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.

Background: Community-acquired pneumonia (CAP) remains a leading cause of emergency department (ED) visits, hospitalizations, and mortality worldwide. The choice between oral (PO) and intravenous (IV) antibiotic administration in the ED varies based on patient presentation and provider preference, yet the impact of this choice on clinical outcomes, including revisit rates and ED length of stay (LOS), remains unclear. This study aimed to compare PO versus IV antibiotic therapy in CAP patients discharged from the ED in terms of baseline characteristics, treatment outcomes, and healthcare utilization. Method: This retrospective cohort study was conducted at a tertiary care ED at the Ministry of National Guard Health Affairs in Saudi Arabia. Adult patients diagnosed treated with antibiotic for CAP and discharged from the ED between 2020–2024 were included. Patients were categorized into two groups based on antibiotic administration: POIV. The primary results were ED LOS and 30-day revisit rates. Secondary outcomes included time to first antibiotic administration, fluid administration patterns, and baseline risk factors. Data was extracted from the electronic health record and analyzed using descriptive and inferential statistics. Results: A total of 430 patients were included, with 162 (37.7%) receiving PO antibiotics and 268 (62.3%) receiving IV antibiotics. Baseline characteristics showed higher heart rate, respiratory rate, and temperature in the IV group, suggesting more severe presentations. The mean ED LOS was similar between groups (oral: 6.5 ± 4.9 h vs. IV: 6.4 ± 4.5 h; p = 0.5559). However, the 30-day ED revisit rate was significantly lower in the IV group (23.1%) compared to oral group (34.0%) (p = 0.0146). IV fluids were administered more frequently in the IV group (60.4% vs. 22.2%). Conclusions: While both PO and IV antibiotic strategies resulted in similar ED LOS, IV antibiotic use was associated with a significantly lower 30-day revisit rate. These findings support the need for risk-based treatment decisions in the ED and highlight opportunities for antibiotic stewardship to improve patient outcomes.

e13049 Background: Breast cancer is the most frequently diagnosed cancer in women, and hormone receptor-positive, HER2-negative (HR+/HER2-) is the most common subtype. Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, such as palbociclib, ribociclib, and abemaciclib, play a role in the treatment of advanced HR+/HER2- breast cancer. However, CDK4/6 inhibitors might be associated with an increased risk of 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) as shown in the table. 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). Conclusions: Our study shows a higher incidence of VTE 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. Incidence of thrombosis. Incidence of thrombosis Thrombotic Events Thrombosis (n= 53) Incidence of thrombotic events during CDK4/6 inhibitor therapy 53 (11.8%) Incidence of arterial thrombosis during CDK4/6 inhibitor therapy 8 (1.7%) Cumulative incidence of thrombosis, by CDK4/6 inhibitor (95% CIs) Palbociclib 10.2% (6.8% to 13.5%) Abemaciclib 16.3% (9.9% to 22.7%) Ribociclib 0 Time to thrombosis while receiving CDK4/6 inhibitors, median in months (IQR) 11.8 (2.7 – 22.4) IQR = Interquartile range.

The American Society of Health-System Pharmacists (ASHP) and the Saudi Society of Clinical Pharmacy (SSCP) believe that the pharmacist plays an important role in substance abuse prevention, education, and assistance. Amphetamine and its derivatives are the second most widely used class of illicit globally. Clinical pharmacists can collaborate with the healthcare team to manage medication therapies for patients experiencing acute methamphetamine abuse. This mini-review aimed to explore the effects of methamphetamine use, discuss the challenges associated with its treatment, and emphasize the crucial role of pharmacists in addressing this growing epidemic.