Leslie Dan Faculty of Pharmacy

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The Leslie Dan Faculty of Pharmacy is Canada’s largest pharmacy school and has a world class reputation in education and research. Educational programming is at the heart of the Leslie Dan Faculty of Pharmacy and it currently offers a number of cutting-edge educational programs.

The research conducted by students, faculty, research associates and postdoctoral fellows at the Leslie Dan Faculty of Pharmacy focuses on drugs and medications. The results of this research have a profound impact in drug therapy on both the molecular level and on entire populations.

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Browsing Leslie Dan Faculty of Pharmacy by Subject "Adverse Events"

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    Adverse Events Associated with Immune Checkpoint Inhibitors: Overview of Systematic Reviews
    (Drugs, 2022-04-13) Morin, Sydney
    Background Recognition and management of adverse events (AEs) associated with immune checkpoint inhibitor (ICI) use by cancer patients requires expertise from multiple disciplines. Greater awareness of potential AEs may result in earlier recognition, appropriate management, and better patient outcomes. Objective The primary objective of this overview of systematic reviews was to synthesize and consolidate systematic review evidence describing the incidence proportion and severity of AEs associated with various ICI therapies across different cancers. Methods A systematic literature search of four databases was conducted to identify systematic reviews that describe the incidence proportion and severity of AEs related to ICI therapy in cancer patients. A systematic review was eligible if it included adults with cancer; on ICI alone or in combination with another ICI, chemotherapy, or targeted therapy; severity (graded according to the Common Terminology Criteria for Adverse Events) and incidence proportion of AEs and whether it reported its eligibility criteria. AEs of interest were identified through an iterative ranking exercise by key stakeholders and knowledge users. Extraction of PICOTTS elements and quality indicators (AMSTAR-2) were used to manage overlap of primary studies across systematic reviews at the outcome level. Cancer subtypes were mapped to drug class and AE severity. Results Overall, 129 systematic reviews met the inclusion criteria for data mapping. Systematic reviews reported incidence proportions for more than 76 AEs, of which 34 were identified as AEs of interest. After overlap assessment, 65 systematic reviews were chosen for data extraction. The three AEs with the highest median incidence were fatigue (18.3%, interquartile range [IQR] 15.0–28.0%), diarrhea (15.3%, IQR 9.7–29.2%) and rash (14.4%, IQR 10.3–19.2%). The three AEs (high-grade) with the highest median incidence were diarrhea (1.5%, IQR 1.2–6.0%), colitis (1.3%, IQR 0.6–6.1%) and neutropenia (1.2%, IQR 0.4–3.3%). Incidence proportions of high-grade AEs were often considerably lower than all-grade AEs and combination therapy (ICI combinations or combinations of ICI with chemotherapy or targeted therapy) was responsible for some of the highest incidence proportions regardless of AE. Rare AEs and certain cancer subtypes were not well reported. Conclusions Early recognition of AEs associated with ICIs requires expertise from diverse specialists, not just oncologists. Greater awareness of potential AEs may result in earlier recognition, appropriate management, and better patient outcomes. PROSPERO Registration CRD42021231593.
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    Optimization of Immune Checkpoint Inhibitor Immune Related Adverse Event Management in the Acute Care Setting: A Quality Improvement Project
    (2020-09-04) Surgenor, Kerstin
    Patients receiving immune checkpoint inhibitor (ICI) medications are at risk of auto-inflammatory toxicities called immune related adverse events (irAEs). Although rare, these irAEs can be very different in presentation, severity, onset and duration and studies have indicated that early recognition and prompt appropriate treatment with systemic corticosteroids is essential to improve patient outcomes. The primary objective of this research project was to assess historical management of irAEs at the Kingston Health Sciences Centre (KHSC), Kingston General Hospital (KGH) site and identify toxicity management trends that would assist recommendations for future clinical support tools for toxicity management. This was a single-centre retrospective chart review of patients who experienced an irAE within 6 months of being on an ICI, conducted at the KHSC KGH site from December 2017 to May 2020. Compliance with the Cancer Care Ontario (CCO) Immune Checkpoint Inhibitor Toxicity Management Clinical Practice Guideline, time to corticosteroid order and administration as well as time to irAE toxicity resolution was assessed. Results showed there were inconsistencies with corticosteroid dosing in accordance with the CCO Immune Checkpoint Inhibitor Toxicity Management Clinical Practice Guideline for patients admitted to the acute care setting, most commonly sub- therapeutic dosing, which may have led to delay in toxicity resolution and readmissions to the hospital. Patients admitted through the Cancer Centre of Southeastern Ontario (CCSEO) appeared to have faster time to irAE diagnosis (often through scheduled oncology ambulatory follow-up visits) and faster time to corticosteroid order than those presenting to the Emergency Department (ED), but similar time from corticosteroid order to first corticosteroid dose administration. Recurrent or unresolved irAEs from ICI medications were common, as 55.2% of patients had a prior irAE, and of these patients 75% were on a corticosteroid at home prior to admission. Immune related adverse events (irAEs) can be difficult to diagnose, which may lead to delays in toxicity management for patients admitted through both the ED and the Cancer Centre of South Eastern Ontario (CCSEO). Clinical support tools for irAE identification and management with clear direction on diagnostic laboratory investigations, corticosteroid dosing guidance based on toxicity type and toxicity severity and first corticosteroid dose to be administered immediately would be beneficial to help manage current gaps in patient care and improve patient outcomes for those who experience irAEs.