The timing of immunotherapy administration influences treatment effectiveness, with morning treatment associated with significantly better survival outcomes, according to new real-world data presented at the EAHP Congress in Barcelona.

Researchers from six hospitals across the Balearic Islands in Spain analysed nearly 9,000 immunotherapy infusions given to 1,175 patients between January 2021 and June 2025. The study examined whether the time of day at which checkpoint inhibitors — pembrolizumab, nivolumab, and atezolizumab — were administered affected overall survival in patients with metastatic cancer.

Patients were divided into two groups based on whether fewer or more than 50% of their doses were given in the afternoon (after 3 pm). The majority of administrations (62.3%) took place in the morning. The cohort was predominantly male (66.4%), with a mean age of 66 years and the most common diagnoses were non-small-cell lung cancer (54%) and small-cell lung cancer (12.7%).

The survival difference between the two groups was striking. Overall survival was not reached in the morning group, compared to just 28.6 months in the afternoon group. The hazard ratio of 0.64 (95% CI 0.53–0.78; p<0.0001) indicates that patients receiving predominantly morning infusions had a 36% lower risk of death during the follow-up period.

These findings align with the emerging field of chronotherapy — the idea that the body’s circadian rhythms influence how well treatments work. Immune function fluctuates throughout the day, and morning administration may coincide with peak immunological activity, enhancing the effectiveness of checkpoint inhibitors.

The authors conclude that where scheduling allows, morning administration of immunotherapy should be prioritised to optimise patient outcomes — a simple, cost-neutral change with potentially significant survival benefits.

The use of autologous serum eye drops (ASED) was associated with promising real-world outcomes in patients with severe ocular surface diseases refractory to conventional treatment, according to a retrospective observational study conducted at Hospital General de Granollers, Spain.

ASED are derived from the patient’s own blood serum, producing a composition analogous to natural tears that promotes ocular surface healing and symptomatic relief. Despite growing clinical use, real-world evidence regarding their effectiveness, safety, and patient-reported outcomes has remained scarce.

This study enrolled 39 patients (mean age 66 ± 11.5 years) treated with ASED between August 2023 and August 2024. Diagnoses included severe dry eye (22), Sjögren’s syndrome (7), corneal injury (7), and other refractory ocular conditions (2). Symptom relief was reported by 28 patients, including improvements in dryness (10), foreign body sensation (6), itching (4), pain (4), irritation (3), and corneal ulceration (1). No adverse events were recorded.

Visual acuity data were available for 35 patients. Of these, 40% demonstrated improvement and 40% remained stable at six months, suggesting a favourable clinical trajectory even in the absence of statistically measurable acuity gains across the full cohort.

Patient-reported satisfaction, assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM v1.4), indicated high scores across all domains: effectiveness 76.8 ± 24.3, side effects 100 ± 0.0, convenience 77.8 ± 16.4, and global satisfaction 84.9 ± 23.8. In total, 85.3% of patients rated global satisfaction at or above the positive threshold of 75.

The authors concluded that their findings support the use of ASED as a clinically relevant therapeutic option for patients with limited alternatives and highlight the value of incorporating patient-reported outcome measures into routine ophthalmic practice.

Continuous piperacillin/tazobactam infusion via elastomeric pump offers a safe, cost-effective alternative to inpatient antibiotic therapy in paediatric oncology, with measurable benefits for ward capacity, healthcare costs and quality of life.

Bacterial infections are among the most common and serious complications in children with cancer, frequently requiring prolonged antibiotic therapy. Piperacillin/tazobactam (pip/taz) is the established first-line intravenous treatment, but its standard three-times-daily dosing schedule creates a significant logistical burden — particularly for families living far from tertiary care centres. A six-month pilot at Oulu University Hospital (OYS) explored whether continuous pip/taz infusion via elastomeric pump could safely shift this therapy out of the inpatient setting, with meaningful benefits for patients, families and the healthcare system.

