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Ueda A, Nohara K, Obara M, Watanabe S. Analysis of anticholinergic drugs associated with aspiration pneumonia using the Japanese adverse drug event report database: Supplementary insights from a scoping review. Respir Investig 2024; 62:1044-1050. [PMID: 39260157 DOI: 10.1016/j.resinv.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/14/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Japan's super-aged society presents significant challenges, particularly with regard to managing aspiration pneumonia among older adults. We aimed to investigate the link between anticholinergic drug use and the incidence of aspiration pneumonia, primarily utilizing data from the Japanese Adverse Drug Event Report (JADER) database. METHODS The primarily analysis included JADER data from the first quarter of 2004 through the third quarter of 2023, focusing on 2367 cases of aspiration pneumonia in individuals aged ≥60 years. The study examined the association of aspiration pneumonia with 49 drugs listed in the Anticholinergic Risk Scale, using the Reporting Odds Ratio for signal detection. A scoping review incorporating findings from MEDLINE and the Cochrane Library was conducted to validate these associations. RESULTS The primary analysis identified an increased risk of aspiration pneumonia associated with specific drugs, including clozapine, haloperidol, risperidone, quetiapine, and olanzapine. A total of 20 drugs were significantly associated with an increased risk of aspiration pneumonia. Our results emphasize the importance of considering the dopamine-blocking effects of these drugs, particularly in at-risk populations, such as older adults, and those with conditions, such as schizophrenia or Parkinson's disease. CONCLUSIONS The study highlights the importance of careful monitoring of anticholinergic drugs with potent dopamine-blocking effects, such as clozapine, haloperidol, risperidone, quetiapine, and olanzapine, to reduce the risk of aspiration pneumonia. Future research should include observational and interventional studies to further investigate these findings. ETHICS AND DISSEMINATION As this study utilized pre-existing anonymized information, approval from an ethics committee was not required.
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Affiliation(s)
- Akihito Ueda
- Doctoral Program in Pharmaceutical Sciences, Graduate School of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan; Medical Corporation Toujinkai, Fujitate Hospital, Osaka, Japan.
| | - Kanji Nohara
- Department of Rehabilitation for Orofacial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Michiko Obara
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
| | - Shinichi Watanabe
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
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2
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Yoshimatsu Y, Thomas H, Thompson T, Smithard DG. Prognostic factors of poor outcomes in pneumonia in older adults: aspiration or frailty? Eur Geriatr Med 2024; 15:481-488. [PMID: 38310191 PMCID: PMC10997696 DOI: 10.1007/s41999-023-00929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/26/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Little is known about the long-term and functional prognoses of older adults with pneumonia, which complicates their management. There is a common belief that aspiration is a poor prognostic factor; however, the diagnosis of aspiration pneumonia (AP) lacks consensus criteria and is mainly based on clinical characteristics typical of the frailty syndrome. Therefore, the poor prognosis of AP may also be a result of frailty rather than aspiration. This study investigated the impact of AP and other prognostic factors in older patients with pneumonia. METHODS We performed a retrospective cohort study of patients aged 75 years and older, admitted with pneumonia in 2021. We divided patients according to their initial diagnosis (AP or non-AP), compared outcomes using Kaplan-Meier curves, and used logistic regression to identify independent prognostic factors. RESULTS 803 patients were included, with a median age of 84 years and 52.7% were male. 17.3% were initially diagnosed with AP. Mortality was significantly higher in those diagnosed with AP than non-AP during admission (27.6% vs 19.0%, p = 0.024) and at 1 year (64.2% vs 53.1%, p = 0.018), with survival analysis showing a median survival time of 62 days and 274 days in AP and non-AP, respectively (χ2 = 9.2, p = 0.002). However, the initial diagnosis of AP was not an independent risk factor for poor prognosis in multivariable analysis. Old age, frailty and cardio-respiratory comorbidities were the main factors associated with death. CONCLUSION The greater mortality in AP may be a result of increased frailty rather than the diagnosis of aspiration itself. This supports our proposal for a paradigm shift from making predictions based on the potentially futile labelling of AP or non-AP, to considering frailty and overall condition of the patient.
