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Faculty Highlights | 1
Dean of the School of Pharmacy
Dr. Mohamad Rahal
SOP Newsletter Editor–in-Chief
Dr. Dalal Hammoudi
Contributors to this issue
(In alphabetical order)
Faculty
Dr. Sahar Abou Rida
Dr. Nour Chamsine
Dr. Michelle Cherfan
Dr. Nermine Choumane
Dr. Hadi Dassouki
Dr. Sahar Haydar
Dr. Razan Mhanna
Dr. Bouchra Mouhtadi
Dr. Nisreen Mourad
Dr. Sylvia Saade
Dr. Samar Younes
Students
Rawane Barakat
Iqbal Fahs
Graphic Designer
Hiba Haj Omar
About the School of Pharmacy
One of the highly ranked private schools
of pharmacy nationwide, the Lebanese
International University School of
Pharmacy maintains an elegant reputation for innovative educational programs
and skillful training through both degrees
it offers, the BPharm and PharmD. Over
the past few years the School has strived
establish a structure which enables our
graduates to become an added quality to
the healthcare system.
The School focuses on clinical pharmacy,
community outreach, and training on
the optimal use of medication therapy
through didactic as well as clerkship/
internship courses. Today, our School is
acknowledged by private, public, and
international institutions.
Our graduates attain high success rate in
the national pharmacy examination
(colloquium), and are highly recognized by
national and international pharmaceutical
companies.
The SOP Newsletter, published
tri-annually, delivers drug and health
information news from the School’s
Faculty members and highlights some of
the School’s events.
© 2016 BY THE LEBANESE INTERNATIONAL
UNIVERSITY SCHOOL OF PHARMACY
Letters to the editor, questions, comments,
and requests should be kindly addressed to:
Dr. Dalal Hammoudi, RPh, MSc, PhD
School of Pharmacy;
Lebanese International University
Bekaa Campus, Khyara, Lebanon
Tel: 961 8 640930/1/2; Ext 22304
[email protected]
EDITOR’S NOTE
Dear Readers,
According to the American Journal of Pharmaceutical Education, successful recruitment
and development of pharmacy faculty members is essential now more than ever. Such
task is achievable through a number of activities, including continuing professional
development, peer evaluation, seminars, teaching and learning workshops, preceptor skill
improvement, research, as well as written communications. Several studies have also
recognized the impact of pharmacy newsletters, both among community and hospital
pharmacists. These periodicals serve as an effective means of communication, for keeping
abreast of pharmaceutical advances, and for “life-long” learning process within the
pharmacy profession.
IN THIS ISSUE
4
6
8
EDITORIAL NOTE
SOP PARTICIPATION IN 75TH FIP
CONGRESS
OSIMERTINIB:
NEW DRUG OF THE MONTH
UPDATES IN CARDIOVASCULAR DISEASE
10 A NEW CLINICAL TOOL FOR CROHN’S DISEASE
11 MEPOLIZUMAB: A NEW MEDICATION FOR ASTHMA
13 PEDIATRIC ANEMIA IN LEBANON
15 ANTIBIOTIC UPDATES
16 PATIROMER: A NEW TREATMENT FOR
HYPERKALEMIA
24 STUDENTS CORNER
27 SAINT JUDE FUNDRAISING CAMPAIGN
28 CONTINUING EDUCATION SESSIONS
29 55TH ICAAC
VISIT TO NEW OPL PRESIDENT
30 SOP GALA DINNERS
32 PHARMACY UNION ACTIVITIES
While the School of Pharmacy at the Lebanese International University strives to promote
pharmacy education and mentor competent pharmacy graduates, SOP Newsletter was
established to aid in providing information to the School teaching community and students.
The purpose of our publication, since the first issue in April 2013, was to highlight new
knowledge that fosters the appropriate use of drugs and improves patient outcomes at
individual and societal level. Through variety of information presented, focus is on the
enduring role of the pharmacist, as the specialized drug consultant to the physician, and
the advisor to the public on multiple health issues.
In the following pages, I invite you to share some of new pharmacy advances and
research pointed out by our faculty. Beside these, a group of events through which the
School communicates with the broad pharmacy sectors and seeks community outreach,
is described in the SOP Newsletter. It also features a calendar of upcoming events that
will be soon tackled by the School.
The SOP Newsletter is still on the start, but definitely improving with your suggestions
and comments as well as your participation.
Enjoy reading the Spring 2016 issue!
33 18TH CONGRESS OF SCIENTIFIC
ASSOCIATION OF COLLEGES OF
PHARMACY IN THE ARAB WORLD
34 23RD OPL CONGRESS
35 PRESIDENT’S AND DEAN’S LISTS
36 50TH ASHP
SOP SOCIAL LIFE
UPCOMING EVENTS
Dalal Hammoudi, PhD
Assistant Professor and Chair
SOP Newsletter Editor-in-Chief
SOP PARTICIPATES IN 75TH
ANNUAL FIP CONGRESS AT
DUSSELDORF, GERMANY
The School of Pharmacy at the Lebanese International University is a member of the International Pharmaceutical Federation Academic Institutional Membership (FIP AIM). Represented by the Dean, Dr. Mohamad Rahal, and Dr. Marwan Akel, the School participated in the FIP 75th World Congress of Pharmacy
and Pharmaceutical Sciences, from September 29th till October 3rd, 2015, in Dusseldorf, Germany. Over
3,000 pharmacists and pharmaceutical scientists from 111 countries attended the congress, the theme
of which was “Better practice — science based, evidence driven”.
In this premier international pharmacy event, experts from around the globe meet, learn, share
and exchange views. A varied and rich program
was featured in the congress, addressing problems and achievements of the pharmacy profession via lectures, plenary sessions, poster exhibitions and leadership meetings.
Like each year at the FIP World Congress of Pharmacy and Pharmaceutical Sciences, the FIP AIM
hosted a Deans’ Forum, inviting all representative
deans from the membership to meet each other
and discuss current and relevant topics in an international arena. Dr. Rahal participated in this
year’s forum, entitled “Integrating science and
practice into the pharmacy/pharmaceutical education”. AIM members, deans and academic leaders discussed, debated and shared how pharmacy
and pharmaceutical sciences education institutions are transforming their programs towards
achieving better health.
Dr. Akel also represented LIU in the “FIP working
group on pharmacists’ role in harm reduction”. The
objectives of this group are to collect available evidence for the role and impact of pharmacists and
their associations in harm reduction programs on
national and regional levels, and to support pharmacists involvement in such activities.
Most of the sessions where interactive, and allowed participants to exchange and expose their
ideas in their fields of expertise. Moreover, field
visits to international pharmaceutical companies
and sections’ dinners were organized. The social
side, meeting with fellows and friends from different pharmacy sectors, complemented the diverse
congress program.
During the forum, inter-professional education, leadership in pharmacy, and integration of research
within education and practice were discussed. Academic issues were highlighted in round tables and
recommendations were drawn. Moreover, quality assurance of pharmacy education made the theme of
a dynamic international workshop. Dr. Rahal communicated his experience and expectations through
different sessions of the forum. The strategic planning for the future focused on coordination between
AIM members, including exchange of faculty and organization of regular meetings and webinars.
As part of the academic/community scientific sessions of the congress, Dr. Marwan Akel delivered an
oral presentation discussing the findings of his study: “An overview of kidney stone disease in Lebanon”.
4 SOP Newsletter | February 2016
|5
New Drug of the Month
OSIMERTINIB – NEW TYROSINE KINASE
INHIBITOR WITH PREMEDICATION TEST:
TOWARDS MORE TARGETED THERAPY
FOR NON-SMALL CELL LUNG CANCER
Sahar Abou Rida, PharmD
Key point: Lung cancer is the leading cause of
cancer death, with an estimated 221,200 new diagnoses and 158,040 deaths in the United States
alone during 2015, according to the National
Cancer Institute. The most common type of lung
cancer is non-small cell lung cancer (NSCLC), in
which mutations in epidermal growth factor receptor (EGFR) increase sensitivity to EGFR tyrosine kinase inhibitors (TKIs), like erlotinib, gefetinib, and afatinib. Thus, these agents are first-line
in patients with newly diagnosed advanced NSCLC
with EGFR-positive mutations.
Finer points: Almost all NSCLC patients who initially respond to an EGFR TKI subsequently develop disease progression, due to acquired resistance. On November 13th, 2015, the U.S. Food and
Drug Administration (FDA) granted accelerated
approval for osimertinib (Tagrisso® , Astra Zeneca), a new, oral EGFR TKI, which retains activity
against EGFR-mutant tumors that have specifically acquired the T790M resistance mutation, and
are resistant to other EGFR-blocking therapy. FDA
also approved the cobas EGFR mutation test (v2),
the first companion diagnostic test to identify the
type of EFGR resistance mutation that osimertinib
is recognized to target.
6 SOP Newsletter | February 2016
Osimertinib is an irreversible EGFR TKI, selective
against T790M resistance mutants and spares
wild-type EGFR. It is available in two strengths,
40 mg and 80 mg tablets.
Moreover, for patients with swallowing problems,
the tablet can be placed in a container with 50
ml of non-carbonated water and stirred till dispersed, and then drank or administered through a
naso-gastric tube.
