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Volume 47 • Number 10 • October 2020
Survival benefit seen in multiple trials CLINICAL
Pharmacists help halt risky gout therapy in ED ..................... Making off-label feeding safer in younger patients .............
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5 stewardship tips for rapid diagnostic testing ........... 9 POLICY
Meeting Medicare’s new payment rules for COVID-19 ....................
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REVIEW ARTICLE
Biosimilars in Oncology Information Technology Integration: Part 2 of 3 See page 22.
Steroids Offer ‘Umbrella’ For COVID Cytokine Storm
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articipants in the 340B drug pricing program scrambled to respond to a flurry of new audit demands from drug manufacturers on the number of contract pharmacies that participants are allowed to use under 340B. The covered entities have been seeking intervention from the Department of Health and Human Services and the Health Resources and Services Administration (HRSA), which administers 340B, but as of the end of September, no action had been taken, experts said at the National Association of Specialty Pharmacy (NASP) 2020 Annual Meeting & Expo Virtual Experience. 340B covered entities began receiving letters from manufacturers outlining new requirements in late July. The demands fell into two broad categories: 1. Submissions by covered entities of all 340B claims data to
teroids appear to improve the survival of the sickest COVID-19 patients, by dampening the cytokine storm, according to three recent reports in JAMA—one of them a meta-analysis. As a result, the World Health Organization issued a new guideline recommending systemic corticosteroids for the treatment of patients with severe and critical COVID-19. However, the guideline suggested that corticosteroids not be used for those with mild disease. The WHO said steroid treatment in mild COVID-19 cases brought no benefits, and could even prove harmful (bit.ly/32Bt2O5). Steroids appear to work by calming the inflammatory response, which occurs when the body’s immune system overreacts, damaging the lungs and surrounding tissue in seriously ill COVID-19 patients. “There is now strong evidence to suggest that the blockade of inflammation in COVID-19 is effective in severely ill patients,” said C. Michael White, PharmD,
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TECHNOLOGY
Guidelines-based AUC vancomycin dosing: one way to get there .....................
340B: Scrambling To Meet New Requirements
The Bottom Line: IV-WMS and Cost Savings
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ost is often cited as one of the barriers to a hospital’s adoption of IV workflow management systems (IV-WMS). But what if the technology actually saves money—to the tune of more than $500,000 annually? That’s the savings accrued at Cincinnati Children’s Hospital, where Alex C. Lin, PhD, and his colleagues at the James L. Winkle College of Pharmacy at the University of Cincinnati found that the adoption of IV-WMS reduced the amount of wasted and missing IV doses by 14,176 and 2,268 doses, Continued on page 21
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Poor feeding linked to big mortality spike
Universal Nutrition Screening Urged for COVID-19 Patients
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utrition experts are urging providers to screen all COVID-19 patients for malnutrition, based on new data showing that infected patients’ mortality rates spike significantly in the presence of suboptimal feeding. The interplay between COVID-19 and nutrition shouldn’t come as a surprise, Leah Gramlich, MD, FRCP, a nutrition specialist based out of the Royal Alexandra Hospital in Edmonton, Alberta, noted during a recent webinar hosted by the American Society for Parenteral and Enteral Nutrition (ASPEN). She explained that patients infected with the coronavirus often have a poor appetite and gastrointestinal symptoms, such as diarrhea,
Oncology Roundup: Updates in oncogeriatric care, metastatic CRC, trophoblastic tumors and more. See pages 12 and 13.
both of which can affect their nutritional status (Gastroenterology 2020;159[2]:775-777). Such patients’ survival literally is at stake, she stressed, citing the new data, which included hundreds of COVID-19 patients in Wuhan, China. The researchers screened patients for nutritional deficiencies using the Nutrition Risk Screening (NRS) score, and found that the vast majority (92%) were at risk for poor nutrition (NRS score ≥3), with 16% at high risk (NRS score ≥5). Patients remained in the hospital for an average of 30 days, but those with NRS scores of at least 5 needed nearly an additional week Continued on page 6
