Evaluation of Hypersensitivity Reactions Following the Discontinuation of Prophylactic Pre-medications: Pharmacotherapy Best Practices Award, sponsored by Pfizer Canada Inc.

摘要

Introduction: Paclitaxel administration is associated with a variable rate of hypersensitivity reactions (HSRs), which are infrequent beyond the second dose. Pre-medications (corticosteroids and anti-histamines) are administered to reduce this risk, but are associated with adverse effects and a longer visit time. It is unclear if pre-medications are needed beyond the second dose. Pre-medications were discontinued for all patients receiving paclitaxel-based regimens beyond the second dose. We evaluated this practice change and hypothesized that this policy is unlikely to result in an increased rate of HSRs. Methods: A retrospective chart review was performed to review the incidence of HSRs. Adult patients were included if they received paclitaxel-based chemotherapy and did not have an HSR during the first two doses. Surveys were administered to patients receiving weekly paclitaxel and time required to administer pre-medications was tracked. Results: Two of 111 (1.80%) patients receiving paclitaxel + platinum and two of 76 (2.63%) patients receiving paclitaxel +/- trastuzumab had non-severe HSRs. An average of 90 minutes of chair time per patient (per clinic visit), was saved. Of 52 surveys, 23 (44%) were returned and 20 patients (86.9%) preferred treatment without pre-medications. Relevance to CSHP 2015 Initiative: This project supports and promotes the implementation of goal 3 (objective 3.2). This project generated evidence to support a practice change and protocol to remove pre-medications based on the evidence of similar rates of HSRs in comparison to current literature. Discussion: This is the first study to remove pre-medications for paclitaxel + platinum regimens, evaluate patient preference and track time savings. Limitations include the retrospective, single center design of the study. Conclusion: The discontinuation of pre-medications is safe and feasible if a patient has not experienced an HSR during the first or second dose of paclitaxel. Omission of pre-medications has substantial time saving implications for chemotherapy chair time.