An oral, potent, and selective third
generation irreversible inhibitor of
EGFR, osimertinib, is now available
with a companion diagnostic test
The safety and efficacy of osimertinib were established in two multicenter, single-arm studies involving a total of 411 patients with advanced EGFR
T790M mutation-positive NSCLC whose disease
worsened after treatment with an EGFR-blocking
medication. In these two studies, 57% of patients
in the first study and 61% of patients in the second study experienced a complete or partial reduction in their tumor size.
Around 60% of patients had partial
or total reduction in tumor size with
osimertinib
What you need to know: The high EGFR expression on NSCLC cell surface leads to faster proliferation. EGFR-blocking drugs disrupt the signal from
the protein that is needed for further cell growth.
But these drugs tend to lose efficacy over time,
often as the result of new mutations in the EGFR
gene, such as T790M mutation. Osimertinib is a
newer type of EGFR-blocking drug that also targets cells with T790M mutation.
References:
1. Food and Drug Administration Press Release. FDA approves new pill
to treat certain patients with non-small cell lung cancer. November 13,
2015.
2. Jänne, PA, et al. AZD9291 in EGFR inhibitor–resistant non–small-cell
lung cancer. N Engl J Med. 2015; 372(18): 1689-1699.
3. Cross DA, et al. AZD9291, an irreversible EGFR TKI, overcomes
T790M-mediated resistance to EGFR inhibitors in lung cancer. Cancer
Discov. 2014; 4(9):1046-1061.
4. de Bruin EC, et al. Reduced NF1 expression confers resistance to
EGFR inhibition in lung cancer. Cancer Discov. 2014; 4(5): 606-619.
Osimertinib is a new choice for
advanced NSCLC with T790M
mutation
The recommended dose is 80 mg once daily with
or without food until disease progression or unacceptable toxicity. Dose can be reduced to 40
mg daily in case of intolerable adverse events.
Critical adverse events include cardiomyopathy,
QT-interval prolongation, interstitial lung disease
and pneumonitis. Most common adverse events
include diarrhea, rash, acne, nausea, decreased
appetite, dry skin, and nail toxicity. Accordingly,
it is recommended to monitor cardiac functions
(electrocardiogram and left ventricular ejection
fraction) before and during treatment, as well as
any signs or symptoms of interstitial lung disease
or pneumonitis, dermatologic, and gastrointestinal toxicity. Besides, osimertinib can harm a developing fetus; men and women should use effective contraception during treatment with the drug.
Faculty Highlights | 7
Updates in Cardiovascular disease
IDRACIZUMAB APPROVAL - A MILESTONE
DEVELOPMENT IN DABIGATRAN REVERSAL
Nour Chamsine, PharmD
Key point: on October 16th, 2015, the U.S. Food
and Drug Administration granted idarucizumab
(Praxbind®) accelerated approval. This drug is a
fully humanized, monoclonal antibody fragment
developed by Boehringer Ingelheim, that rapidly
reverses the blood-thinning effects of the anticoagulant dabigatran in patients who require emergency surgery or other urgent procedures, or who
have life-threatening or uncontrolled bleeding.
8 hours. Idracizumab resulted in a median maximum reversal of anticoagulation of 100% in the
first 4 hours, with 88% to 98% of patients achieving complete reversal. The effect was seen within
minutes of drug administration. Most frequently
reported adverse reactions were hypokalemia,
delirium, constipation, pyrexia, and pneumonia.
Idarucizumab quickly nullifies the
anticoagulant effect of dabigatran
within minutes of intravenous
administration
Finer points: Since approval of dabigatran five
years ago, the lack of reversal agents for this drug
as well as other recent oral anticoagulants, including rivaroxaban, apixaban and edoxaban has
been an issue. Idarucizumab is the first agent for
such purpose, that binds tightly to dabigatran and
neutralizes its anticoagulant activity. It is administered via intravenous injection.
The safety and efficacy of idarucizumab have
been established in 3 trials with a total of 283 dabigatran-treated healthy volunteers. The reversal
agent caused an immediate drop in plasma concentrations of dabigatran that was sustained for at
least 24 hours. The most common adverse reaction reported was headache.
Idracizumab was approved under
the FDA’s accelerated approval
program, which allows earlier access
to breakthrough drugs for serious
conditions
Idarucizumab also continues to be evaluated in
REVERSE-AD (Reversal Effects of Idarucizumab
on Active Dabigatran), an ongoing single-cohort
case series trial that includes dabigatran-treated
patients who have uncontrolled or life-threatening
bleeding or require emergency surgery or other invasive procedures that cannot be delayed at least
8 SOP Newsletter | February 2016
Aripazine is a new molecule under
investigation as a nonspecific
reversal agent
What you need to know: Given the growing use
of direct oral anticoagulants, rapid and effective
reversal agents would be advantageous. Idarucizumab is a promising antidote to reverse action of
dabigatran. The drug fills an unmet medical need
with direct clinical benefit to patients. Accordingly, it was cleared under the FDA’s accelerated approval program, designed to provide patients with
earlier access to promising new drugs.
Interestingly, a new synthetic molecule, aripazine,
is currently undergoing phase 2 trials for bleeding
reversal. This molecule binds to all novel anticoagulants, as well as to heparins, low molecular–
weight heparins, and fondaparinux. Aripazine has
multiple binding sites present on the molecule for
each anticoagulant, making it a nonspecific reversal agent and warranting its yet-to-prove usefulness.
References:
1. Food and Drug Administration Press Release: FDA approves Praxbind, the first reversal agent for the anticoagulant Pradaxa. October
16, 2015.
2. Pollack CV Jr, Reilly PA, Eikelboom J, et al. Idarucizumab for dabigatran reversal. N Engl J Med. 2015;373:511-520
3. Glund S, Stangier J, Schmohl M, Gansser D, Norris S, van Ryn J, et
al. Safety, tolerability, and efficacy of idarucizumab for the reversal
of the anticoagulant effect of dabigatran in healthy male volunteers:
a randomised, placebo-controlled, double-blind phase 1 trial. Lancet.
2015;386(9994):680–690.
4. Burness CB. Idarucizumab: First Global Approval. Drugs.
2015;75(18):2155–2161.
5. Ansell JE, Bakhru SH, Laulicht BE, Steiner SS, Grosso M, Brown K,
et al. Use of PER977 to reverse the anticoagulant effect of edoxaban.
N Engl J Med. 2014;371(22):2141–2142.
WILL ANDEXANET ALFA BE THE FIRST REVERSAL
AGENT FOR RIVAROXABAN AND APIXABAN?
Sahar Haydar, PharmD
Key point: Over the past decade, rivaroxaban, apixaban, and endoxaban have emerged as orally active, direct factor Xa inhibitors. They are indicated for stroke prophylaxis in patients with nonvalvular atrial fibrillation,
treatment and prevention of deep vein thrombosis and pulmonary embolism, and the prevention of venous
thrombosis after orthopedic surgery. Unlike bleeding caused by warfarin, which can be reversed using lowdose vitamin K1, there is no available agent to reverse bleeding or stop anticoagulant effects of oral factor Xa
inhibitors.
Andexanet alfa reverses bleeding due to factor Xa inhibitors minutes after
injection and without serious adverse effects
Finer points: Andexanet alfa is a recombinant modified human factor Xa decoy protein that has the ability to
bind to factor Xa inhibitors at their active site with high affinity. Because only the unbound forms of factor Xa
inhibitors apixaban and rivaroxaban are active, andexanet alfa would therefore inactivate the factor Xa inhibitor by binding to the active site. This would increase factor Xa levels in the body, which in turn would reduce
anticoagulant activity. Andexanet alfa retains the ability of native factor Xa to bind direct factor Xa inhibitors
as well as low molecular weight heparin–activated antithrombin III (ATIII).
Two parallel trials, ANNEXA-A and ANNEXA-R (Andexanet Alfa, a Novel Antidote to the Anticoagulation
Effects of Factor Xa inhibitors Apixaban and Rivaroxaban), were designed to establish the efficacy and safety
of andexanet alfa for the reversal of anticoagulation with apixaban or rivaroxaban in older healthy volunteers.
Andexanet alfa was dosed as shown in Table 1.
ANNEXA-A
ANNEXA-R
Bolus
400 mg IV bolus (30 mg/min)
800 mg IV bolus (30 mg/min)
Bolus and continuous infusion
400 mg IV bolus +
Continuous infusion of of 4 mg/min
for 120 min
800 mg IV bolus +
Continuous infusion of of 8 mg/min
for 120 min
Table 1: Dosing of Andexanet alfa in ANNEXA-A and ANNEXA-R trials
Activity of anticoagulants decreased by 94% for apixaban and by 92% for rivaroxaban after administration of andexanet alfa
The results of both trials showed reduction in anti–factor Xa activity among patients receiving andexanet
alfa compared to those on placebo (Table 2 and Table 3). There were no serious adverse events reported.
Researchers concluded that andexanet alfa reversed the anticoagulant activity of apixaban and rivaroxaban
minutes after administration and for the duration of infusion.
Andexanet Alfa
Placebo
Anti-factor Xa
activity reduction
94 %
21%
Thrombin generation
restoration
100%
11%
Table 2: Results among the apixaban treated patients (ANNEXA-A)
Andexanet Alfa
Placebo
Anti-factor Xa
activity reduction
92%
18%
Thrombin generation
restoration
96%
7%
Table 3: Results among rivaroxaban treated patients (ANNEXA-R)
Currently, the FDA has designated andexanet alfa as a breakthrough therapy, which helps accelerate the development and review of drugs for serious or life-threatening conditions. Antidotes to the new generation of
oral anticoagulants, would be extremely valuable for managing otherwise-uncontrolled bleeding.
