients (49(2010) and 36(2011)) were included in a retrospective observational study of ART and laboratory/microbiology parameters (January 2010 – September 2011), in a 450-bed tertiary hospital. The latest GESIDA guidelines (January 2010 and January 2011) were reviewed. Excel 2007 and SPSS Statistics 19 were used for statistical analysis. Results There were slight differences in ART between GESIDA-2010 and GESIDA-2011 according to the new investigation carried out during 2010, but none of them seem to be reflected in PP-2011, as there were non-significant differences in all aspects of treatment. The main difference was the reduction in the number of recommended treatment combinations (16 to 9). While GESIDA-2010 allowed antiretroviral drugs to be combined relatively freely, GESIDA-2011 narrowed it to only certain combinations. Looking at patients with a CD4 count in the range 350-500, in general, and leaving exceptions aside, GESIDA-2010 recommended not starting treatment while GESIDA-2011 considers the patients as treatable. In our study, 12% started in 2010, while 23% started in 2011(RR≈2). The table below shows the adherence of the prescription profile to GESIDA. Conclusions The results suggest that the prescription profile seems to adhere more to the previous year's recommendations (GESIDA 2011 adherence: PP-2010(87%); PP-2011(78%)). The high percentage of adherence of PP-2010 to the 2010 guidelines could be partly explained by the freedom of therapeutic options available under it at that time. GESIDA is a reference for ART, and when it is published once a year, prescribers should update their practice in line with it.