Polypharmacy, potentially inappropriate medications and drug-drug interactions in geriatric patients with hematologic malignancy: Observational single-center study of 122 patients

Léger, David Y.; Moreau, Stéphane; Signol, N.; Fargeas, J.B.; Picat, Marie‐Agnès; Penot, Amélie; Abraham, Julie; Laroche, Marie‐Laure; Bron, Dominique

doi:10.1016/j.jgo.2017.07.015

Cited by 32 publications

(25 citation statements)

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“…In screening patients for inclusion in the study, we identified an overall PIM(s) rate of 27.3%, which is fairly similar to rates reported in other literature, although the other studies looked at all STOPP criteria, instead of just focusing on drug-disease interactions, and did not require one of the PIM(s) related to drug-disease interactions to be included on all patients enrolled [10,12]. Also, due to the limitations of the drug formulary at the study site, not all the medications listed on the selected STOPP version 2 criteria were involved in the development of drug interactions.…”

Section: Discussionsupporting

confidence: 64%

“…PIM is defined as any medication that poses more risk than benefit, and increases the risk of adverse drug events (ADEs). Other studies have shown the rate of PIMs to be anywhere from 19% to 61% [5,6,7,8,9,10,11]. Due to age-related physiological changes, polypharmacy, and multiple comorbidities, geriatric patients, particularly, are highly susceptible to ADEs.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Drug-Disease Interactions and Their Association with Unplanned Hospital Readmission Utilizing STOPP Version 2 Criteria

Lau

Tenney

2017

Geriatrics

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Abstract:Early hospital readmission is a common problem among geriatric patients, as they are more susceptible to adverse drug events, which are associated with increased hospital admission. The objective is to examine the association between exposure to potentially inappropriate medications under selected STOPP version 2 criteria related to drug-disease interactions and unplanned early hospitalization within 28 days of index admission in elderly patients prescribed a potentially inappropriate medication. This retrospective single-center study reviewed patients 75 years of age or older that were discharged with 5 or more medications, including at least one selected medication listed in the STOPP version 2 criteria relating to drug-disease interactions. 182 patients, with a mean age of 83.5 years, were included in the study, with anticholinergics being the most common potentially inappropriate medications (22.4%). Potentially inappropriate medications (57.1% vs. 17.1%, p < 0.001), gout (31% vs. 11.5%, p = 0.003), and gastrointestinal disease (11.9% vs. 2.5%, p = 0.026) were shown to increase risk of 28-day readmission, whereas no other factors assessed correlated with readmission. A rapid evaluation of elderly patient discharge medications and concomitant disease states with the aid of the STOPP version 2 criteria could potentially reduce hospital readmissions or emergency department visits.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Evaluation of Drug-Disease Interactions and Their Association with Unplanned Hospital Readmission Utilizing STOPP Version 2 Criteria

Lau

Tenney

2017

Geriatrics

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“…Only 38.1% of the participants had metastatic cancer in this study, and approximately 30% of the patients did not receive chemotherapy. Leger et al evaluated three drug measures in 122 patients with hematologic malignancy, showing high prevalence of polypharmacy (75.4%), PIM use (34.4%), and DDIs (71.3%). Mostafa et al reported high prevalence of polypharmacy (88%), PIM (55%), and potential drug interaction (55%) and no association with dose intensity of chemotherapy in older adults with advanced cancer.…”