What you need to know: Andexanet Alfa has high potential to become the first FDA-approved universal
antidote for reversal of bleeding due factor Xa inhibitors. Its approval will be a substantial improvement to
overcome a major limitation of these agents.
References:
1. Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet alfa for the reversal of factor
Xa inhibitor activity. N Engl J Med. 2015; DOI: 10.1056/NEJMoa1510991.
2. Lu G, DeGuzman FR, Hollenbach SJ, et al. A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Nat Med. 2013;
19:446-451.
3. Crowther M, Gold A, Lu G, Leeds J, Wiens B, Conley P, et al. 101: Phase 3 of
andexanet alfa for reversal of apixaban and rivaroxaban anticoagulation in older
subjects. Crit Care Med. 2015;43(12 Suppl 1):26–27.
Faculty Highlights | 9
Updates in Gastroenterology
A NEW TOOL FOR IDENTIFICATION,
ASSESSMENT, AND INITIAL MANAGEMENT OF
CROHN’S DISEASE
Michelle Cherfan, PharmD, MSc
Key point: The treatment of Crohn’s disease is in evolution. Historically, patients were treated based on
clinical symptoms. In recent years, it was understood that symptomatic response and remission alone
are insufficient to ensure that underlying inflammation has resolved. More recently, data support the
use of both symptomatic remission and endoscopic remission as treatment goals for patients with the
disease.
Finer points: To help clinicians better assess and treat patients with Crohn’s disease, the American
Gastroenterological Assocaiation (AGA) released a clinical decision support tool in September, 2014. This
tool was created using a rigorous review process and is based on current evidence and AGA’s practice
guideline for the management of Crohn’s disease. This tool incorporates assessments for inflammatory
status, comorbidities, and disease- and therapy-related complications, as well as treatment recommendations based on patient risk and remission status.
According to the decision tool, patients should be classified as low risk or moderate-to-high
risk, with treatments assigned according to risk status.
Low risk patients
Moderate-to-high risk patients
•
•
•
•
•
•
•
•
•
•
•
•
Age at initial diagnosis > 30 years
Limited anatomic involvement
No perianal and/or severe rectal disease
Superficial ulcers
No prior surgical resection
No stricturing and/or penetrating behavior
In low risk patients who do not achieve remission, recommendations include an assessment of drug
levels for immunosuppressive therapy, with consideration given to an anti-TNF therapy. For moderateto-high risk patients not in remission, treatment options were similar to those recommended as initial
therapy. The decision tool also suggests treatment recommendations for patients in remission for both
low risk and moderate/high risk patients.
The AGA noted that this tool is only a starting point, as there is a future opportunity to create tools that
focus on both treating the underlying disease and providing psychosocial care to the patient. Moreover,
they noted that with the recent push towards providing better value in health care, future tools should
include quality indicators and cost utility analyses to better help select therapies that provide value to
patients and to society. In patients receiving treatments such as azathioprine, steroids, methotrexate,
and/or anti-TNF, extensive education should be provided about their proper and safe use.
What you need to know: A new Crohn’s disease clinical decision support tool was released by the AGA
to help clinicians assess and stratify patients and determine effective therapies for disease management
based on evidence-based treatment recommendations. It is available at: http://campaigns.gastro.org/
algorithms/IBDCarePathway/.
Reference:
Sandborn WJ. Crohn’s disease evaluation and treatment: clinical decision tool. Gastroenterology 2014;147: 702–05.
Updates in Respiratory Disorders
FDA-APPROVES MEPOLIZUMAB FOR
PATIENTS WITH SEVERE ASTHMA
Sylvia Saade, PharmD
Age at initial diagnosis < 30 years
Extensive anatomic involvement
Perianal and/or severe rectal disease
Deep ulcers
Prior surgical resection
Stricturing and/or penetrating behavior
Treatment options have also evolved based on evidence from controlled trials. Treatment options were
modified from mesalamine and antibiotics for low-risk patients and steroids, azathioprine, and methotrexate for moderate-to-severe disease, to budesonide, steroids and azathioprine for low-risk patients,
and biologic therapy with tumor necrosis factor (TNF) antagonists (ideally in combination with azathioprine) and integrin antagonists for high-risk patients. Therapeutic drug monitoring is applied to help
guide decision making in patients treated with biologic agents who lose response.
Initial treatment includes the following:
Low risk patients
Moderate-to-high risk patients
Ileum and/or proximal colon — none to
minimal systemic symptoms
• Budesonide 9 mg per day with or without
azathioprine
• Tapering course of prednisone with or
without azathioprine
Diffuse or left colon — none to minimal
systemic symptoms
• Tapering course of prednisone with or
without azathioprine
Moderately severe Crohn’s disease
• Use anti-TNF monotherapy over no therapy or
thiopurine monotherapy
• Use anti-TNF + thiopurine over thiopurine
monotherapy or anti-TNF monotherapy
• Use methotrexate for patients who do not
tolerate purine analog in combination with anti-TNF
• Combination therapy with an immunosuppressant and an anti-TNF should be considered for
patients requiring a 2nd or 3rd biologic agent
Key point: The World Health Organization estimates that over 235 million people live with asthma worldwide. For many of these patients, existing therapies can provide adequate symptom
control if used appropriately. However, approximately 5% of patients with severe asthma cannot
achieve symptom control with existing therapies.
On the 4th of November, 2015, the FDA approved
mepolizumab (Nucala®), a humanized monoclonal
antibody, as add-on maintenance treatment for
patients with severe asthma aged 12 years and
older, and with an eosinophilic phenotype.
Finer points: Severe asthma is defined as “asthma which requires treatment with high dose in-
10 SOP Newsletter | February 2016
haled corticosteroids (ICS) plus a second controller (and/or systemic corticosteroids) to prevent it
from becoming ‘uncontrolled’, or which remains
‘uncontrolled’ despite this therapy”. Severe asthma patients are also often categorized by longterm use of oral corticosteroids (OCS). In a subset
of severe asthma patients, the over-production of
eosinophils is known to correlate with severity and
frequency of exacerbations. Interleukin-5 (IL-5) is
the major cytokine responsible for growth, differentiation, recruitment, activation, and survival of
eosinophils. Mepolizumab is a humanized IL-5 antagonist produced in Chinese hamster ovary cells,
and it reduces the production and survival of eosinophils by inhibiting IL-5 signaling.
Faculty Highlights | 11
75 mg intravenous (IV), 100 mg subcutaneous
(SC), or placebo every four weeks.
For the primary endpoint of reduction in exacerbations, defined as worsening of asthma requiring
use of systemic corticosteroids and/or hospitalization, both mepolizumab treatment arms showed
a statistically significant reduction in frequency of
clinically significant asthma exacerbations compared to placebo (75 mg IV, 47%, P<0.001; 100
mg SC, 53%, P<0.001). For endpoints of lung
function, time to first exacerbation, quality of
life, and asthma control, both mepolizumab arms
generated improvement across all measures compared to placebo.
The safety and efficacy of mepolizumab were established based on data from three clinical studies: A phase II 52-week dose-ranging and exacerbation-reduction trial in subjects with asthma
with a history of two or more exacerbations in the
previous year despite regular use of high-dose
ICS plus an additional controller(s) with or without OCS; and two Phase III confirmatory trials
(MENSA and SIRIUS trials). Mepolizumab was administered every 4 weeks in all 3 trials as add-on
to background treatment. All subjects continued
their background asthma therapy throughout the
duration of the trials.
A total of 711 subjects with asthma were studied
in the 2 confirmatory trials. They were required
to have blood eosinophils of greater than or equal
to 150 cells/mcL at screening (within 6 weeks of
dosing), or blood eosinophils of greater than or
equal to 300 cells/mcL within 12 months of enrollment.
Mepolizumab is a humanized IL-5
antagonist which reduces the
production and survival of eosinophils
by inhibiting IL-5 signaling
In addition, a second phase III study, SIRIUS
(Steroid Reduction with Mepolizumab Study), was
a 24-week double-blind, placebo-controlled, parallel group multicentre study designed to evaluate mepolizumab 100 mg SC, every 4 weeks in
comparison to placebo in reducing daily OCS use
while maintaining asthma control. Results showed
that patients on mepolizumab 100 mg SC were
able to achieve a 50% median overall reduction
from baseline in their maintenance OCS dose during weeks 20-24 compared to 0% with placebo (P
=0.007), while maintaining asthma control. Patients receiving mepolizumab also reported a significant improvement in their asthma control and
their quality of life. Patients receiving mepolizumab also had a significant reduction (P<0.001) in
their eosinophil count throughout the duration of
the study.
What you need to know: For patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype, mepolizumab is the first anti-IL-5 treatment. It is administered as 100 mg every
four weeks by SC injection in upper arm, thigh or abdomen. Mepolizumab is not approved for use in
patients with other eosinophilic conditions or for emergency treatment of acute bronchospasm or status
asthmaticus, but is being investigated in eosinophilic chronic obstructive pulmonary disease (COPD) and
eosinophilic granulomatosis with polyangiitis (EGPA).