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Affiliation(s)
- Yuki Yoshimatsu
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK.
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK.
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.
| | - Heledd Thomas
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK
| | - Trevor Thompson
- Centre for Chronic Illness and Ageing, University of Greenwich, London, UK
| | - David G Smithard
- Elderly Care, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Rd, London, SE18 4QH, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK
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3
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Hamaya H, Kojima T, Hattori Y, Akishita M. Association of pneumonia admission with polypharmacy and drug use in community-dwelling older people. Geriatr Gerontol Int 2024; 24:404-409. [PMID: 38497333 DOI: 10.1111/ggi.14860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
AIM The purpose of the present study was to clarify the association of pneumonia admission with polypharmacy and specific drug use in community-dwelling older people. METHODS Using health insurance and long-term care insurance data from Kure city in Japan, we retrospectively collected data for older community-dwelling people (aged ≥65 years) from April 2017 to March 2019. The outcome was pneumonia admission. We carried out multivariate logistic regression analysis to identify the association of pneumonia admission with polypharmacy (≥5 drugs), the use of psychotropic drugs or anticholinergics with adjustment for patient backgrounds, such as comorbidity, and the daily life independence level for the older people with disability. RESULTS Of 59 040 older people, 4017 (6.8%) participants were admitted for pneumonia in 2 years. The ratio of polypharmacy, and the use of psychotropic drugs and anticholinergics in the admission group were significantly higher than the non-admission group. Multivariate logistic regression analysis showed that polypharmacy (odds ratio 1.29, 95% confidence interval 1.18-1.41), and the use of conventional antipsychotic drugs (odds ratio 1.39, 95% confidence interval 1.02-1.90), atypical antipsychotic drugs (odds ratio 1.67, 95% confidence interval 1.37-2.05) and anticholinergics (odds ratio 1.22, 95% confidence interval 1.13-1.33) were significantly associated with pneumonia admission. CONCLUSION The present results suggest that polypharmacy, and the use of psychotropic drugs and anticholinergics are risk factors for pneumonia admission. Geriatr Gerontol Int 2024; 24: 404-409.
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Affiliation(s)
- Hironobu Hamaya
- Department of Geriatrics, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
- Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Hattori
- Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, The University of Tokyo, Tokyo, Japan
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4
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Yoshimatsu Y, Kragholm K, Clemmensen SZ, Melgaard D, Torp-Pedersen C, Smithard DG, Riis J. The predictive value of anticholinergic drug exposure and the outcome of pneumonia: a Danish database study. Age Ageing 2024; 53:afae012. [PMID: 38337045 DOI: 10.1093/ageing/afae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Older adults are susceptible to anticholinergic effects. Dysphagia and pneumonia are associated with anticholinergic usage, though a definitive causative relationship has not been established. There is no effective way to predict the prognosis of older adults with pneumonia; therefore, this study investigates the predictive value of anticholinergic burden. METHODS Patients aged 65 years and above admitted for community-acquired pneumonia from 2011 to 2018 in Denmark were included through Danish registries. We calculated anticholinergic drug exposure using the CRIDECO Anticholinergic Load Scale (CALS). The primary outcome was in-hospital mortality, and other outcomes included intensive care unit admission, ventilator usage, length of stay, 30-day/90-day/1-year mortality, institutionalisation, home care utilisation and readmission. RESULTS 186,735 patients were included in the in-hospital outcome analyses, 165,181 in the readmission analysis, 150,791 in the institutionalisation analysis, and 95,197 and 73,461 patients in the home care analysis at follow-up. Higher CALS score was associated with higher in-hospital mortality, with a mean risk increasing from 9.9% (CALS 0) to 16.4% (CALS >10), though the risk plateaued above a CALS score of 8. A higher CALS score was also associated with greater mortality after discharge, more home health care, more institutionalizations and higher readmission rates. CONCLUSIONS High anticholinergic burden levels were associated with poor patient outcomes including short-/long-term mortality, dependence and readmission. It may be useful to calculate the CALS score on admission of older patients with pneumonia to predict their prognosis. This also highlights the importance of avoiding the use of drugs with a high anticholinergic burden in older patients.
