Frequency, severity, and factors associated with clinically significant drug-drug interactions among patients with cancer attending Mbarara Regional Referral Hospital Cancer Unit, Uganda

Abstract

Background Cancer is a major public health problem with pharmacotherapy being the cornerstone of its management. Cancer patients receive multiple drugs concurrently risking Drug-Drug Interactions (DDIs). DDIs, though avoidable, can significantly contribute to morbidity, mortality, and increased healthcare costs in this population of patients. Currently, there is no published study from Uganda on clinically significant DDIs (cs-DDIs) among cancer patients. This study identifies frequency, severity, and factors associated with cs-DDIs at Mbarara Regional Referral Hospital Cancer Unit (MRRHCU). Method A cross-sectional study was conducted among 300 cancer patients receiving chemotherapy from a tertiary care hospital in western Uganda from January–February 2022. A questionnaire and data collection form were used to collect patient data. Lexicomp® Drug interaction software was used to screen the patient drug information for DDIs and assess their severity. Predictors of DDIs were identified using logistic regression using SPSS (Statistical Package for Social Sciences). Result Three hundred participants were enrolled with a mean age of 48 ± 23.3 years. One hundred eighty-one patients experienced 495 cs-DDIs; with a mean of 1.7 ± 2.2. The prevalence of cs-DDI was 60.3% (55.0-66.0% at 95% CI). Digestive organ neoplasms were the most commonly (80, 26.7%) diagnosed category, and ‘plant alkaloids and other natural products were the most frequently (143, 47.7%) used chemotherapeutic drug classes. About three-quarters of cs-DDIs were rated as category C risk (367, 74.1%) whereas over two-thirds (355, 71.7%) were moderate in severity.. Being female (aOR = 2.43 [1.23–4.48 at 95% CI]; P-value = 0.011) and use of ≥ 6 drugs concurrently (aOR = 18.82 [9.58–36.95 at 95% CI]; P-value < 0.001)) were significantly associated with cs-DDIs. Conclusion More than half of the participants experienced at-least one cs-DDI which is generally higher than what was reported in high-income settings. About three-quarters were category C and moderate in severity, and require enhanced monitoring for safety and treatment outcome. Being female and using ≥ 6 drugs were significantly associated with cs-DDIs.

Potential drug–drug interaction and its determinants among patients with cancer receiving chemotherapy in oncology centres of Northwest Ethiopia: an institutional-based cross-sectional study

“…This finding agrees with studies conducted in Brazil,60 Pakistan,25 48 the USA,40 India28 and Taiwan 17. This might be due to cancer-related illnesses and treatment side effects, such as pain and adverse drug reactions, which demand pharmacological intervention and expose individuals to polypharmacy, a known risk factor of DDIs 61. This guides the development of preventive interventions for medication discrepancy, such as the inclusion of clinical pharmacists in the healthcare management team at the cancer unit, who can minimise DDIs by performing medication reconciliation 62.…”

“… 17 This might be due to cancer-related illnesses and treatment side effects, such as pain and adverse drug reactions, which demand pharmacological intervention and expose individuals to polypharmacy, a known risk factor of DDIs. 61 This guides the development of preventive interventions for medication discrepancy, such as the inclusion of clinical pharmacists in the healthcare management team at the cancer unit, who can minimise DDIs by performing medication reconciliation. 62 In addition, because polypharmacy is common among patients with cancer, screening of prescribed drugs is necessary for prompt prediction, avoidance or reduction of any undesirable negative effects.…”

Prevalence and factors associated with potential drug-drug interactions in prescriptions presented at private pharmacies in Mbarara city, southwestern Uganda

“…According to a study conducted by Lubinga and Uwiduhaye in 2011, 23% of in-patient prescriptions in Mbarara Regional Referral Hospital had potential DDIs [ 7 ]. A recent cross-sectional study conducted in the oncology unit of the same hospital revealed a 60.3% prevalence of clinically significant DDIs among chemotherapy patients, majority of whom (79.9%) were outpatients [ 14 ]. To the best of our knowledge, there is no country wide study that explored the prevalence of potential DDIs in Uganda.…”

Eri̇şki̇n Kemi̇k İli̇ği̇ Transplantasyon Üni̇tesi̇nde Olasi İlaç Etki̇leşi̇mleri̇ni̇n Beli̇rlenmesi̇ -Prospektif Çalişma

“…Farklı ülkelerdeki hematoloji kliniğinde yürütülen çalışmalarda, potansiyel ilaç etkileşimlerinin oranının %40-78 arasında olduğu belirtilmektedir [1,[9][10][11][12]. Hematoloji kliniğinde ayakta tedavi alan hastaların tedavisinde kullanılan ve ilaç etkileşimine sık karşılaşılan ilaçlar arasında, flukonazol, sülfametoksazol-trimetoprim, doksorubisin, siklofosfamid ve metotreksat yer almaktadır [1,12,13]. Kemik iliği transplantasyonu sürecinde tedavide sıklıkla kullanılan busulfan, siklofosfamid, etoposit gibi birçok etken madde CYP450 izoenzimleriyle metabolize ve eliminize edilmektedir.…”