References:
1. Food and Drug Administration Press Release. FDA approves Nucala to treat severe asthma. November 4, 2015.
2. Ortega HG, Liu MC, Pavord ID, Brusselle GC, FitzGerald JM, Chetta A, Humbert M, Katz LE, Keene ON, Yancey SW, and Chanez P. Mepolizumab
treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014; 371:1198-1207.
3. Ortega H, Chupp G, Bardin P, Bourdin A, Garcia G, Hartley B, Yancey S, Humbert M. The role of mepolizumab in atopic and nonatopic severe asthma with persistent eosinophilia. Eur Respir J. 2014; 44: (1) 239-241.
4. Pavord ID, Kom S, Howarth P, Bleecker ER, Buhl R, Kene ON, Ortega H, Chanez P. Mepolizumab for severe eosinophilic asthma (DREAM): a multicentre, double-blind, placebo-controlled trial. Lancet. 2012; 380, 9842: 651-659.
Updates in Pediatrics
PREVALENCE AND RISK FACTORS
OF PEDIATRIC IRON DEFICIENCY
ANEMIA IN LEBANON
Razan Mhanna, PharmD
Mepolizumab treatment decreases
asthma exacerbations, improves quality
of life and produces better asthma control
In both studies, most common adverse events
were headache, nasopharyngitis, bronchitis, sinusitis, fatigue and asthma. Injection site reactions (pain, redness, swelling, itching, or burning)
were higher in the mepolizumab groups.
The MENSA (Mepolizumab as adjunctive therapy
in patients with severe asthma) study was a 32week double-blind, double-dummy, placebo-controlled, parallel group multicentre study that randomized and treated 576 patients with severe
asthma, who had experienced frequent exacerbations despite treatment with high dose ICS plus
at least one other controller medication. Patients
were randomized to receive either mepolizumab
12 SOP Newsletter | February 2016
Faculty Highlights | 13
Key point: Iron deficiency (ID) the most common single nutritional deficiency worldwide, and
iron deficiency anemia (IDA) in infancy remains
of great concern, due to its damaging effects on
infant growth, cognition, and behavioral as well as
neural development.
Finer points: In preterm infants, term infants
and preschoolers (1-3 years), iron demand is
particularly high, so deficiency occurs when the
stores are exhausted and tissue supply is compromised. According to the American Academy of Pediatrics (AAP), ID prevalence is 4% for 6 months
infants, 12% for 12 months infants, and ranges
between 6.6-15.2% among children 1-3 years old.
The WHO global database on anemia estimates a
prevalence of 46.6% among preschoolers in Eastern Mediterranean region, which is much higher
than that estimated in America (29.3%) and Europe (21.7%). In areas geographically close to
Lebanon, prevalence varies from 20% to 67%.
Developmental defects, lower
intelligence quotient, abnormal
motor and socio-emotional
function, and altered behavioral
and neural growth are only some
of the consequences of iron
deficiency in infants
According to American Family Physician, ID risk
groups include: premature babies or those with
low birth weight, babies with early introduction
of cow milk (before one year of age), exclusively
breastfed or regular formula-fed babies not receiving iron fortification (above six months of age)
and children who have special needs (with chronic
infections or restricted diets). Iron deficient toddlers not only have a lower mean developmental
quotient at initial testing, but also have a lower
intelligence quotient in adolescence, abnormal
motor and socio-emotional function, as well as altered behavioral and neural development and reports of cerebral thrombosis.
Among studied Lebanese infants,
incidence of iron deficiency
anemia was moderate
risk factors of pediatric IDA. The study was a sixmonth, prospective, multicenter, cross-sectional
survey involving pediatrics departments of three
Lebanese hospitals. Preterm to term infants aged
6 to 24 months were included; infants with blood
disorders, chronic infections, congenital immunodeficiency and mental or congenital growth retardation were excluded.
Key associated risk factors were
prolonged exclusive breastfeeding,
low income, rural residency,
mothers’ low education, and
inadequate iron supplementation
in both infants and mothers
Among 520 screened infants, a total of 100 patients were selected. Thirty-seven percent of patients were anemic, with hemoglobin levels <11g/
dL. Significant risk factors for IDA were: exclusive breastfeeding for more than 6 months (95%
confidence interval [CI], 1.03-8.9; P=0.043), low
family income (95% CI, 0.19-0.98; P= 0.045), rural residency (95% CI, 0.0509-0.064; P<0.001),
inadequate maternal iron supply (95% CI, 1.018.26; P=0.05), low maternal education level (95%
CI, 0.07-0.88; P=0.03), and lack of infant iron
supply (95% CI, 1.39-8.41; P=0.007).
What you need to know: The AAP recommends
1mg/kg/day of oral iron supplementation at 4
months of age for breastfed infants until complementary foods are introduced. Universal screening for hemoglobin or hematocrit, once between
9 and 12 months and again between 15 and 18
months, is also recommended in populations with
high prevalence of IDA. In Lebanon, with moderate incidence of IDA and multiple contributing factors, screening measures as well as raising IDA
awareness among families should be considered.
References:
1. Baker R, and Greer F. Diagnosis and prevention of iron deficiency and
iron-deficiency anemia in infants and young children (0-3 years of age).
Pediatrics. 2010; 126: 1040-1050.
2. The global prevalence of anemia in 2011. World Health Organization.
3. Mhanna R, Rahal M, Iskandarani M and Hammoudi D. Incidence and
risk factors associated with iron deficiency anemia among hospitalized
Lebanese infants. Int J Pharm Pract. 2015;doi:10.1111/ijpp.12236.
Antibiotic Updates
NEW METAL ANTIMICROBIALS CAN BE
EFFECTIVE AGAINST RESISTANT BACTERIA
Nermine Choumane, PharmD
Key point: Although current infection rates are
declining, invasive methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible
for increasing mortality. However, new research
has uncovered a new group of antibiotics with significant antimicrobial activity against both S. aureus and MRSA.
Finer points: According to a recent study, the
potential new antibiotics are unlike contemporary
antibiotics because they contain iridium, a silvery-white transition metal. New transition metal complexes do not easily breakdown, rendering
them important for delivery of antibiotics to the
sites where they are needed to fight infection.
In mice models, the incorporation of
iridium with antimicrobials results
in direct toxicity on bacteria and
lowers doses of antibiotics needed
Silver is proposed to alter cellular processes that
keep bacteria alive, such as metabolism, internal
iron levels, and ability to form bonds between vital
proteins. Researchers also found that silver works
to increase the amounts of oxygen present in bacteria – which often cannot handle high levels of
oxygen and thus will be killed. Moreover, in a toxicity measurement performed on mice up to 48
hours after treatment, it was noted that levels of
silver in the blood did not persist for more than
two days, and did not cause any adverse effects
on kidneys or liver. Only low concentrations of silver were needed to get antibiotics to work effectively.
The addition of silver can also reduce the amount
of antibiotics; in fact, adding a small amount of
silver corresponded to a two-fold decrease in antibiotic dose needed to eradicate the infection. This
is likely because the silver makes the antibiotic’s
role easier; it simply needs to kill bacteria after
silver weakens them.
What you need to know: The uses of silver in
addition to antibiotics are quite promising. Nothing has yet been established about role in humans, but the study concluded that the release of
these silver-complexed antimicrobials at the site
of infection could prove very useful.
Reference:
Karpin GW, Morris DM, et al. Transition metal diamine complexes with
antimicrobial activity against Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA). Med Chem Commun. 2015;6:
1471-1478.
A study, recently published in the International
Journal of Pharmacy Practice, was undertaken by
the School of Pharmacy at the Lebanese International University, to investigate the incidence and
14 SOP Newsletter | February 2016
Faculty Highlights | 15
Updates in Metabolic Disorders
PATIROMER: A NEW MEDICINE FOR
HYPERKALEMIA TREATMENT SINCE
MORE THAN 50 YEARS
Samar Younes, PharmD
Key point: On October 21st, 2015, the U.S. Food
and Drug Administration (FDA) approved patiromer (Veltassa®, Relypsa Inc. California), a nonabsorbable potassium binder, for the treatment of
hyperkalemia.
Finer points: Hyperkalemia is a potentially
life-threatening condition, defined as a serum potassium concentration exceeding the normal range
of 3.5-5.5 mEq/L in adults. High levels of potassium cause abnormal heart and skeletal muscle
function, and can lead to sudden death from cardiac arrhythmias, even without any warning sign.
Risk factors for hyperkalemia include advanced
age, significant prematurity, as well as coexisting
renal failure, diabetes mellitus, and heart failure.
Polypharmacy, particularly the use of potassium
supplements, potassium-sparing diuretics and renin-angiotensin-aldosterone inhibitors in patients
with underlying renal insufficiency contribute to
hyperkalemia in almost 50% of the cases.
The FDA approval of patiromer was based on a
clinical development program that studied patients with hyperkalemia, including people who
had chronic kidney disease (CKD), heart failure,
In hyperkalemic
patients with
renal failure
or diabetes,
potassium levels
decreased to
normal range
following oral
treatment with
patiromer
diabetes and hypertension. The pivotal phase III
study evaluating the efficacy and safety of patiromer for the treatment of hyperkalemia showed
that patiromer significantly decreased potassium
levels in hyperkalemic CKD patients taking renin-angiotensin-aldosterone system (RAAS) inhibitors (mean decrease of -1.01 ± 0.03 mEq/L
from baseline; P<0.001). At four weeks, 76 % of
patients had potassium levels in the target range
(3.8 to <5.1 mEq/L). During the second part of
the trial, patients taking patiromer had no change
in median potassium from baseline (0.00 mEq/L),
whereas potassium levels significantly increased
in the placebo group (0.72 mEq/L; P<0.001).