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Affiliation(s)
- Yuki Yoshimatsu
- Geriatric Medicine, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Dorte Melgaard
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - David G Smithard
- Geriatric Medicine, Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, London, UK
- Centre for Exercise Activity and Rehabilitation, School of Human Sciences, University of Greenwich, London, UK
| | - Johannes Riis
- Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark
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Siraj RA, Bolton CE, McKeever TM. Association between antidepressants with pneumonia and exacerbation in patients with COPD: a self-controlled case series (SCCS). Thorax 2023; 79:50-57. [PMID: 37336642 DOI: 10.1136/thorax-2022-219736] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/26/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To assess whether antidepressant prescriptions are associated with an increased risk of pneumonia and chronic obstructive pulmonary disease (COPD) exacerbation. METHODS A self-controlled case series was performed to investigate the rates of pneumonia and COPD exacerbation during periods of being exposed to antidepressants compared with non-exposed periods. Patients with COPD with pneumonia or COPD exacerbation and at least one prescription of antidepressant were ascertained from The Health Improvement Network in the UK. Incidence rate ratios (IRR) and 95% CI were calculated for both outcomes. RESULTS Of 31 253 patients with COPD with at least one antidepressant prescription, 1969 patients had pneumonia and 18 483 had a COPD exacerbation. The 90-day risk period following antidepressant prescription was associated with a 79% increased risk of pneumonia (age-adjusted IRR 1.79, 95% CI 1.54 to 2.07). These associations then disappeared once antidepressants were discontinued. There was a 16% (age-adjusted IRR 1.16, 95% CI 1.13 to 1.20) increased risk of COPD exacerbation within the 90 days following antidepressant prescription. This risk persisted and slightly increased in the remainder period ((age-adjusted IRR 1.38, 95% CI 1.34 to 1.41), but diminished after patients discounted the treatment. CONCLUSION Antidepressants were associated with an increased risk of both pneumonia and exacerbation in patients with COPD, with the risks diminished on stopping the treatment. These findings suggest a close monitoring of antidepressant prescription side effects and consideration of non-pharmacological interventions.
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Affiliation(s)
- Rayan A Siraj
- Department of Respiratory Care, King Faisal University, Al-Ahasa, Saudi Arabia
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Charlotte E Bolton
- Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
| | - Tricia M McKeever
- NIHR Nottingham Biomedical Research Centre Respiratory Theme, School of Medince, University of Nottingham, Nottingham, UK
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Wu M, Li Z, Zheng W, Zhuang J, Wu S, Zhou Q, Cai J, Zheng H, Zeng G, Zhang W, Zhang S, Lin M, Zhong X, Zhang Q. Association between anticholinergic medication uses and the risk of pneumonia in elderly adults: a meta-analysis and systematic review. Ann Med 2023; 55:2209736. [PMID: 37190776 DOI: 10.1080/07853890.2023.2209736] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE To conduct a meta-analysis and systematic review on the association between anticholinergic medication uses and the risk of pneumonia in elderly adults. MATERIALS AND METHODS Medical databases were searched included PubMed, Web of Science, EBSCO and Google Scholar (up to December 7, 2022). Studies evaluating association between anticholinergic medication uses and the risk of pneumonia in elderly adults were included. Studies without available data were excluded. We made meta-analysis by using adjusted odds ratio (aOR) with 95% confidence intervals (CIs) from random-effects model. The risk of bias was assessed using ROBINS-I tool and statistical heterogeneity using the I2 statistic. Registration: INPLASY202330070. RESULTS A total of six studies with 107,012 participants were included. Meta-analysis results showed that anticholinergic medication uses was related with an increased risk of pneumonia (aOR = 1.59; 95%CI, 1.32-1.92) and stroke-associated pneumonia (aOR = 2.02; 95%CI, 1.76-2.33). Moreover, risk estimates of pneumonia for high-potency anticholinergics (aOR = 1.96; 95%CI, 1.22-3.14) were higher than those for low-potency anticholinergics (aOR = 1.58; 95%CI, 1.27-1.97). And increased risk of pneumonia was associated with the anticholinergic medication uses within 30 days (aOR = 2.13; 95%CI, 1.33-3.43), within 90 days (aOR = 2.03; 95%CI, 1.26-3.26) and chronic use (aOR = 1.65; 95%CI, 1.09-2.51). CONCLUSIONS The risk of pneumonia is increased in elderly adults with anticholinergic medication, especially with higher-potency anticholinergic drugs and in the initiation phase of anticholinergic medication. Clinicians should monitor their use in older patients carefully, especially when the pneumonia-related signs and symptoms are identified.
