Servet opens the way to clinical trials to stop the coronavirus

The hospital has at least six research plans in place led by the Pharmacy service // The center has stocked up on medications in case there is a resurgence and there is a spike in income

If the pandemic and the lack of knowledge about the coronavirus have shown anything, it is that research is more vital than ever. And not only what is done in laboratories or in highly recognized centers, but hospital research has also taken a step forward to help at such a critical moment and try to find evidence that will help stop the coronavirus.

One of the ways to achieve this objective is in the clinical trials that the Miguel Servet hospital is carrying out, through its Pharmacy service, which has decided to promote these projects. In fact, there are currently at least six clinical trials underway at the center related to the coronavirus. "Some have been proposed by us, such as the use of molecules used for rheumatoid arthritis, and others have been promoted by the community," explains Rafa Huarte, in charge of clinical process management at the hospital.

Among the open lines of work there is one where different molecules are being tested, as a preventive measure, among health workers; another develops the initial part of an antiviral treatment; and on the other hand, work is also being done with anti-inflammatory drugs and their immune system reaction. "With passive operation, in all areas of Servet there may be around 180 clinical trials initiated and the hospital is selected to participate by a promoter who offers the option," he explains.

However, in these months this formula has changed and it has been the hospital itself that has looked for "alternatives" to have drugs or access processes that would allow treating, at least, a group of patients with coronavirus. «The pharmaceutical industry changed, stock began to be lacking and what we wanted, by all means, was to participate in trials because it was a way to have treatment for the sick. For example, we managed to access a remdesivir project that allowed us to care for patients," he says. "They were days of great uncertainty, of overwhelm, of many hours of work with the sole purpose of being able to attend to as many more cases as possible," says Huarte.

The Pharmacy service even contacted colleagues from other hospitals to find out if there were trials to which they could apply and participate. "Once we achieved this, we looked for a doctor here in Servet who wanted to act as an investigator for the study, he could select the patients," he explains.

Everything happened "very quickly" and Huarte does not forget "very anxious situations" when "suddenly" some of the treatment options stopped being provided. «We believed that we were not going to have drugs for all the patients who arrived, especially those related to sedation in the ICUs. Consumption skyrocketed and we thought we were running out of resources," he confesses. In the event of an increase in income, the Pharmacy service has already stocked up on certain medications to prevent this situation from happening again.

Home delivery of drugs

One of the activities that has been most promoted by the Miguel Servet hospital during the pandemic is the home delivery of medications to chronic patients or patients with pathologies that require drugs dispensed from the hospital service. There have been almost 3.400 actions of this type, thanks to the collaboration agreement with Red Cross volunteers, who have been carrying this material.

Currently, the hospital has almost 9.000 outpatients who are given medication from the hospital. The health crisis situation and confinement led to recommending that these people not go there to pick up their medication so as not to put their health at risk. At this time, the telephone was used to offer pharmaceutical care to these patients during this two-month period, according to service data. Of these, given the circumstances and need, the formula of home delivery of drugs to people with all types of pathologies was valued. «It has been a success and I think that we should take several lessons learned from all this. One of them is telepharmacy, which I think should be maintained," says Reyes Abad, head of the Pharmacy Service at Servet. "Obviously not with the same intensity, because the situation has been exceptional, but it is a good resource that allows for better optimization of resources," she says.

In this sense, Abad suggests that "it would be good" to maintain this telephone service and the home delivery drug service for "a subgroup" of patients, more vulnerable or with difficulties, who do not have to travel. «The situation is being studied to see how it can be maintained, but we would have to look at user selection criteria and so on. It is under analysis and obviously ultimately we would have to have permission from the Health Department," Abad explained.

The service has also delved a lot into the preparation of medications using master formulas, but they have also made 13.000 parenteral nutrition for adults and pediatrics or 10.000 intravenous mixtures. Also, given the shortage of certain products such as hydroalcoholic gel, from pharmacotherapy up to 3.1000 liters were produced in a month and a half to cover the needs of the hospital.

Rigorous management

Regarding the provision of resources, stock management has been "rigorous", with daily inventories and an "extreme" requirement to cover needs. "To facilitate the work of health workers with patients with coronavirus, the Pharmacy worked to provide the appropriate doses, guaranteeing quality and safety," Abad explained. "Everyone's collaboration was extraordinary and for everyone it was a unique experience. The entire hospital worked to solve the problems of a group of patients, but also of society, and that must be highlighted," said the head of service.

According to the data, more than 180 requests for individualized medications have been made for coronavirus patients. "Restrictive criteria for the use of medicines had to be established because, when the pandemic begins, there is an increase in certain drugs and there is a tension in the supply. The objective of every hospital is to ensure the availability of medicines, but we live in a moment , throughout Spain, where consumption forecasts had to be required from all communities to make a balanced distribution," Abad commented.