Gastrointestinal excretion of potassium
is increased via exchange with calcium,
primarily in the colon
Moreover, a phase 2 trial evaluated use of patiromer over 52 weeks in hyperkalemic patients
with CKD and type II diabetes who were taking
RAAS inhibitors. Throughout the year-long study,
the majority of patients had potassium levels in
the target range (3.8-5.0 mEq/L).
Patiromer is made in powder form consisting of
smooth, spherical beads. It is mixed with 90 mL
of water and taken once daily with food. It is not
absorbed and acts within the gastrointestinal tract
by binding to potassium in exchange for calcium, primarily in the colon. The potassium is then
excreted from the body through the normal excretion process. Patiromer should not be used as
an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
In the clinical trials, most adverse reactions were
mild to moderate in intensity, including constipation,
hypomagnesemia, diarrhea, nausea, abdominal discomfort, and flatulence. Patiromer can bind to many
other orally administered medications, which could
decrease their absorption and reduce their effec-
References:
1. Food and Drug Administration Press Release. FDA approves new
drug to treat hyperkalemia. October 21, 2015.
2. Weir MR, Bakris GL, Bushinksy DA, et al. Patiromer in patients with
kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J
Med. 2015;372:21-221.
3. Bakris GL, Pitt B, Weir MR, et al. Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease:
The AMETHYST-DN randomized clini cal trial. JAMA. 2015;314(2):151161.
Updates in Psychiatry
DO INCREASED TELEVISION VIEWING AND
LOW PHYSICAL ACTIVITY AFFECT THE
COGNITIVE FUNCTION OF YOUNG ADULTS?
Bouchra Mouhtadi, PharmD
Key point: Physical inactivity and sedentary lifestyle are emerging trends worldwide, and may lead to
accelerated aging, numerous diseases, and an overall decline in the quality of life. Television watching
has been linked not only to increased cardiovascular risk factors, but also to other behavioral patterns,
including social inactivity and poor diet.
Finer points: To determine the effect of high television viewing and low physical activity on cognition,
young adults aged 18-30 years, from four US cities were enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. The study was prospective and carried out from March 25th, 1985,
to August 31st, 2011. A total of 3247 participants completed the study.
The participants were followed through visits every 2- 5 years over a period of 25 years. Physical activity
was assessed using the Physical Activity History Questionnaire at each visit. Low physical activity was
characterized by having a level of activity less than sex-specific baseline quartile for more than twothirds of the visits. Television watching was assessed by asking participants about the number of hours
they spent watching television during a day. A high television viewing was characterized by spending 3
or more hours per day watching TV for more than two-thirds of the visits. Three tests were done at the
25th year: the Digit Symbol Substitution Test (DSST), to assess processing speed and executive function;
the Stroop test, to assess executive function; and the Rey Auditory Verbal Learning Test (RAVLT), to assess verbal memory. Results are shown in the table below:
Test
DSST
Stroop test
RAVLT
16 SOP Newsletter | February 2016
tiveness; therefore, a boxed warning recommends
taking it and any other orally administered medication at least six hours apart.
What you need to know: Patiromer is the first
new medication for the treatment of hyperkalemia
in more than 50 years. It will provide doctors and
patients with a new option for daily treatment of
hyperkalemia, and may be chronically used to
keep potassium levels in the target range.
TV Viewing Pattern
)%( Poor Cognitive Performance
Low to moderate TV viewing
14.3
High TV viewing
27.4
Low to moderate TV viewing
12
High TV viewing
21.4
Low to moderate TV viewing
19.1
High TV viewing
27.1
Faculty Highlights | 17
The results for DSST and STROOP test were significant. After adjustment for age, race, sex, smoking, educational level, alcohol use, body mass index, and hypertension the results of the RAVLT
test were not significant.
Watching television for 3 hours or
more a day in young adulthood,
coupled with low levels of
physical activity, may lead to
poorer cognitive function
Individuals with low physical activity were 47%
more probable to do poorly on the DSST than
those with moderate-high physical activity. In
combination, individuals with low physical activity
and high TV viewing were almost twice as likely
to perform poorly on the STROOP test and DSST
than those with high physical activity and low TV
watching.
What you need to know: High levels of television viewing might lead to poorer cognitive performance in midlife. The study adds evidence to
the growing consensus that there is a link between lifestyle factors and cognitive aging. An
active lifestyle is important for keeping the brain
healthy, even for young and middle-aged adults.
References:
1. Hoang T, Reis J, Zhu N, Jacobs D, Launer L, Whitmer R, et al. Effect
of early adult patterns of physical activity and television viewing on
midlife cognitive function. JAMA Psychiatry. 2015;2; doi: 10.1001/
jamapsychiatry.2015.12236.
2. Warren T, Barry V, Hooker S, Sui X, Church T, & Blair S. Sedentary
behaviors increase risk of cardiovascular disease mortality in men.
Med Sci Sports Exerc. 2010; 42(5): 879-885.
An active lifestyle is important for keeping the brain
healthy, even for young and middle-aged adults
Interesting News
A MINIMALLY INVASIVE LIQUID
BIOPSY FOR CANCER DETECTION
Nermine Choumane, PharmD
Key point: Conventional means of cancer diagnosis can involve numerous types of scans and invasive methods like surgical biopsies, but a new
method of identifying the disease may involve
nothing more than a simple prick of a finger.
Finer points: In recent years, it was discovered
that platelets take up protein and RNA molecules
from cancer tumors and may have a role in tumor
growth and metastasis. Hence, the researchers at
the Umea University in Sweden in collaborations
with researchers from the Netherlands and the
United States aimed to investigate whether RNA
from tumors carried in platelets could be used to
identify and classify common cancer types.
According to the study published in Cancer Cell,
investigators developed a new RNA test of blood
platelets that can detect, classify and determine
the location of cancer in the body by analyzing
a blood sample equivalent in size to just a single
drop of blood. Blood samples from 283 individuals were studied of which 228 patients had some
form of cancer and 55 showed no evidence of cancer. By comparing the blood samples RNA profiles,
18 SOP Newsletter | February 2016
researchers could identify the presence of cancer
with 96% accuracy and the type of cancer with
71% accuracy in organs like the lungs, pancreas,
brain, liver, and colon. In 39 patients where cancer had been detected early, they were able to
identify and classify the cancer with 100% accuracy. The test is based on the discovery that cancer
tumors “educate” blood platelets by altering the
platelets’ RNA profile. Thus, analyzing the mRNA
profiles of tumor-educated platelets provides diagnostic information about the tumor’s type and
location.
What you need to know: While the technique is
not perfect, the results show that blood platelets
could constitute a complete and easily accessible
blood-based source for sampling. If further trials
validate this “ liquid biopsy”, the test promises to
be used for blood-based cancer diagnosis, treatment and monitoring.
Reference:
Myron G. Best, Nik Sol, Irsan Kooi, et al. RNA-Seq of Tumor-Educated
Platelets Enables Blood-Based Pan-Cancer, Multiclass, and Molecular
Pathway Cancer Diagnostics. Cancer Cell. 2015; 28 (5): 666-676.
Faculty Highlights | 19
According to recent research, it is suggested that the best bee’s honey is made by Apis mellifera, and
its overall composition differs according to the flowers on which the bee feeds. Although honey contains
about 200 substances, its general chemical composition is as follows:
Alternative Medicine Corner
Average composition of honey (Nutritional value per 100 g)
HONEY:
AN EXTRAORDINARY
THERAPY WITHIN
EVERYONE’S REACH
Nisreen Mourad, PharmD
Whether it is called “ ‫ســل‬
َ ‫ ” َع‬in Arabic, honey in English or miel in French and Spanish, they
all refer to one of the most prized and treasured natural products that has been widely
used throughout history for its therapeutic effects. In fact, honey has had a valued place
in traditional medicine for centuries, where the first written reference to its use was on a
Sumerian tablet going back to 2000-2100 BC, then later it was used by Ancient Egyptians,
Chinese, Greeks, Romans and Arabs till today.
Component
Average content
Carbohydrates
Fructose
Glucose
Sucrose
Other Sugars
Dietary Fiber
82.4 g
38.5 g
31 g
1g
11.7 g
0.2 g
Fat
0g
Protein
0.3 g
Water
17.1 g
Vitamins
Riboflavin (Vitamin B2)
Niacin (Vitamin B3)
Pantothenic acid (Vitamin B5)
Pyridoxine (Vitamin B6)
Folate (Vitamin B9)
Vitamin C
0.038 mg
0.121 mg
0.068 mg
0.024 mg
0.002 mg
0.5 mg
Minerals
Calcium
Iron
Magnesium
Phosphorus
Potassium
Sodium
Zinc
6 mg
0.42 mg
2 mg
4 mg
52 mg
4 mg
0.22 mg
Since Stone Age, honey has been an important source of carbohydrates and a widely available sweetener. However, with time its use expanded from a nutritional supplement to further treat several ailments.
