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EBMT 2021 Annual Meeting - Supportive Care

Pharmacist Committee

Pharmacists Day - Pharm2 Supportive care 1

Tuesday, March 16, 11:00 - 12:15, Auditorium 5

The second of today’s Pharmacist Day sessions explores supportive care, and is opened with a talk on drug-drug interactions between antifungals and immunosuppressive agents, delivered by Dr Eline Muilwijk, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.

Her presentation will give an update on the newest data on drug-drug interactions between triazoles and the immunosuppressive agents cyclosporine A, tacrolimus and sirolimus, and provide insight in the empirical dose reductions necessary when combining these drugs.

This will be followed by a talk from Professor Cristoph Ritter, of the Institute for Pharmacy and Clinical Pharmacy, Greifswald University, Germany, who will discuss drug interactions with complementary and alternative herbs and medicines.

“Complementary herbal preparations are increasingly used by oncological patients. This can pose a significant risk for herb-drug interactions and potentially jeopardise treatment outcome,” he explains. “In contrast to chemically defined drugs, herbal preparations are often not well characterised to estimate their herb-drug interaction potential. Moreover, how clinical herb-drug interactions are conducted can vary substantially.”

In order to support professionals to advise patients on the use of complementary herbal preparations, Professor Ritter’s team systematically searched for and identified evidence for the herb-drug interaction potential of representative herbs. From these, herb-drug interaction data were extracted and collated into a relational database. Based on these data, they developed an algorithm that calculates the herb-drug interaction risk of an herb and an oncological or supportive drug. The risk grading is displayed in a pairwise herb-drug interaction matrix, and detailed information on the underlying investigations is provided.

Prof Ritter says: “From the analysis of the retrieved herb-drug interaction data we conclude that for a better estimation of the herb-drug interaction potential of an herbal preparation, a high grade of standardisation when assessing herb-drug interactions is required. In addition, to individually estimate the herb-drug interaction risk it is necessary to provide sufficient information on the herbal preparations’ characteristics and herb-drug interaction assessment parameters.”

In the final presentation, Raakhee Shah, Lead Pharmacist (Haematology, BMT & ATMP) at University College London Hospital NHS Trust, London, will discuss new developments in the management of steroid-refractory GVHD.

He will discuss the mechanism of acute and chronic GVHD and different management strategies being investigated to improve patient outcomes and morbidity. The JAK inhibitor, Ruxolitinib, which is US FDA-approved for the treatment of steroid refractory acute GVHD and NHS England-approved for the treatment of steroid refractory acute and chronic GVHD; and the BTK inhibitor, Ibrutinib, which is FDA approved for the treatment of steroid refractory chronic GVHD, will be discussed. The clinical evidence that led to the funding of these first licensed treatment options for steroid refractory GVHD will be presented.

Novel treatment options currently being investigated for the management of steroid refractory acute or chronic GVHD such JAK1 inhibitor Itacitinib, cytokine modulators, immune checkpoint inhibitors, ROCK inhibitor Belumosudil (KD025) and proteasome inhibitors will also be presented.