Background and rationale

OYS serves children across the Northern Finland collaboration area, a large and sparsely populated region where many families cannot realistically attend three outpatient infusion visits per day. Prior to the pilot, pip/taz therapy therefore required full hospitalisation for the entire treatment course — often three to five days, but sometimes several weeks. Elastomeric pumps, well-established in adult oncology, offered an alternative: continuous 24-hour infusion requiring only once-daily pump replacement, enabling home-based treatment or a single daily outpatient visit.

Methods

The pilot ran from November 2024 to April 2025. Weight-based dosing was established for children weighing 15–37.5 kg, using 120 ml FOLfusor (Baxter) pumps for lighter patients and 240 ml pumps for those weighing 30 kg and above. Children weighing 40 kg or more received the standard adult pump containing 12/1.5 g of pip/taz. Piperacillin was reconstituted at 173 mg/ml; tazobactam calculations were unnecessary given the fixed 4:0.5 ratio of the infusion powder. All pumps were prepared centrally at the hospital pharmacy under cleanroom conditions, with full batch documentation for every dose.

Results

The pilot demonstrated clear clinical and operational benefits. First, children were discharged from hospital earlier; once home, families reported improved appetite and increased physical activity in their children. Second, ward workload fell substantially — 117 hospital days were saved over the six-month period. Each elastomeric pump was priced at €95, a figure that covers the medication, the device itself, all required supplies and materials, and pharmacy preparation costs including personnel, cleanroom facilities, and microbiological monitoring. Compared with the cost of inpatient care, this translated to total savings of €54,000–73,000 over the pilot period. Third, pump therapy was successfully delivered to children throughout the collaboration area, including the smallest eligible patients, with centralised pharmacy preparation supporting consistent medication safety.

Implications for practice

These results confirm that elastomeric pump-delivered pip/taz, long used in adults, can be extended effectively to the paediatric oncology population. The model reduces pressure on inpatient beds, lowers nursing workload and generates significant cost savings — while simultaneously improving quality of life for children and their families during an already demanding period of treatment. On the basis of the pilot’s findings, pump-based pip/taz therapy has been adopted as standard practice at OYS Paediatric Haematology and Oncology.

Healthcare professionals seeking further information may contact the OYS Pharmacy team at elina.smolander@pohde.fi or tiina.kallio@pohde.fi.

Early results from the community pharmacy independent prescribing (IP) pathfinder programme show that the community pharmacy is increasing patient access to advice and medicines for acute and long-term conditions, according to an audit presented by Paula Wilson (Strategic Pharmacy Leader, NHS Midlands and Lancashire Commissioning Support Unit).

From 2026 onwards, all newly-registered pharmacists will be qualified as Independent Prescribers. In preparation for this development the Independent Prescribing in Community Pharmacy Pathfinder programme was set up, in selected sites, and went live in September 2024.  The purpose of the programme was to explore how community pharmacists and their teams could deliver integrated clinical services aligning prescribing activity with general practices and the population needs of local communities. The results from the pathfinder sites will be used to inform a commissioning framework for IP.

The data from 171 pathfinder sites were analysed for the period August 2024 to July 2025. A total of 30,351 consultations was recorded with 55% resulting in a prescribing decision – starting (42.3%), changing (10.2%), or stopping (2.9%) a prescription.  In total, 98.6% cases were closed by the pharmacist.  A number of different of clinical models or services were involved. By far the most common was for minor ailments (68%) followed by prescription management (8.4%), hypertension (7.5%) and lipid management (5.6%). The majority (79.7%) of consultations were completed face-to-face. Telephone consultations accounted for 17.8%. The average time taken for completion of a consultation was 22 minutes.

The authors concluded that the IP programme offered patients convenient appointments of longer duration than typical GP appointments and comparable to those offered by PCN pharmacists. As a result of the service, many patients did not need appointments with GPs. It is anticipated that a national roll-out will increase prescribing capacity in primary care, potentially increasing patient services, access and choice in the future.