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Affiliation(s)
- Mindan Wu
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Zhixuan Li
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Wenchuan Zheng
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Jia Zhuang
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Shuhan Wu
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Qipeng Zhou
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Junfu Cai
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Houzhen Zheng
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Guixing Zeng
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Weilin Zhang
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Shengbin Zhang
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Maohuang Lin
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
| | - Xianyang Zhong
- Department of Gastroenterology, Shantou Central Hospital, Shantou, China
| | - Qichuan Zhang
- Department of Pulmonary and Critical Care Medicine, Shantou Central Hospital, Shantou, China
- Shantou University Medical College, Shantou, China
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Kunieda K, Hayashi Y, Yamada M, Nishida S, Moribayashi R, Ohno T, Fujishima I, Kimura A, Shimohata T. The Evaluation of Benzodiazepine-induced Dysphagia Using High-resolution Manometry. Intern Med 2023; 62:3537-3540. [PMID: 37062746 PMCID: PMC10749804 DOI: 10.2169/internalmedicine.1539-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
We evaluated the pathophysiology of dysphagia considered to be induced by benzodiazepine using high-resolution manometry (HRM). A 53-year-old man with Parkinson disease had had dysphagia for over 3 months. He had been taking several benzodiazepines for more than four years. Two weeks after discontinuation of the benzodiazepines, HRM revealed increased pharyngeal contractility and residual pressure at the upper esophageal sphincter. A video-fluoroscopic swallowing study showed improved pharyngeal bolus passage. Benzodiazepine-induced dysphagia may be due to the muscle relaxant effects on the swallowing muscles and attenuation of the barrier function which prevents reflux from the esophagus into the pharynx.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Nursing, Tsuruga City Nursing University, Japan
| | - Megumi Yamada
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | | | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
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Abdulrahman S, Al-Balushi N, Holdcroft-Long J, Khan U, Ravindran B, Das S, Rajkumar AP. Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study. Int J Psychiatry Med 2023; 58:493-509. [PMID: 37528759 PMCID: PMC10111158 DOI: 10.1177/00912174231171220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE COVID-19 may lead to a range of clinical outcomes among older people with psychiatric and medical conditions. Evidence guiding management of future outbreaks among this vulnerable population in psychiatric hospital settings are sparse. In this study, we examined the correlates of poor clinical outcomes related to COVID-19 and explored the perspectives of COVID-19 survivors hospitalized in psychiatry settings. METHOD The correlates of poor clinical outcomes related to COVID-19 were examined using a retrospective chart review of 81 older people hospitalized in psychiatry settings. Correlates of clinical outcomes related to COVID-19 were assessed by multiple logistic regression models. In addition, the perspectives of 10 COVID-19 survivors were explored by qualitative interviews. The qualitative data was subject to thematic analysis. RESULTS Although 25.9% (n = 21) participants were asymptomatic, there was high COVID-19 related mortality (14.8%; n = 12). Vitamin-D deficiency, anticholinergic burden, and isolation policies within psychiatric wards were significantly (p < 0.05) related to COVID-19 related deaths. In qualitative interviews, participants emphasized the importance of strengthening local support networks and making vaccination centers more accessible. CONCLUSIONS Reducing anticholinergic prescriptions and improving isolation policies may help to mitigate poor clinical outcomes. Future research investigating the impact of vitamin-D supplementation on COVID-19 related outcomes is warranted.