When it comes to the traditional uses of honey, several civilizations employed it mostly for the treatment
of wounds and diseases of the gut. Of notice are the following:
Civilization
Ancient India
- Benefits those with weak digestion
- Treats irritating cough, eye diseases, insomnia, skin disorders, anemia,
cardiac pain and palpitation
- Keeps the teeth and gums healthy
- Prevents cataract
Ancient Egypt
- Treats wounds
Ancient Greece
- Treats gout and certain nervous disorders
- Hippocrates prescribed it:
oTo treat pain, acute fevers, thirst, baldness, wounds, constipation,
cough, sore throat and eye diseases
oTo prevent and treat scars
o As topical antiseptic and contraceptive
Arabs
20 SOP Newsletter | February 2016
Most common uses of honey
- Prophet Muhammad (peace be upon him) recommended the use of honey
for the treatment of diarrhea
- Avicenna used it as a remedy for tuberculosis
Faculty Highlights | 21
Hadi Dassouki, RPh, MSc
THE PHARMACIST ROLE IS CHANGING TO HELP
BETTER MAINTAIN YOUR HEALTH
TALK TO YOUR PHARMACIST!
THIS IS A CROSSWOD PUZZLE ADDRESSING MAJOR INFORMATION PATIENTS SHOULD CONSULT
ABOUT WITH THIER PHARMACIST
22 SOP Newsletter | February 2016
With such varied biological and pharmacological
properties, honey has proved to be a remarkable natural substance with diverse uses, and, no
doubt, other unseen effects that are yet to be discovered, warranting further experimentation.
References:
1. Eteraf-Oskouei T, Najafi M. Traditional and modern uses of natural
honey in human diseases: A review. Iran J Basic Med Sci. 2013; 16:
731-742.
2. Ahmed S, Othman NH. Honey as a potential natural anticancer
agent: A review of its mechanisms. Evid Based Complement Alternat
Med. 2013; article ID 829070.
3. Ediriweera ER, Premarathna NY. Medicinal and cosmetic uses of
bee’s honey-A review. Ayu 2012; 33 (2): 178-182.
4. Bogdanov S, Jurendic T, Sieber R, Gallmann P. Honey for nutrition
and health: A review. Am J College Nutr. 2008; 27: 677–689.
Answers
Because of all of these properties, a branch of alternative medicine called “Apitherapy” has been
recently developed, offering therapies based on
Down:
2. Keep that new year’s resolution! Your pharmacist can give you some good tips on how to quit this habit
3. Don’t throw it out! Bring this type of unused medication to your local pharmacy for safe disposal
6. You can get this from your pharmacist if you are interested in learning about non-prescription products
7. All pharmacists are interested in helping patients stay ________
9. Some pharmacists do this type of work to help discover new medications
12. Many pharmacists can give you one of these to help protect you against flu
14. You can come here anytime to ask questions about your health or pick up your prescriptions
1. Vitamins
2. Smoking
3. Expired
4. Hospital
5. Diabetes
6. Advice
7. Healthy
8. Awareness
9. Research
10. Allergies
11. Exercise
12. Vaccine
13. Appointment
14. Pharmacy
15. Heart
16. Hands
17. Doctor
As science progressed, laboratory and clinical
investigations on honey proved its role in modern medicine as well. Currently, honey is known
to act both as bacteriostatic and bactericidal
to about 60 species of aerobes and anaerobes,
gram-positive and gram-negative bacteria including Pseudomonas aeruginosa, Acinetobacter
spp., Helicobacter pylori and community-associated Methicillin-resistant Staphylococcus aureus
(MRSA). In contrary to conventional antibiotics,
honey is not associated with resistance and can
be used continuously. In addition to its antibacterial effects, honey has antifungal properties on
some species of Aspergillus, Candida albicans,
dermatophytes and Penicillium, as well as antiviral effects on herpes, rotavirus and rubella virus.
Furthermore, honey has anti-inflammatory effects
(reducing the activities of both cyclooxygenase-1
and -2, and inhibiting TNF-α), antioxidant properties (with remark that the darker the honey, the
higher its antioxidant capacity) and finally antileukemic and anticarcinogenic activities against various cancer cell line and tissues, such as breast,
colorectal, renal, prostate, endometrial, cervical
and oral cancer.
honey. In fact, nowadays honey is most commonly used for wound healing, treatment of various
dermatologic diseases (such as eczema, psoriasis
and dandruff), ophthalmological conditions (such
as keratitis, conjunctivitis and corneal injuries)
and gastrointestinal infections (such as gastritis, duodenitis and gastric ulceration). In diabetes, honey is known to stimulate insulin secretion
thus reducing glucose levels while elevating the
hemoglobin concentration and improving the lipid
profile, consequently reducing cardiovascular risk
factors. Indeed, many compounds in honey have
promising effects in the treatment of various cardiovascular diseases.
Across:
1. Tell your pharmacist about any of these supplements you are taking so they can help you prevent drug interactions
4. Besides your community pharmacy, pharmacists also work here to help patients
5. Your pharmacist can help you determine if you are at risk to develop this chronic condition, and help you manage it if you do
8. Pharmacists raise this in the community towards drugs and diseases
10. Ask your pharmacist to help you discover the best therapy for these common complaints that can cause itchy eyes, a
runny nose and sneezing
11. Regular amounts of this activity improves your general health, increases energy and decreases stress
13. You don’t need one of these to visit your pharmacist
15. This type of disease is one of the leading causes of death for men and women
16. Wash these often to avoid spreading germs, colds and flu
17. Your pharmacist can work with this other health care provider to make sure you’re taking the right medications
Faculty Highlights | 23
ROLE OF PHARMACISTS IN IMPROVING
ADHERENCE IN ACS PATIENTS
A combination of the above strategies may prove most beneficial. A recent study has shown improved
adherence in a group of patients with ACS receiving a package of education, voice messages (educational
and reminders) and a pharmacist-led tailored medication regimen compared with the usual care group
(89.3%vs 73.9% , p=0.003).
Pharmacists are among the most accessible health care providers in the community, and are prime resources in improving adherence and outcomes in ACS patients. As we move into an increasingly technological future with the potential to use devices as smart phones and tablets, pharmacists can educate
patients about these applications that both provide information on cardiac health and also act as diaries
and reminder systems.
Iqbal Fahs, PharmD Candidate
Secondary prevention after acute coronary syndrome (ACS) events reduces morbidity, mortality and financial burden. However, adherence to
secondary prevention is disappointingly low, with
rates of around 40-75%. In a multicenter study
involving 19 US hospitals, 1 month after discharge
on aspirin, β-blocker and statin, 34% of patients
had stopped at least one and 12 % had stopped
all of the three medications.
Simple pharmacist approaches include recommendation of calendars or pill boxes to reduce
forgetfulness, and single dosing or combinations
of medications whenever applicable to reduce the
number of pills per day. Another strategy is patient education via personal contact or telephone
calls to improve awareness and encourage patients to discuss and identify potential barriers to
medication adherence. Pharmacists should also
deliberate with ACS patients the benefits of medications, the importance of adhering to the regimen, dosing, timing of administration, side effects
and tolerability, and customize the regimen to
accommodate patient preference if possible. The
pharmacist should provide precise and clear instructions with positive reinforcement to motivate
patients to do better.
Numerous factors contribute to low adherence
including poor motivation, forgetfulness, lack of
education about medications, complicated poly-pharmacy of ACS regimens, adverse side effects, cost, and limited practical support. Pharmacists’ involvement in ACS adherence programs is
essential and has been shown to improve patient
outcomes.
Using SMS messages to remind ACS patients to
take their anti-platelet therapy post-ACS improved
adherence significantly over one month (odds ratio
[OR] = 0.37). In a recent randomized trial, phone
calls that assess adherence to dual anti-platelet
therapy and emphasize its importance improved
1-year adherence (aspirin 99.2% vs 90.2% and
clopidogrel 99.3% vs 91.5%, P<0.0001 for both).
References:
1. Ho PM, Lambert-Kerzner, Cary EP, et al. Multifaceted intervention
to improve medication adherence and secondary prevention measures
after acute coronary syndrome hospital discharge: a randomized clinical
trial. JAMA Intern Med. 2014;174(2):186-193.
2. Jeannette Y. Wick. Pharmacists praised for promoting ACS medication adherence. Pharmacy Times. August 2015.
3. Kevin Cheng, Nicola Ingram, et al. Evidence of poor adherence to
secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies. Open Heart 2015;
24;2(1):e000166. doi: 10.1136/openhrt-2014-000166.
4. Stacy JN, Schwartz SM, et al. Incorporating tailored interactive patient solutions using interactive voice response technology to improve
statin adherence: results of a randomized trial in a managed care setting. Popul Health Manag. 2009; 12(5):241-254.
UPDATES TO THE GUIDELINES OF ANTIRETROVIRAL
AGENTS IN HIV-1-INFECTED ADULTS AND
ADOLESCENTS
Rawane Barakat, PharmD Candidate
Human immunedeficiency virus replication in the human T4 lymphocyte
and targets of antiretroviral therapy
24 SOP Newsletter | February 2016
Students Corner | 25
Key point: on April 8th, 2015, The Department of Health and Human Services (HHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel), a working group of the Office of AIDS Research Advisory Council (OARAC), updated its recommendations on the diagnosis, management and treatment of HIV.
