Banca de DEFESA: TAIANE CANDEIAS DA SILVA

THE CHALLENGES OF THE USE OF VENETOCLAX IN PATIENTS WITH ACUTE MYELOID LEUKEMIA.

Drug Interactions, Leukemia e Antineoplastic Agents

Introduction: Venetoclax is a selective inhibitor of lymphoma B cell (BCL-2), an anti-apoptotic protein. Was approved in 2018 by major regulatory agencies in the United States, European Union and Brazil for the treatment of patients with Acute Myeloid Leukemia (AML) that are refractory to previous treatments or with relapse. Innovations in cancer treatment have directed therapies to target cells. These therapies are more tolerable than conventional chemotherapies, however potential, drug interactions are more frequent. Knowledge of drug interactions, individualization treatment and adequate pharmacotherapy management are important to ensure therapeutic success, as it offers the patient less experience with adverse events, improved treatment adherence, reduced additional costs to manage drug-related problems, improves the patient's quality of life and has a smaller impact on costs to public coffers than those that are already spent directly with the provision of treatment. Objective: Describe drug interactions and the challenges of using venetoclax in patients with AML at a Sentinel Hospital in Salvador. Methodology: This descriptive, observational and retrospective study. Data collection was performed using secondary data obtained from the search of medical records and clinical documents of these patients. Drug interactions induced by treatment with venetoclax were identified using the website drugs.com, which classifies interactions according to the effect and necessary management in: contraindicated, major, intermediate and minor. For data evaluation, parametric and non-parametric statistical tests were used. Results and Discussion: Ten patients who used venetoclax were evaluated, 100% of the patients (n=10) had a diagnosis of AML. Mean age was 46 years with standard (SD=17). A total of 319 drug interactions were found in the 10 patients and found that the greater the number of drugs prescribed, the greater the number of interactions. Drug interactions with venetoclax were identified as serious and contraindicated. About drug interactions, with venetoclax, the most frequent were venetoclax + voriconazole, followed by venetoclax + morphine, which are important drugs used in oncology. When it comes to contraindicated drug interactions, regarding the interactions mechanism, it was observed that 40% are pharmacokinetic, however, the serious interactions with venetoclax 100% are pharmacokinetic mechanisms involving the enzymes of Cytocromop450 and P-glycoprotein Conclusion: Drug interactions related to CYP and Glycoprotein P are the main limiting factors for the use of venetoclax in combination to other drugs. Therefore, a monitoring system needs to be adopted to check and evaluate these interactions and access their efficacy and safety, as much as the adverse arising events and impacts happened in cancer treatment. These impacts can be lead to an increase in the length of hospital stay or be fatal