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Affiliation(s)
| | - Naser Al-Balushi
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
- Department of Behavioural Medicine, College of Medicine & Health Science, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | | | - Uzma Khan
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Bipin Ravindran
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Sujata Das
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Anto P Rajkumar
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
- Institute of Mental Health, Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham, Nottingham, United Kingdom
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9
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Doumat G, Daher D, Itani M, Abdouni L, El Asmar K, Assaf G. The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study. BMC PRIMARY CARE 2023; 24:120. [PMID: 37237338 DOI: 10.1186/s12875-023-02070-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU. METHODS This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes. RESULTS A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08-2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03-5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00-5.31, p = 0.049). The association lost significance after adjustment. CONCLUSIONS The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.
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Affiliation(s)
- George Doumat
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Darine Daher
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mira Itani
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Georges Assaf
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
- Division of Academic Internal Medicine & Geriatrics, The University of Illinois at Chicago, Chicago, USA.
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10
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Birkmose ALL, Kristensen PK, Madsen M, Pedersen AB, Hjelholt TJ. Association of anticholinergic drug use with postoperative mortality among patients with hip fracture. A nationwide cohort study. Arch Gerontol Geriatr 2023; 113:105017. [PMID: 37116258 DOI: 10.1016/j.archger.2023.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE Anticholinergic (AC) drugs are associated with various determinantal outcomes. Data regarding the effect of AC drugs on mortality among geriatric hip fracture patients are limited and inconsistent. METHODS Using Danish health registries, we identified 31,443 patients aged ≥65 years undergoing hip fracture surgery. AC burden was assessed 90 days before surgery by the Anticholinergic Cognitive Burden (ACB) score and number of AC drugs. Logistic and Cox regression producing odds ratios (OR) and hazard ratios (HR) for 30- and 365- day mortality, adjusting for age, sex, and comorbidities were computed. RESULTS AC drugs were redeemed by 42% of patients. The 30-day mortality increased from 7% for patients with ACB score of 0 to 16% for patients with ACB score of ≥5, corresponding to an adjusted OR 2.5 (CI: 2.0-3.1). The equivalent adjusted HR for 365-mortality was 1.9 (CI: 1.6-2.1). Using count of AC drugs as exposure we found a stepwise increase in ORs and HRs with increased number of AC drugs; Compared to non-users, adjusted ORs for 30-days mortality were 1.6 (CI: 1.4-1.7), 1.9 (CI: 1.7-2.1), and 2.3 (CI: 1.9-2.7) for users of 1, 2 and 3+ AC drugs. HRs for 365-day mortality were 1.4 (CI: 1.3-1.5), 1.6 (CI: 1.5-1.7) and 1.8 (CI: 1.7-2.0). CONCLUSION Use of AC drugs was associated with increased 30-day and 365-day mortality among older adults with hip fracture. Simply counting the number of AC drugs may be a clinically relevant and easy AC risk assessment tool. Continued effort to reduce AC drug-use is relevant.