Finer points: HIV is a retrovirus transmitted by sexual, parenteral or vertical means. The major markers used to stage HIV disease and to assist in the selection of antiretroviral drug regimens are CD4 T-cell
count (CD4 count) and Plasma HIV RNA (viral load). The primary goals for initiating antiretroviral therapy (ART) are to reduce HIV-associated morbidity, prolong the duration and quality of survival, restore
and preserve immunologic function, maximally and durably suppress plasma HIV viral load, and prevent
HIV transmission.
What‘s new in the Guideline?
There are now five recommended regimens for ART-naive patients—four integrase strand transfer inhibitor (INSTI)-based regimens and one ritonavir-boosted protease inhibitor (PI/r)-based regimen, as
listed below:
INSTI-Based Regimens:
• Dolutegravir/abacavir/lamivudine (DTG/ABC/3TC)—only for patients who are HLA-B*5701 negative
• DTG plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC)
• Elvitegravir/cobicistat/TDF/FTC (EVG/c/TDF/FTC)—only for patients with pre-ART CrCl >70 mL/min
• Raltegravir (RAL) plus TDF/FTC PI/r-Based Regimen
• Darunavir/ritonavir (DRV/r) plus TDF/FTC
Two regimens previously classified as recommended regimens have been moved to the alternative regimens category, with the rationale stated below:
• Atazanavir/ritonavir (ATV/r) plus TDF/FTC—The results of a large comparative clinical trial showed a
greater rate of discontinuation with ATV/r plus TDF/FTC because of toxicities (nephrolithiasis, nephrotoxicity, cholelithiasis, and reversible indirect hyperbilirubinemia with or without jaundice or sclera icterus)
when compared to (DRV/r or RAL) plus TDF/FTC.
SAINT JUDE FUNDRAISING CAMPAIGN
The extracurricular committee at SOP carried, on
January 13th, 2016, a fundraising campaign for
the Saint Jude’s Children’s Cancer Center of Lebanon (CCCL). According to the policy statement of
CCCL, children cancer patients of Lebanon should
have access to latest cancer treatments, at no
cost to the parents and without any discrimination. Eighty-percent of the patients at CCCL are
cancer free after the treatment.
The event consisted of selling CCCL gadgets including support stickers, stainless steel thermos
mugs, stress balls and golden ribbons available at
Juod Boutique. The participants in this event sold
around 200 pieces, and collected the amount of
2378 US dollars. The gesture conveyed a message
to the students, administrators, staff, and faculty about the mission of health schools, including
pharmacy schools, in raising awareness, community work, and patient-centered care. The organizing team will be always ready for similar events.
• Efavirenz/TDF/FTC (EFV/TDF/FTC)—Concerns excist about the tolerability of EFV in clinical trials and
practice, especially the high rate of central nervous system (CNS)-related toxicities (abnormal dreams,
dizziness, headache, depression and neuropsychiatric effects that can occur on the long term) and a
possible association with suicidality.
Three regimens (ATV/r plus ABC/3TC, EFV plus ABC/3TC, and rilpivirine/TDF/FTC) that were previously
listed as recommended regimens for baseline HIV RNA 200 cells/mm3, are now in the alternative or other
category, with the same caveat about limiting their use in these populations.
Two regimens that use fewer than two nucleoside reverse transcriptase inhibitors (DRV/r plus RAL and
lopinavir/ritonavir plus 3TC) are now listed among the other regimens, with the caveat that their use
would be limited to those patients who cannot take either TDF or ABC.
Coformulations of atazanavir (ATV) and darunavir (DRV) with the pharmacokinetic (PK) enhancer cobicistat (COBI) have been added to the alternative regimen options.
Reference:
Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.
Department of Health and Human Services. Available at http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
26 SOP Newsletter | February 2016
Students Corner | 27
SOP PARTICIPATES IN A CONTINUING EDUCATION
HALF-DAY AND GATHERING FOR PHARMACISTS AT
AL-KHAYYAL HOTEL, RAYAK, BEKAA
SOP PARTICIPATES IN THE ANNUAL ICAAC AT SAN
DIEGO, CALIFORNIA – NETWORKING WITH THE
WORLD’S EXPERTS IN INFECTIOUS DISEASES
SOP, represented by Dr. Dalal Hammoudi, participated in
the 55th Interscience Conference on Antimicrobial Agents
and Chemotherapy joined with the International Congress
of Chemotherapy and Infection (ICAAC/ICC 2015), during
September 18 – 21th , 2015, at San Diego, California.
The Continuing Education (CE) Committee at the
Order of Pharmacists of Lebanon (OPL) organized
a half-day at Al-Khayyal Hotel, Rayak, Bekaa, on
September 12th, 2015. The activity was organized
in presence of OPL former president, Dr. Rabih
Hassouneh, who stressed on importance of CE
and its coverage of different Lebanese regions.
SOP actively participated in the program by three
lectures presented by our faculty.
Antibiotic resistance, advances in new antibiotic development, and antibiotic stewardship were the main themes
of the annual meeting. Through poster and slide sessions,
symposia, and Meet-the-Expert sessions, ICAAC/ICC 2015’s
scientific program showcased the most notable names and
recent discoveries from all disciplines of the infectious disease community. Dr. Hammoudi presented a poster from
her research on carbapenem resistance in Lebanon.
Dr. Bahia Chahine delivered a lecture on psoriasis treatment and recent advances, while Dr. Shahanz Al Masri lectured on common ear disorders
often seen in community practice and their management. “Constipation: It is time for the bowel to
move” was the subject of a third presentation by
Dr. Marwan Akel. The attendees were involved in
case discussions and asking questions at the end
of each lecture, and CE credits were allocated.
SOP VISITS THE NEWLY ELECTED PRESIDENT OF OPL
The newly elected president of the Order of Pharmacist of Lebanon (OPL), Dr. George Sili, was visited
by the Dean, Dr. Mohamad Rahal, and Faculty from SOP, to congratulate him and the new members of
the Order council for their recent election during November, 2015, and wish them excellence in their
new appointment.
SOP CONTRIBUTIONS TO CONTINUING
EDUCATION SESSIONS AT THE AUDITORIUM OF
THE LEBANESE ORDER OF PHARMACISTS
Dr. Sili acknowledged SOP Faculty for their pleasant gesture, emphasizing on the continuous collaboration that should persist between SOP and OPL, especially with SOP’s great input into different OPL
committees and events. He also appreciated the high standards that SOP graduates show, and their
reflection of a good image of their School and University. He presented his future plans for improvement
of the pharmacy profession in Lebanon.
cused on appropriate antimicrobial regimens for
urinary tract infection, in light of the increased
antimicrobial resistance of urinary pathogens.
Moreover, she discussed the importance of minimizing “collateral damage” associated with the
use of third-generation cephalosporins and fluoroquinolones. The lecture was concluded by raising
awareness towards having pharmacists actively
engage with other clinicians to select the suitable
treatment for acute uncomplicated cystitis.
As part of their several contributions to Continuing
Education (CE) program of the Order of Pharmacists of Lebanon (OPL), SOP faculty delivered two
lectures at the auditorium of the OPL, Cornich-ElNahr, Beirut.
Dr. Jihan Safwan presented a CE lecture on November 5th, 2015, entitled: “Community Practice:
Uncomplicated Cystitis Treatment”. Dr. Safwan fo28 SOP Newsletter | February 2016
“It is Bedtime” was the title of another CE lecture
delivered by Dr. Marwan Akel, on November 18th,
2015. Dr. Akel discussed sleep problems, highlighting their effect on health and on other diseases, with 30-40% of adults reporting symptoms of
insomnia. He described the available behavioral,
non-pharmacological and pharmacological approaches for insomnia management, pointing out
the essential safety concerns of the various drug
classes, herbals, and supplements used for this
purpose.
SOP Events & Activities | 29
NINTH PROMOTION OF SOP BEKAA CAMPUS
GRADUATES CELEBRATED IN A GALA DINNER
SOP AT BEIRUT CAMPUS CELEBRATES ITS ELEVENTH
PROMOTION OF GRDAUATES IN A GALA DINNER
In commemoration of its ninth promotion of graduates, the School of Pharmacy at Bekaa Campus
cordially organized a gala dinner at Park Hotel,
Chtoura, on November 13th, 2015. LIU president,
H.E. Mr. Abdul Rahim Mourad, represented by Bekaa Campus Academic Director, Dr. Ahmad Faraj,
former President of the Lebanese Order of Pharmacists, Dr. Rabih Hassouneh, and other Order
personnel, LIU Vice President, Dr. Samir Abou
Nassif, LIU Provost, Dr. Ali Tarabay, administrative
personnel from LIU Bekaa, Bekaa Campus Council, pharmacists and hospital directors attended
the dinner, together with the Dean, Dr. Rahal,
graduates, and their instructors.
Speakers were presented by Dr. Samar Younes,
Assistant Dean of SOP at Bekaa Campus, who
highlighted the success continuously attained by
SOP, which was possible through collaboration of
its team and encouragement from the University.
Graduates’ speech was delivered by Mohamad
Henduas, PharmD candidate, who mentioned that
SOP graduates at LIU have the goal of being model pharmacists, and expressed gratitude for the
University in creating an atmosphere conductive
of learning and success.
