Comprehensive Evaluation of Drug-Related Problems and Pharmacotherapy Patterns in Non-Hodgkin’s Lymphoma Patients in Yemen

Mohammed Mohammed Battah,1,2 Hadzliana Zainal,2 Doa’a Anwar Ibrahim,1 Nur Hafzan Md Hanafiah,2 Syed Azhar Syed Sulaiman2 1Department of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology, Sana’a, Yemen; 2Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MalaysiaCorrespondence: Mohammed Mohammed Battah, Department of Clinical Pharmacy and Pharmacy Practice, University of Science and Technology, Sana’a, Yemen, Tel +‏ 967777404880, Email [email protected] Hadzliana Zainal, Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, 11800, Malaysia, Email [email protected]: Drug-related problems (DRPs) are critical challenges in oncology practice, particularly among patients with non-Hodgkin lymphoma (NHL), due to complex regimens and high toxicity potential.Purpose: This study aimed to identify, classify, and evaluate the prevalence of DRPs and associated factors, and explore the pattern of chemotherapy prescribing for NHL patients.Methods: A cross-sectional study was conducted from November 2022 to September 2023 at National Oncology Centre (NOC), Al-Jomhouri Teaching Hospital. Adult NHL patients undergoing chemotherapy were enrolled, with a final sample of 279 patients. DRPs were identified and classified using the validated Pharmaceutical Care Network Europe (PCNE) and cross-checked against National Comprehensive Cancer Network (NCCN) guidelines. Potential drug-drug interactions (DDIs) were evaluated using the Lexicomp® drug interactions database. Data was collected from patients’ interviews, treatment charts and medical records. Descriptive statistics and linear regression were used for analysis.Results: Among the 279 NHL patients included in the study, a total of 1870 DRPs were identified (average 6.7 per patient). Advanced-stage disease was observed in 79.6% of patients, and 63.4% received rituximab-containing regimens. The R-CHOP regimen being the most frequently used, which was associated with 52.7% of all DRPs. The most frequent DRPs involved dosing issues, including drug doses too low (26.5%) and incorrect or missing dose calculations (13.1%). DDIs contributed to 13% of the total identified DRPs, with the majority classified as mild interaction. Multivariate regression analysis identified comorbidities, lymphoma subtype, and number of chemotherapy cycles as significant predictors of DRP occurrence.Conclusion: A high number of DRPs were identified among NHL patients in Yemen, with an average of 6.7 DRPs per patient, predominantly due to dosing issues. Integration of clinical pharmacy services, guideline-based prescribing, and systematic medication reviews are essential to minimize DRPs and improve treatment outcomes.Keywords: non-Hodgkin lymphoma, drug-related problems, drug-drug interactions, PCNE, Yemen