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11
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Han J, Lv Z, Shen M, Wan Q, Xiao L, Wang G. Risk factors for hospital-acquired pneumonia among inpatients with mental disorders in a large mental health center within a tertiary general hospital. Am J Infect Control 2022; 51:446-453. [PMID: 35728721 DOI: 10.1016/j.ajic.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few researchers have investigated the incidence of and risk factors for hospital-acquired pneumonia (HAP) among inpatients with mental disorders in a general hospital. METHODS This study included patients with mental disorders hospitalized in a large mental health center (situated in a general hospital) between January 1, 2017 and July 31, 2021 (excluding January 1, 2020 to May 31, 2020). Risk factors for HAP were identified by logistic regression analysis after propensity score matching (PSM, 1:4) for gender, age, duration of observation and hospital ward. RESULTS The study included 16,864 patients. HAP incidence rate was 1.15% overall, 2.11% on closed wards, 0.75% on open wards, 4.45% in patients with organic mental disorders, 1.80% in patients with schizophrenia spectrum disorder, and 0.84% in patients with mood disorders. Risk factors for HAP after PSM were hypoproteinemia, chronic liver disease, use of clozapine, hospitalization during the previous 180 days, body mass index (BMI) ≤18.5 kg/m2, cholinesterase inhibitor use and mood stabilizer use. CONCLUSION HAP was common among inpatients with mental disorders. Risk factors for HAP in patients with mental disorders include hypoproteinemia, chronic liver disease, hospitalization during the past 180 days, BMI ≤18.5 kg/m2, and use of clozapine, cholinesterase inhibitors or mood stabilizers.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Zhihua Lv
- Department of Clinical laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Meiyu Shen
- Department of Mental Health Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Qirong Wan
- Department of Clinical Psychology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China
| | - Ling Xiao
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
| | - Gaohua Wang
- Insititute of Neuropsychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, China.
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12
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Gradek-Kwinta E, Slowik A, Dziedzic T. The use of anticholinergic medication is associated with an increased risk of stroke-associated pneumonia. Aging Clin Exp Res 2022; 34:1935-1938. [PMID: 35416612 DOI: 10.1007/s40520-022-02123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pneumonia is a frequent medical complication after stroke. A few studies showed that the use of anticholinergic medication is associated with a higher risk of community acquired pneumonia in the elderly. We aimed to determine if there is any association between anticholinergic medication used before stroke and stroke-associated pneumonia (SAP). METHODS We analysed prospectively collected data of 675 patients with acute stroke (mean age 71.4 ± 13.3; 53.1% female). We used the Anticholinergic Drug Scale to assess anticholinergic exposure during a month preceding stroke onset. RESULTS We diagnosed SAP in 14.7% of patients. The use of anticholinergic medication was associated with an elevated risk of SAP (OR 2.56, 95% CI 1.59-4.11, P < 0.01) in univariate analysis. This association remained significant in multivariable analysis adjusted for age, stroke severity, atrial fibrillation, previous myocardial infarction and respiratory tract diseases (OR 2.06, 95% CI 1.01-4.22, P = 0.04). CONCLUSIONS The use of anticholinergic medication before stroke is associated with an increased risk of SAP.
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Affiliation(s)
- Elżbieta Gradek-Kwinta
- Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503, Kraków, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503, Kraków, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, ul. Botaniczna 3, 31-503, Kraków, Poland.
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13
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The Association between Anticholinergic Medications for Overactive Bladder and Pneumonia. Ann Am Thorac Soc 2022; 19:1605-1609. [PMID: 35404777 DOI: 10.1513/annalsats.202201-080rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Yang Y, Kong D, Li Q, Chen W, Zhao G, Tan X, Huang X, Zhang Z, Feng C, Xu M, Wan Y, Yang M. Non-antipsychotic medicines and modified electroconvulsive therapy are risk factors for hospital-acquired pneumonia in schizophrenia patients. Front Psychiatry 2022; 13:1071079. [PMID: 36713903 PMCID: PMC9880231 DOI: 10.3389/fpsyt.2022.1071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Hospital-acquired pneumonia (HAP) has a significant and detrimental impact on schizophrenia patients. Non-antipsychotic medicines and modified electroconvulsive therapy (MECT) are frequently used in conjunction with antipsychotics to treat schizophrenia. Whether non-antipsychotic medicines or MECT are risk factors for HAP in schizophrenia treated with antipsychotics is still unknown. METHODS Patients with schizophrenia who were admitted to the Fourth People's Hospital of Chengdu between January 2015 and April 2022 were included in this retrospective cohort study. Individuals with HAP were 1:1 matched to individuals without HAP (non-HAP) using propensity score matching (PSM). The risk factors for HAP were analyzed by comparing the two groups. RESULTS A total of 7,085 schizophrenia patients were included in this study, with a mean age of 39.77 ± 14.45 years. 193 patients developed HAP on an average of 22.26 ± 21.68 days after admission with an incidence of 2.73%. After 1:1 PSM, 192 patients from each group (HAP and non-HAP) were included. The HAP group had significantly more patients with MECT and taking benzodiazepines, antidepressants, mood stabilizers, and anti-parkinsonians both before and after PSM by Bonferroni correction (P < 0.001). Multivariate logistic regression analysis showed that, combined with antipsychotics, non-antipsychotic medicines including benzodiazepines (OR = 3.13, 95%CI = 1.95-5.03, P < 0.001), mood stabilizers (OR =3.33, 95%CI =1.79-6.20, P < 0.001) and MECT (OR =2.58, 95%CI =1.49-4.46, P = 0.001) were associated with a significantly increased incidence of HAP. CONCLUSION The incidence of HAP in schizophrenia patients in our cohort was 2.73%. MECT and non-antipsychotic medicines, including benzodiazepines and mood stabilizers were risk factors for HAP in schizophrenia patients treated with antipsychotics.
