Clinical pharmacists are responsible for guiding pharmacotherapy and ensuring medication safety along with other health-care providers. This study highlighted barriers that physicians and nurses encounter when interacting with clinical pharmacists. Twenty-seven physicians and nurses were randomly invited to participate in focus-group discussions. Five focus-group discussions were recorded and then transcribed, and the transcripts were reviewed and coded. Three major themes were identified, which were the role of clinical pharmacists, interprofessional communication, and competency. The greatest challenge reported in this study was lack of consistent understanding of the role of clinical pharmacists which to some extent caused communication deficiencies and affected the level of involvement with multidisciplinary teams. Despite that, majority of the participants perceived pharmacists as beneficial in optimizing pharmacotherapy and improving quality of care. Clinical pharmacy services are perceived positively in impacting quality of care as expressed by majority of the study participants. However, there is a lack of common understanding of the role of clinical pharmacists by other health-care providers.

Purpose: The pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of zanbrutinib are described. Summary: Mantle cell lymphoma (MCL) is a mature B-cell lymphoma that is typically associated with unfavorable outcomes, and virtually all patients with MCL have refractory or relapsed disease despite aggressive treatment. The treatment paradigm for MCL has transformed dramatically over the past decade owing to rapid advancements in immunotherapy and molecular-targeted therapies. Zanubrutinib, a second-generation Bruton’s tyrosine kinase inhibitor (BTKI) designated for mature B-cell non-Hodgkin’s lymphoma (NHL), has drastically improved the survival outcomes in relapsed/refractory (R/R) MCL patients. This selective BTKI is a small molecule that functions by forming a covalent bond in the active site of BTK. The inhibition of BTK activity is essential for the signaling of B-cell antigen receptor (BCR) and cytokine receptor pathways. In a preclinical study, zanubrutinib inhibited malignant B-cell proliferation and reduced tumor growth. Zanubrutinib was granted FDA-accelerated approval based on the results of Phase I and II trials. The investigator-assessed overall response rate was 83.7%, of which 78% of patients achieved complete response. The median duration of response was 19.5 months, and the median progression-free survival was 22.1 months. The most common (≥ 20%) all-grade adverse events were low neutrophil count (46.5%), upper respiratory tract infection (38.4%), rash (36.0%), low white blood cell count (33.7%), and low platelet count (32.6%). Conclusion: Zanubrutinib is a selective, next-generation, orally active, irreversible BTK inhibitor. The selectivity of zanubrutinib and its superior efficacy, with a well-tolerated safety profile, have proven to be attractive options for other malignancies.

Background: Antiphospholipid Syndrome (APS) is an autoimmune condition that increases thrombosis risk. Although Vitamin K antagonists (VKA) are standard treatment, interest in direct oral anticoagulants (DOAC) has grown. Recent studies evaluated DOAC across all APS subgroups. This review updates our understanding of DOAC's efficacy and safety compared to VKA in preventing thrombotic complications, integrating new findings into the literature. Methods: A systematic review across PubMed/Medline, Embase, and Cochrane was conducted in accordance with PRISMA guidelines. The quality of randomized controlled trials (RCTs) and cohort studies was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale, respectively. Meta-analysis calculated odds ratios (OR) using the random effect model for arterial and venous thrombotic and bleeding outcomes Results: Of a total of 2385 records identified, the meta-analysis included 11 studies, comprising 5 RCTs and 7 observational studies, with a combined total of 1813 participants. The analysis revealed no significant difference in the odds of venous thromboembolism (VTE) between DOAC and VKA (OR = 0.80; 95% CI 0.41-1.56). However, a significant increase in thromboembolism recurrence was noted in triple-positive APS patients using DOAC compared to VKA (OR = 3.62; 95% CI 1.10-11.98). The risk of major bleeding was similar between DOAC and VKA (OR = 1.02; 95% CI 0.62-1.68). Additionally, the pooled analysis indicated a higher risk of arterial thrombosis with DOAC (OR = 6.21; 95% CI 2.06-18.76). Conclusion: Overall, findings suggest DOAC are comparably safe but increase the risk of arterial thrombosis and VTE in triple-positive APS, favoring warfarin for prophylaxis.