Section: Discussionmentioning

confidence: 99%

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

et al. 2019

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Background Polypharmacy is an important issue in the care of older patients with cancer, as it increases the risk of unfavorable outcomes. We estimated the prevalence of polypharmacy, potentially inappropriate medication (PIM) use, and drug–drug interactions (DDIs) in older patients with cancer in Korea and their associations with clinical outcomes. Subjects, Materials, and Methods This was a secondary analysis of a prospective observational study of geriatric patients with cancer undergoing first‐line palliative chemotherapy. Eligible patients were older adults (≥70 years) with histologically diagnosed solid cancer who were candidates for first‐line palliative chemotherapy. All patients enrolled in this study received a geriatric assessment (GA) at baseline. We reviewed the daily medications taken by patients at the time of GA before starting chemotherapy. PIMs were assessed according to the 2015 Beers criteria, and DDIs were assessed by a clinical pharmacist using Lexi‐comp Drug Interactions. We evaluated the association between polypharmacy and clinical outcomes including treatment‐related toxicity, and hospitalization using logistic regression and Cox regression analyses. Results In total, 301 patients (median age 75 years; range, 70–93) were enrolled; the most common cancer types were colorectal cancer (28.9%) and lung cancer (24.6%). Mean number of daily medications was 4.7 (±3.1; range, 0–14). The prevalence of polypharmacy (≥5 medications) was 45.2% and that of excessive polypharmacy (≥10 medications) was 8.6%. PIM use was detected in 137 (45.5%) patients. Clinically significant DDIs were detected in 92 (30.6%) patients. Polypharmacy was significantly associated with hospitalization or emergency room (ER) visits (odds ratio: 1.73 [1.18–2.55], p < .01). Neither polypharmacy nor PIM use showed association with treatment‐related toxicity. Conclusion Polypharmacy, PIM use, and potential major DDIs were prevalent in Korean geriatric patients with cancer. Polypharmacy was associated with a higher risk of hospitalization or ER visits during the chemotherapy period. Implications for Practice This study, which included 301 older Korean patients with cancer, highlights the increased prevalence of polypharmacy in this population planning to receive palliative chemotherapy. The prevalence of polypharmacy and excessive polypharmacy was 45.2% and 8.6%, respectively. The prescription of potentially inappropriate medications (PIMs) was detected in 45.5% and clinically significant drug–drug interaction in 30.6% of patients. Given the association of polypharmacy with increased hospitalization or emergency room visits, this study points to the need for increased awareness and intervention to minimize polypharmacy in the geriatric cancer population undergoing chemotherapy. Moreover, specific criteria for establishing PIMs should be adopted for the treatment of older adults with cancer.

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“…Well-published and validated tools to reduce the widespread use of potentially inappropriate medications in older adults are available (e.g., the Beers criteria [19], the Screening Tool of Older Persons' potentially inappropriate Prescriptions [STOPP] criteria [20,21], the Medication Appropriate Index [22]). Yet among older adults with cancer, the prevalence of polypharmacy remains high, with a range from 48%-80%, and the prevalence of potentially inappropriate medication ranges from 11%-63% [12,13,[23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

Lu‐Yao

Nightingale

Nikita

et al. 2020

Journal of Geriatric Oncology

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Objectives: Polypharmacy (≥5 concurrent medications) is common among older patients with cancer (48%-80%) and associated with increased frailty, morbidity, and mortality. This study examined the relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous (IV) chemotherapy. Materials and Methods: The main data source was the Surveillance, Epidemiology, and End Results-Medicare linked files. Patients (≥65 years) were included if they were diagnosed with prostate (n = 1430), breast (n = 5490), or lung cancer (n = 7309) in 1991-2013 and received IV chemotherapy in 2011-2014. The number of medications during the six-month window pre-IV chemotherapy initiation determined polypharmacy status. Negative binomial models were used to assess the association between polypharmacy and post-chemotherapy inpatient hospitalization. The results were presented as incidence rate ratios. Results: We identified 13,959 patients with prostate, breast, or lung cancer treated with IV chemotherapy. The median number of prescription medications during the six-month window pre-IV chemotherapy initiation was high: ten among patients with prostate cancer, nine among patients with breast cancer, and eleven among patients with lung cancer. Compared to patients taking b5 prescriptions, post-chemotherapy hospitalization rate for patients with prostate cancer was 42%, 75%, and 114% higher among those taking 5-9, 10-14, and 15 + medications, respectively. Patients with breast and lung cancer demonstrated similar patterns. Conclusion: This large population-based study found that polypharmacy during the six-month window pre-IV chemotherapy is highly predictive of post-chemotherapy inpatient hospitalization. Further studies are needed to evaluate whether medication management interventions can reduce post-chemotherapy inpatient hospitalization among older patients with cancer.

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Polypharmacy, potentially inappropriate medications and drug-drug interactions in geriatric patients with hematologic malignancy: Observational single-center study of 122 patients

Cited by 32 publications

References 59 publications

Evaluation of Drug-Disease Interactions and Their Association with Unplanned Hospital Readmission Utilizing STOPP Version 2 Criteria

Evaluation of Drug-Disease Interactions and Their Association with Unplanned Hospital Readmission Utilizing STOPP Version 2 Criteria

Polypharmacy, Inappropriate Medication Use, and Drug Interactions in Older Korean Patients with Cancer Receiving First-Line Palliative Chemotherapy

Relationship between polypharmacy and inpatient hospitalization among older adults with cancer treated with intravenous chemotherapy

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