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Affiliation(s)
- Yan Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Di Kong
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Qiwen Li
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Wei Chen
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Guocheng Zhao
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xi Tan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xincheng Huang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Zipeng Zhang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Can Feng
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Min Xu
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Ying Wan
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China
| | - Mi Yang
- The Fourth People's Hospital of Chengdu, Chengdu, Sichuan, China.,MOE Key Lab for Neuroinformation, The Clinical Hospital of Chengdu Brain Science Institute, University of Electronic Science and Technology of China, Chengdu, China.,School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, China
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15
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Javelot H, Meyer G, Becker G, Post G, Runge V, Pospieszynski P, Schneiderlin T, Armand-Branger S, Michel B, Weiner L, Faria CGF, Drapier D, Fakra E, Fossati P, Haffen E, Yrondi A, Hingray C. [Anticholinergic scales: Use in psychiatry and update of the anticholinergic impregnation scale]. Encephale 2021; 48:313-324. [PMID: 34876278 DOI: 10.1016/j.encep.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
Anticholinergic properties are well known to prescribers, notably in mental health, as a therapeutic strategy for i.e. extrapyramidal syndrome but also as a source of numerous adverse side effects. Herein, we propose a narrative literature review describing: (i) cholinergic pharmacology and anticholinergic properties; (ii) the importance of anticholinergic therapeutic properties in psychiatry; (iii) the existing anticholinergic drug scales and their usage limitations in Psychiatry and; last (iv) an update to the anticholinergic drug impregnation scale, designed for the French psychiatry practice. The anticholinergic side effects can appear both in the peripheral level (dry mouth, constipation, etc.) and in the central level (especially as cognitive deficits). Many of the so called « anticholinergic » drugs are in fact entirely or mostly antimuscarinic and act essentially as parasympathetic system antagonists. Overall, anticholinergic/antimuscarinic side effects are usually attributed to psychotropic medications: to certain antipsychotics, notably classical neuroleptics such as phenothiazine and also to tricyclic antidepressants. In practice, the impact of anticholinergic toxicity treatments is often highlighted due to their excessively prolonged use in patients on antipsychotics. Interestingly, these antipsychotic treatments are better known for their anticholinergic side effects, especially cognitive ones, with an early onset specially in elder patients and/or in the case of polymedication. In order to evaluate anticholinergic side effects, metrics known as anticholinergic burden scales were created in the last few decades. Nowadays, 13 different scales are documented and accepted by the international academic community, but only three of them are commonly used: the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Burden Scale (ACB). All of them are based on a similar principle, consisting of grading treatments individually, and they are normally scored from 0 - no presence of side effects - to 3 - anticholinergic effects considered to be strong or very strong. Using these scales enables the calculation of the so-called "anticholinergic burden", which corresponds to the cumulative effect of using multiple medications with anticholinergic properties simultaneously. The application of anticholinergic scales to patients with psychiatric disorders has revealed that schizophrenic patients seem to be especially sensitive to anticholinergic cognitive side effects, while elder and depressed patients were more likely to show symptoms of dementia when exposed to higher anticholinergic burden. Unfortunately, these tools appear to have a low parallel reliability, and so they might induce large differences when assessing side effects predictability. In