Introduction: The evolving field of oncology necessitates effective management of cancer-related cardiovascular diseases. In Saudi Arabia, the incidence of cancer is rising, and there is a critical need for cardio-oncology services to address cancer treatment-related cardiovascular toxicity. This study aimed to evaluate the knowledge and practices of healthcare providers (HCPs) in Saudi Arabia regarding cardio-oncology. Methods: A cross-sectional study was conducted from January 2024 to April 2024 using an online survey targeting cardiologists, oncologists, and clinical pharmacists. The survey assessed demographics, perceptions of cardio-oncology, availability of services, and current practices. Data were analyzed using descriptive statistics, chi-squared tests, and bivariate analyses. Results: The survey received responses from 116 HCPs, including cardiologists (63.79%), oncologists (23.28%), and clinical pharmacists (12.93%). Most participants had over six years of experience, and only one had formal cardio-oncology training. While 84.48% recognized the importance of managing cardiac complications in cancer patients, only 42.24% were familiar with existing guidelines. Limited training programs and institutional resources were significant barriers to implementing cardio-oncology services. Despite agreement on the need for cardiotoxicity management, only one-third recommended cardioprotective agents as standard care. Conclusion: There is a notable deficiency in formal training and resources for cardio-oncology in Saudi Arabia. To bridge this gap, integrating cardio-oncology into training programs, establishing institutional guidelines, and adopting multidisciplinary care models are crucial. These measures will enhance the quality of care for cancer patients and improve their cardiovascular outcomes.

Introduction: Hormone receptor-positive, HER2-negative (HR+/HER2-) is the most common subtype of breast cancer in women. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, such as palbociclib, ribociclib, and abemaciclib play an important role in the treatment of advanced HR+/HER2- breast cancer. However, CDK4/6 inhibitors might be associated with an increased risk of thrombotic events, including venous thromboembolism (VTE). Methods: We conducted a retrospective study at two centers in Saudi Arabia, analyzing data from 447 patients treated with CDK4/6 inhibitors for HR+/HER2- breast cancer between 2016 and 2023. Patients with early-stage, high-risk breast cancer receiving abemaciclib for at least one month were included. The primary outcomes were the incidence of VTE and arterial thrombosis. Results: A total of 505 patients were screened in which 447 breast cancer patients receiving CDK4/6 inhibitors were included. Majority of patients were on palbociclib (70.4%), followed by abemaciclib (28.8%), and then ribociclib (0.67%). The thrombotic events were 11.8% (n=53), with 37.7% of these being pulmonary embolism (PE) and 18.8% symptomatic deep vein thrombosis (DVT). Patients with a prior history of VTE had a significantly higher risk of thrombosis (p=0.03). Abemaciclib was associated with a higher incidence of thrombosis (16.3%), followed by palbociclib (10.2%), and none of the three patients on ribociclib developed thrombosis. The median time to develop thrombosis while receiving CDK4/6 inhibitor therapy was 11.8 months. There was no significant difference in overall survival in breast cancer patients who developed thrombosis compared to patients without thrombosis (p=0.55). Conclusion: This study shows a higher incidence of thrombotic events in real-world settings than clinical trials, emphasizing the need for risk assessment and possible thromboprophylaxis in patients receiving CDK4/6 inhibitors. Future risk assessment tools needed to be applied in breast cancer patients receiving CDK4/6 inhibitors and risk of developing thrombosis.

Acute lymphocytic leukemia (ALL) is a hematologic malignancy commonly treated with pegasparaginase (PEG-ASP). Limited data exist on PEG-ASP-induced hepatotoxicity in the Saudi population; therefore, this study aimed to determine the rate and risk factors of PEG-ASP-induced hepatotoxicity in Saudi pediatric and adult ALL patients. This retrospective cohort study reviewed the records of ALL patients who had been treated with or received at least 1 dose of PEG-ASP between 2014 and 2021. Hepatotoxicity was graded using the Common Terminology Criteria for Adverse Events (CTCAE) Version 5. Bivariate and multiple logistic regression analyses were used to analyze the relationships between the variables and the risk of PEG-ASP-induced hepatotoxicity. A total of 368 patients were included in the study, with an overall hepatotoxicity rate of 38.8 (95% CI = 33.9–43.8) per 100 patients. Hepatotoxicity was observed in 35.7% (n = 117/328) of pediatric patients and 7.6% (n = 25/328) of adult patients. Risk factors of hepatotoxicity were identified: bilirubin level (odds ratio = 1.324, 95% CI = 1.089–1.610), presence of hyperdiploidy (OR = 1.456, 95% CI = 1.112–1.907), PEG-ASP dose (OR = 1.287, 95% CI = 1.021–1.623), and vincristine administration (OR = 1.398, 95% CI = 1.087–1.798). Additionally, the liver function test levels included alanine aminotransferase (OR = 1.512, 95% CI = 1.198–1.909), aspartate aminotransferase (OR = 1.445, 95% CI = 1.156–1.806), and gamma-glutamyl transferase (OR = 1.367, 95% CI = 1.089–1.716). PEG-ASP-induced hepatotoxicity poses a significant risk to Saudi patients with ALL. Further studies are needed to identify additional risk factors and improve the management of hepatotoxicity in ALL patients receiving PEG-ASP.