The Dean addressed the graduates, congratulating their achievements, while pointing out
the challenges they will face as they move from
academia into their career, and asking them to
maintain their smile and their hard work. He also
expressed thankfulness to hospitals and pharmacists who were fully cooperative throughout the
training programs developed by SOP.
Dr. Faraj expressed the President’s joy in witnessing the graduates ripe the fruits of their previous
endeavors. Moreover, he stressed on role of both
University education and professional work by OPL
Like in Bekaa, SOP at Beirut Campus also celebrated the 2015 promotion of pharmacy graduates in a
gala dinner at Coral Beach Hotel and Resort, Beirut, on December 18th, 2015. The dinner was a friendly
gathering for LIU administration, School graduates and Faculty, newly elected President of the Order of
Pharmacists of Lebanon (OPL), Dr. George Sili, and the new Order council members.
30 SOP Newsletter | February 2016
in maintaining strong backgrounds and innovation
in the pharmacy profession.
The last speech was delivered by Dr. Hassouneh,
who appreciated the role SOP plays in advancing
pharmacy education in Lebanon, through participation in continuing education programs and
preparations for the national colloquium examinations.
The dinner was concluded by a celebration cake
and graduates presenting a trophy to the Dean to
cherish his notable support during their years of
study.
Dr. Marwan Akel welcomed the guests and introduced the speakers. The graduates’ speech was
delivered by Pharmacist Sanaa Al Khatib, who reminded her colleagues of difficulties they had to
face during their study years, and the fruition of
such efforts later after graduation.
Following speeches were by the Dean, Dr. Mohamad Rahal, who congratulated the graduates, asking them to maintain hard work, creativity, and
professionalism in their future tasks with patients;
then Dr. Sili who mentioned the notable achievements of SOP over the past years, and announced
the willingness of OPL to maintain cooperation
with the School, as usual. LIU President, H.E. Mr.
Abdul Rahim Mourad, congratulated the new President and members of OPL council, and highlighted success of the School in national colloquium
examinations and in various work fields.
Finally, SOP Faculty presented a trophy of appreciation to the former Dean’s assistant, Mrs. Siba
Matar, who was leaving the School for personal
and family obligations.
SOP Events & Activities | 31
Pharmacy Union Activities
BREAST CANCER AWARENESS, LECTURE ON
PHARMACIST ROLE IN COMMUNITY, AND
PALESTINE ISSUE
Pharmacy Union members also invited to Bekaa
Campus Dr. Asmaa Saliba Abi Nasr, consultant to
the President of the Lebanese Order of Pharmacists, to deliver a lecture entitled: “The Pharmacist as A Health Security Guard: Where are We
Now?”. In her presentation, Dr. Abi Nasr focused
on the role of pharmacists in healthcare, and the
strength they have to improve health outcomes
for patients as well as to advance their own profession.
To illustrate her ideas, Dr. Abi Nasr cited examples
from real cases to encourage students to concentrate on patient counseling and adequate revision
of medical data when they move on from University to practice their profession.
Apart from health and pharmacy-related activities, Pharmacy Union, in collaboration with “Al
Ghad Al Afdal Club”, organized the event “Palestine is Our Case”, in synchronization with the
Palestinian “Rock Revolution”. Faculty members,
administration, and students from Bekaa Campus
gathered in remembrance of the event. Fifth year
pharmacy student and Pharmacy Union member,
Tarek Al Jinani, delivered a speech in tribute of the
Palestinian issue.
Pharmacy Union students at SOP, Bekaa Campus, participated in a campaign on breast cancer awareness organized by the School of Arts and Sciences. Under the slogan “Best Protection, Early Detection”,
students stood up and united to form the pink solidarity badge carrying the awareness message for early
detection of breast cancer. Furthermore, Pharmacy Union members distributed educational brochures on
early detection of breast cancer.
DR. RAHAL PARTICIPATES IN THE 18TH CONGRESS
OF THE SCIENTIFIC ASSOCIATION OF COLLEGES OF
PHARMACY IN THE ARAB WORLD AT AL-KHARTOUM,
SUDAN
The Dean of the School of Pharmacy, Dr. Mohamad Rahal, participated in the 18th Congress of the Scientific Association of the Colleges of Pharmacy in the Arab World that was held between 18th and 20th of
November, 2015, at Omdurman Islamic University, Al-Khartoum, Sudan. The theme of the conference
was: “Sudan Initiative: Harmonization of Pharmacy Education and Practice”, and it brought together key
professionals in pharmacy and pharmaceutical sciences from Arab and other countries, as well as deans
of pharmacy schools from the Arab World.
Major conference tracks included pharmaceutical
education (curriculum development, quality assurance and accreditation) and pharmacy practice
updates, in addition to workshops on pharmacy
research and regulatory drug affairs. Recommendations of the conference were to seek improvement in pharmacy education in the Arab World,
through unified curricula and continuing education
programs, and to deal with challenges that face
the pharmacy profession in the region.
32 SOP Newsletter | February 2016
SOP Events & Activities | 33
SOP AT 23RD CONGRESS OF OPL – PARTICIAPTION
BY FACULTY AND STUDENTS
Faculty and students from SOP at LIU participated in the 23rd annual congress of the Order of Pharmacists
of Lebanon (OPL), that was held in the period from 16th to 18th of October, 2015, at Biel, Beirut. This year’s
theme was: “Connecting Science to Practice”, and under this title, our faculty have presented several continuing education lectures and chaired several sessions. Alcohol dependence, dealing with drug abusers, antimicrobial resistance, obesity management, and pharmacy practice safety pearls were presented by Doctors Jihan
Safwan, Zeinab Abbas, Malak Alame, Dalal Hammoudi, Marwan Akel and Sylvia Saade.
BEKAA CAMPUS HONORS DISTINGUISHED
PHARMACY STUDENTS ON PRESIDENT’S LIST AND
DEAN’S LIST
Student participation was also remarkable this year, with students from different Lebanese schools of pharmacy joining a student session for career orientation. Students from SOP had their print in this session,
chaired by pharmacists working in different sectors. These professionals discussed various career choices with
the students, shared with them their experience, and answered the students’ questions.
Three distinguished students on the President’s
list (semester Grade point Average, GPA, above
4 with a minimum of 12 credits) and 25 students
on the Dean’s list (semester GPA above 3.5 with
a minimum of 12 credits) from SOP were honored
in a celebration at Bekaa Campus on December
11th, 2015, in presence of faculty, administrative
personnel, and students’ parents.
Dr. Mohamad Rahal, Dean of the School, addressed
the honorees expressing the pride they give to the
university through their accomplishment and dedication. He encouraged them to keep the same
pace, reminding them that success is not a destination, but rather a journey. Honorary certificates
were presented to the students by Dr. Rahal and
the Administrative director of Bekaa Campus, Mr.
Bassem Hazime.
34 SOP Newsletter | February 2016
SOP Events & Activities | 35
SOP PARTICIPATES IN THE ASHP MIDYEAR CLINICAL
MEETING ND EXHIBITION - “THE WORLD’S LARGEST
GATHERING OF PHARMACISTS”
Like every year, SOP participated the 50th American Society of Health-system Pharmacists (ASHP) Midyear Clinical Meeting and Exhibition, at New Orleans, Louisiana, on December 6-10th, 2015. More than
22,000 pharmacists, residents, pharmacy students, and industry representatives from over 40 countries
attended the meeting. They took advantage of the wide range of educational sessions, special events,
and networking opportunities offered.
Doctors Fadi Hdeib, Jihan Safwan, and Faraj Saade from SOP attended the conference, and presented
posters from 17 studies realized by PharmD candidates. The studies revolved around various topics, including meningitis in Lebanese population, vaccine awareness, pharmacotherapy of Parkinson’s disease,
urinary tract infections in hospitalized patients, pharmacist interventions in arthritis, multidrug resistant
pathogens, drug abuse, hemodialysis-related electrolyte abnormalities, bariatric surgery and hypertension. A group of posters also addressed some conditions related to pregnancy, like gastrointestinal and
urinary ailments, immunization and smoking in Lebanese pregnant females, gestational diabetes, gestational hypertension, and folic acid deficiency.
Faculty also attended numerous grand lectures discussing updates in pulmonary diseases, infections,
endocrine disorders, new technologies of drug manufacturing, and others.
SOP is currently preparing for the following two events:
SOP Social Life
The SOP family would like to congratulate our colleagues:
•
•
•
•
•
Dr. Mariam Dabbouss and Dr. Fouad Sakr for having their newborn twins.
Mrs. Siba Matar, Former Dean’s assistant, for her marriage.
Dr. Jihan Safwan and Dr. Faraj Saade for their marriage.
Mrs. Faten Boukarroum, for joining SOP family as the newly recruited Dean’s assistant.
The Dean, Dr. Mohammad Rahal, and his family for their Omra visit to Mekka.
36 SOP Newsletter | February 2016
• The eleventh annual pharmacy day, which will be held on Friday, May 27th, 2016, at Beirut Campus,
Blocks D and F, and it will address the theme of over-the-counter drugs.
• The first International conference which coincides with the 19th congress of the Association of Colleges of Pharmacy in the Arab World, between October 18th and 20th, 2016, at Bekaa Campus, Khyara.
The theme of the conference will be: “Advancing Pharmacy Horizons: Integrating Education, Practice,
and Research”, and will host national and international speakers, who will present and discuss latest
pharmacy updates.