Wilson P, Baqir W, Sidhu J, Titterton J, Dance J, Hampshaw S, Haydar G, Crouch T, Pearson H, Dulay M, Hobbs C Joshua A, Horgan J. Wearly findings from the Community Pharmacy Independent Prescribing Pathfinder Programme in England. Clinical Pharmacy Congress North, November 2025

Photo: Paula Wilson

National prescribing of transdermal and vaginal HRT and micronised progesterone increased while prescribing of oral HRT decreased after the documentary Sex, Myths and the Menopause, presented by Davina McCall, was aired, according to Dr Rosie Adsley (Assistant Professor in Pharmacy Practice, Nottingham University).

The Channel 4 documentary aired in May 2021 and provoked a large public response which was dubbed ‘the Davina effect’. The purpose of this study was to investigate prescribing trends for HRT before and after the documentary to examine whether the public discussion and awareness of menopause management had any impact on HRT prescribing.

Data on HRT prescribing over the period February 2019 to January 2024 were collected from the Open Prescribing Database.

The results showed that from April 2021 to January 2024:

• There was a 21% decrease in prescribing of oral conjugated equine oestrogens (CEE) and a 2% decrease in oral oestradiol prescribing
• Prescribing of transdermal combined HRT quadrupled with a sharp up-tick after May 2021
• Prescribing of transdermal oestrogen-only HRT more than tripled with a sharp up-tick after May 2021
• Prescribing of micronised progesterone capsules increased more than four-fold with a sharp up-tick after May 2021
• Prescribing of vaginal oestrogen-only HRT increased by 61% with a sharp up-tick after May 2021

Adsley R, Gonet D Mofunanya B. Prescribing trends of hormone replacement therapy (HRT) from 2019-2024 and ‘the Davina effect’. Clinical Pharmacy Congress North, November 2025

Photo: Dr Rosie Adsley

A drug-eluting implant has been shown to reverse cystoid macular oedema and reduce the need for systemic treatment in 80% of uveitis patients according to a real-world study presented by Ann-Marie Goacher (University Hospitals Sussex).

Uveitis is an inflammatory condition that affects the middle part of the eye (the uvea or uveal tract). It is often associated with systemic inflammatory (auto-immune) disease but many cases are idiopathic. Although uveitis is relatively rare it is important because it is a sight-threatening condition. Treatment involves the use of corticosteroids (first line) and immunosuppressant treatment (second line).

Iluvien (Alimera Sciences Ltd), a fluocinolone acetonide intravitreal implant has been developed to provide a continuous microdose of corticosteroid over an extended period.

The present study was undertaken to determine how these implants perform in a real-world setting.

Patient data for a five-year period were reviewed. This involved 45 eyes from 34 patients, 65% of whom were female.

Key findings included:

• The mean time to treatment failure (reactivation of disease) was 15 months.
• At 6 months, 80% of patients had a resolution of cystoid macular oedema.
• 84% of patients on systemic treatment were able to reduce their doses and 15% were able to stop all systemic treatment
• 58% of patients experienced improved vision.
• 14 eyes developed cataracts, a known complication of corticosteroid treatment; all had previously received dexamethasone implants.

The authors concluded that Iluvien offers significant benefits in managing inflammation and improving visual outcomes.

Goacher A-M, Ortiz G, Hughes E, Davidson C. Evaluating the use of Iluvien in uveitis patients in a real-world clinical setting. Poster presentation. Clinical Pharmacy Congress North, November 2025

Photo: Ann-Marie Goacher

Impedance flow cytometry is a quick and easy method for estimating the numbers and viability of bacteria in faecal microbiota samples, according to Anne-Christine Joly (Saint Antoine Hospital, Paris).

Pharmaceutical preparation units need rapid, economical methods for testing of faecal microbiota transplant material. It is possible to estimate the total microbial load and viability using flow cytometry but this is costly and complex to implement. The technique requires fluorescent labelling of cells. Impedance flow cytometry (IFC) counts and analyses cells by measuring variations in electrical current as they pass individually through an electromagnetic field. This study aimed to compare IFC with the current reference method (culture) to determine its usefulness for routine use.

