Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review

Morris, Earl J.; Hollmann, Josef; Hofer, Ann Kathrin; Bhagwandass, Hemita; Oueini, Razanne; Adkins, Lauren; Hallas, Jesper; Vouri, Scott Martin

doi:10.1016/j.sapharm.2021.08.003

Cited by 21 publications

(32 citation statements)

References 79 publications

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“…concluded that PSSA methodology demonstrated only moderate sensitivity and specificity in identifying prescribing cascades and more consistency was required in how these studies were reported. 127 As described previously, similar issues with methodological quality were identified in this systematic review.…”

Section: Principal Findingsmentioning

confidence: 67%

“…A recent scoping review reported that whilst the PSSA method is a useful tool in detecting prescribing cascades, such cascades need careful clinical review as there is a risk of both false positive and false negative findings. 127 This is particularly problematic when screening for cascades without predefined hypotheses. In our systematic review, the vast majority of included studies (n=94, 93%) examined predefined medications as potentially contributing to a prescribing cascade.…”

Section: Principal Findingsmentioning

confidence: 99%

“…1,8,131 Comparison with existing literature Two scoping reviews of prescribing cascades have been conducted to date, one that focused on literature surrounding the prevention, detection and reversal of prescribing cascades 11 and the second that focused on the use of PSSA as a potential pharmacovigilance tool. 127 In 2018, Brath et al retrieved 10 original investigations and seven case reports pertaining to prescribing cascades. 11 A considerable number of studies have been published since, indicating that this is a rapidly developing field.…”

Section: Principal Findingsmentioning

confidence: 99%

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Prescribing cascades in community-dwelling adults: a systematic review

Doherty

Shahid

Cotter

et al. 2022

Preprint

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Background: The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. Methods: Systematic review reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline (Ovid), EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: Community-dwelling adults; Risk-prescription medication; Outcomes-initiation of new medicine to ‘treat’ or reduce ADR risk; Study type-cohort, cross-sectional, case-control and case-series studies. Title/abstract screening, full-text screening, data extraction and methodological quality assessment was conducted independently in duplicate. A narrative synthesis was conducted. Results: A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11,593,989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n=5), amiodarone to levothyroxine (n=5), inhaled corticosteroid to topical antifungal (n=4), antipsychotic to anti-Parkinson drug (n=4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n=4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Conclusion and implications: Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months. Word count: 245

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Section: Principal Findingsmentioning

confidence: 67%

Section: Principal Findingsmentioning

confidence: 99%

Section: Principal Findingsmentioning

confidence: 99%

See 1 more Smart Citation

Prescribing cascades in community-dwelling adults: a systematic review

Doherty

Shahid

Cotter

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…There has been an increasing number of publications using this methodology, with many more presented as conference abstracts that have yet to result in a published manuscript. [4][5][6] The PSSA uses a relatively simple design and computationally efficient approach. 5 Following a case-only design approach, the first step of the PSSA is to identify case-only patients who are those initiated on both an index and marker medication within a pre-specified exposure window (e.g., initiation of a marker drug within 365 days before or after index drug initiation).…”

Section: Introductionmentioning

confidence: 99%

“…Relevant to this research question, it could also be an indicator of inappropriate prescribing, that is, a prescribing cascade where an adverse event is treated with another drug rather than removing the cause for the adverse event. There has been an increasing number of publications using this methodology, with many more presented as conference abstracts that have yet to result in a published manuscript 4–6 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of the key prescription sequence symmetry analysis assumption using the calcium channel blocker: Loop diuretic prescribing cascade

Vouri

Morris

Usmani

et al. 2021

Pharmacoepidemiology and Drug

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Objectives: To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)induced edema.

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High‐throughput screening for prescribing cascades among real world statin initiators

Vouri

Morris

Walsh

et al. 2023

Pharmacoepidemiology and Drug

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Purpose Statins are among the most prevalent medications prescribed and associated with adverse events that may prompt additional treatment (i.e., a prescribing cascade). No comprehensive assessment of statin‐related prescribing cascades has been performed to our knowledge. Methods We utilized sequence symmetry analysis to iteratively screen prescribing sequences of all therapeutic classes (“marker” classes) based on Level 4 Anatomical Therapeutic Chemical codes among adult statin initiators, using IBM Marketscan commercial and Medicare supplemental claims databases (2005–2019). Order of initiation and secular trend‐adjusted sequence ratios were calculated for each statin‐marker class dyad, among marker class initiators ±90 days of statin initiation. Among signals classified as prescribing cascades, we calculated naturalistic number needed to harm (NNTH) within 1 year as the inverse of the excess risk among exposed. Results We identified 2 265 519 statin initiators (mean ± SD age, 56.4 ± 12.0 years; 48.7% women; 7.5% with cardiovascular disease). Simvastatin (34.4% of statin initiators) and atorvastatin (33.9%) were the most commonly initiated statins. We identified 160 significant statin‐marker class dyad signals, of which 35.6% (n = 57) were classified as potential prescribing cascades. Of the top 25 strongest signals (lowest NNTH), 12 were classified as potential prescribing cascades, including osmotically acting laxatives (NNTH, 44, 95% CI 43–46), opioids + non‐opioid combination analgesics (81, 95% CI 74–91), and first‐generation cephalosporins (204, 95% CI 175–246). Conclusions Using high‐throughput sequence symmetry analysis screening, we identified previously known prescribing cascades as well as potentially new prescribing cascades based on known and unknown statin‐related adverse events.

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Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review

Cited by 21 publications

References 79 publications

Prescribing cascades in community-dwelling adults: a systematic review

Prescribing cascades in community-dwelling adults: a systematic review

Evaluation of the key prescription sequence symmetry analysis assumption using the calcium channel blocker: Loop diuretic prescribing cascade

High‐throughput screening for prescribing cascades among real world statin initiators

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