Polypharmacy in patients with chronic liver disease: a systematic review of definitions

Abstract

Background Despite its central role in drug metabolism, there is still residual uncertainty regarding the rising burden as well as exact definition of polypharmacy in patients with chronic liver disease. Methods We carried out a systematic search of EMBASE, PUBMED, Cochrane Database of Systematic Reviews, Science Citation Index, and Database of Abstracts of Reviews of Effects (DARE) between 1st January 2000 and 30th January 2022 for studies exploring polypharmacy in patients with chronic liver disease. We excluded studies that had no explicit numerical or descriptive definition of polypharmacy. Results We retrieve (N = 171) reports from systematic literature search with six studies (N = 918 548 patients) meeting criteria for inclusion in the review. A total of (N = 8) iterations of polypharmacy definitions were retrieved with numerical definitions (≥ 5 medications) constituting up about 62.5% of this. The latter is the most reported definition of polypharmacy. Two studies described polypharmacy based on the duration of exposure. None of the reviewed studies examined the constituent of polypharmacy (i.e., whether liver-related or non-liver related medications). Conclusion In a systematic review of current reports on medication counts in patients with chronic liver disease, we found an intake of 5 or more medications as consistent with the definition of polypharmacy in this patient cohorts. It remains uncertain if adoption of “non-liver related polypharmacy” as a definition will best characterize this therapeutic morbidity in these cohorts of patients. Prospero Number: CRD42022306572