Twenty stool samples, 10 from healthy donors and 10 from patients, were analysed by both methods. The results showed that there was no statistical difference between the two counting methods. The researchers concluded that the high degree of concordance between the results suggested IFC would be a robust method for estimating total bacterial concentration and viability. IFC has the advantage of not needing specific [fluorescent] markers. However, it cannot identify bacterial species, noted Mme Joly.

Sintes R et al. Evaluating microbial viability differently: impedance cytometry versus culture. Short communication. GERPAC Congress 2025

Photo: Anne-Christine Joly.  Photo – courtesy of GERPAC

Cyclodextrin-based chlorhexidine eye drops represent a promising approach to formulating stable and effective treatments for Acanthamoeba keratitis, according to researchers from the University of Picardy Jules Verne.

Acanthamoeba keratitis is a rare but serious, sight-threatening corneal infection caused by the acanthamoeba parasite. Chlorhexidine has demonstrated efficacy against acanthamoeba but no eye-drop formulation was available. Moreover, the use of chlorhexidine digluconate (CD), the most soluble form, was limited due to precipitation (of chlorhexidine hydrochloride) in the presence of chloride ions in vivo. In 2024 Akantior® eyedrops (polyhexanide 0.08%) were approved for this indication. Akantior was designated as an orphan medicine. Professor Frédéric Marçon noted that Akantior costs about €8,754 for 30 vials of 0.3 ml. The present study screened a number of cyclodextrins for their ability to form inclusion complexes with CD that would effectively protect the chlorhexidine from precipitation in saline conditions. Two suitable products were found and further investigations showed that they could be formulated as eyedrops and that the antibacterial activity of the chlorhexidine was preserved in vitro.

In vitro conditions may not reflect conditions in the eye and this could influence the efficacy of the formulation. Professor Marçon said that another important consideration was that acanthamoeba parasites tend to encyst in the cornea.

Professor Irene Kraemer said that at the University Hospital of Mainz they prepare polyhexanide eyedrops for this indication in a different strength from the commercial product.

Sebastian Rigaud et al. Formulation of a Cyclodextrin-Based Ophthalmic Drug Solution of Chlorhexidine for the treatment of Acanthamoeba Keratitis. Short communication. GERPAC Congress 2025

Photo: Frédéric Marçon. Photo – courtesy of GERPAC

The use of licensed ready-to-use (RTU) gemcitabine in polypropylene infusion bags (Sun Pharma) is associated with fewer carbon emissions than in-house compounding from glass vials, according to Dorian Protzenko (Centre Hospitalier Intercommunal des Alpes du Sud).

The researchers conducted a “cradle-to-grave” analysis of the carbon emissions associated with each product, taking into account the active pharmaceutical ingredient (API), excipients, packaging, upstream and downstream transport, formulation losses, consumables and disposal.  Carbon emissions were calculated using standard methods – Ecovamed© 2025, Carebone© v2.3 and in-house hospital data.

The results showed that RTU gemcitabine bags were associated with carbon savings of 40-60% per dose compared with traditional in-house preparation of doses. Major factors in the carbon savings were the switch to lightweight plastic containers (~42%), the elimination of sterile consumable devices (~19%) and lower quantities of clinical waste incinerated (~14%).

The researchers concluded that replacing glass vials of gemcitabine with the RTU bags reduced the environmental impact with up to 1.7 Kg of exhaust gas carbon dioxide (EGCO₂) avoided per dose administered. This corresponds to the emissions generated by a 15-minute car journey in an average petrol vehicle.

Protzenko D & Plan A. licensed ready-to-use gemcitabine bags cut carbon emissions versus in-house vial compounding. Short communication. GERPAC Congress 2025

Photo: Dorian Protzenko. Photo – courtesy of GERPAC

A near-infrared (NIR) spectroscopic method for analytical checks of compounded anti-cancer drugs could replace the current double visual checks in future, according Julie Evrard (Groupe Hospitalier Artois-Ternois). The major advantage of the NIR method is that the measurements are carried out through the final container – a bag, syringe or elastomeric pump – and no sample is required.

An evaluation of a NIR device (Ayna Analytics) was undertaken to evaluate its performance under real-life conditions. During a three-month period 10 commonly-prepared drugs – five cytotoxic drugs and five monoclonal antibodies – were included. For each molecule, diluents and final containers were identified in order to establish the calibration curves. Up to 50 data points for each molecule are required for calibration. During the study double visual checks (“four eyes”) were continued.

Ms Evrard said that the analytical procedure took just two minutes. So far, this analytical procedure has been validated for routine use for daratumumab SC, rituximab SC and fluorouracil Neopump 48h. have been validated for routine use. The next step will be to finalise calibrations for the remaining molecules before extending the project to include other molecules and containers.

During the discussion one member of the audience said that in a department that prepares 70 doses a day, this technology could eliminate the need for a someone to perform the visual checks (second checks).

Evrard J. et al. Analytical control of anticancer agents via sample-free near infrared spectroscopy: first feedback. Short communication. GERPAC Congress 2025

Photo – Julie Evrard

3D-printed doses of melatonin 1mg cost approximately half as much as the same doses prepared by manual encapsulation, according to an economic evaluation by Lena Lemierre (MB Therapeutics & University of Montpelier) and colleagues.

A study compared two hospital-based manufacturing methods for personalised oral dosage forms – semi-solid extrusion (SSE) 3D printing and traditional capsule compounding.  Resource inputs were calculated for preparation of 600-unit batches by each method. The 3D printing process relied on semi-solid extrusion of an industrially validated pharmaceutical cartridge, followed by drying within the printer (MED U PROD 1.0 ® – MB Therapeutics). Manual capsule preparation was carried out using a 300-capsule filling plate.

The costs for each dose were €1.55 (capsules) versus €0.72 (printed oral doses). The staff time required was: 35 min for analysis of printed forms (mass control only), versus 4 h 30 min for capsules (mass and content uniformity testing). HPLC analysis accounted for a large proportion of the cost of the capsules.

The authors concluded that the results demonstrated the potential of SSE 3D printing as a faster and more cost-effective alternative for hospital manufacturing of personalised oral dosage forms. The significant reduction in production time, particularly during analytical phases, enables more efficient use of human resources.

Lemierre L. et al. Techno-Economic Comparison Between Semi-Solid Extrusion 3D Printing of Oral Forms and Capsule Compounding in a Hospital Setting. Short communication. GERPAC Congress 2025

Photo – Lena Lemierre

The successful development of fenfluramine-loaded albumin nanoparticles paves the way for nasal administration of fenfluramine in drug-resistant epilepsy in children. Nasal administration would deliver the drug to the brain via the olfactory and trigeminal nerves and avoid significant hepatic metabolism to norfenfluramine which is cardiotoxic, explained Maxime Petit.

Successful nasal delivery of a drug depends on having a small volume and a prolonged residence time in the nasal cavity, to overcome mucociliary clearance. This calls for a formulation that combines a high concentration of the drug and a gelling agent or muco-adhesive.

In this study fenfluramine-loaded albumin nanoparticles were prepared and dispersed in an aqueous solution of pectin to make a final drug concentration of 10mg/mL. The particles were 107-135nm making them small enough to pass through the nasal mucosa. A stability study showed that 18.6% of the fenfluramine was released after three hours, indicating that the majority of the drug remained encapsulated. Local cytotoxicity (cell lysis) was assessed by measuring lactate dehydrogenase (LDH) release from a suitable cell line, as a model for nasal epithelium. The results showed that fenfluramine alone caused extensive cell lysis whereas with the nanoparticle formulation it was negligible.

The authors concluded that the sizes of the nanoparticles and the concentration of fenfluramine made the nanoparticle formulation suitable for therapeutic use. They plan to complete physicochemical studies before starting in vivo studies in mice.

Petit M et al. Development of fenfluramine in albumin nanoparticles for nasal administration. Short communication. GERPAC Congress 2025

Photo – Maxime Petit