addition, the capacity of these scales to predict central adverse effects is limited due to the fact they poorly or do not differentiate, the ability of treatments to cross the blood-brain barrier. Finally, one last limitation on the validity of these scales is prescription posology is not accounted for side effects considered to be dose dependent. Recently, the MARANTE (Muscarinic Acetylcholine Receptor ANTagonist Exposure) scale has incorporated an anticholinergic burden weighting by posology. Nevertheless, this new model can be criticized, due to the limited number of medications included and due to testing a limited number of potency ranges and dosages for each treatment. Herein, we propose an update to the Anticholinergic Impregnation Scale, developed specifically for the French Psychiatry practice. The scale validation was based on an evaluation of the prescriptions correcting anticholinergic peripheral side effects (constipation, xerostomia and xeropthalmia). This indirect evaluation allowed us to show patients with an anticholinergic impregnation score higher than 5 received significantly more treatments for constipation and xerostomia. This strategy bypasses the bias of a cognitive evaluation in patients with severe mental health disorders. Moreover, the relevance of a tool developed specifically for French psychiatry is justified by the fact that some highly prescribed treatments for mental illness in France (cyamemazine and tropatemine) are strong anticholinergics, and also by the fact they are rarely included in the existing anticholinergic scales. This update of the original scale, published in 2017, includes information whether prescribed drugs cross the blood-brain barrier and thus makes possible a more accurate assessment when evaluating anticholinergic central side effects. Finally, the anticholinergic impregnation scale will soon be integrated into a prescription help software, which is currently being developed to take into consideration dose dependent adverse effects.
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Affiliation(s)
- H Javelot
- Établissement public de santé Alsace Nord, 67170 Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, 67084 Strasbourg cedex, France.
| | - G Meyer
- Établissement public de santé Alsace Nord, 67170 Brumath, France
| | - G Becker
- Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, 67084 Strasbourg cedex, France
| | - G Post
- Centre hospitalier de Rouffach, 68250 Rouffach, France; GIP Symaris, 68250 Rouffach, France
| | - V Runge
- Laboratoire de mathématiques et modélisation d'Evry (LaMME), UEVE - université Paris-Saclay, 91037 Evry cedex, France
| | | | | | - S Armand-Branger
- ServicePharmacie, Centre de santé mentale Angevin (CESAME), 49130 Sainte-Gemmes-sur-Loire, France
| | - B Michel
- ServicePharmacie, CHU de Strasbourg, 67000 Strasbourg, France
| | - L Weiner
- Clinique de psychiatrie, CHU de Strasbourg, 67000 Strasbourg, France; Laboratoire de psychologie des cognitions, université de Strasbourg, 67000 Strasbourg, France
| | - C G F Faria
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brésil
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, 35700 Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, 35000 Rennes, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Fossati
- Inserm U1127, ICM, service de psychiatrie adultes, groupe hospitalier pitié Salpêtrière, Sorbonne université, AP-HP, 75013 Paris, France
| | - E Haffen
- CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, 25000 Besançon, France; Laboratoire de Neurosciences, université de Franche-Comté, 25000 Besançon, France
| | - A Yrondi
- Service de Psychiatrie et de Psychologie Médicale, CHU de Toulouse, Hôpital Purpan, 31059 Toulouse, France; Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, 31059 Toulouse, France; ToNIC Toulouse NeuroImaging Centre, Université de Toulouse, INSERM, UPS, 31024 Toulouse, France
| | - C Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, Centre psychothérapique de Nancy, 54520 Laxou, France; Département de neurologie, CHU de Nancy, 54000 Nancy, France
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16
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Javelot H, Straczek C, Meyer G, Gitahy Falcao Faria C, Weiner L, Drapier D, Fakra E, Fossati P, Weibel S, Dizet S, Langrée B, Masson M, Gaillard R, Leboyer M, Llorca PM, Hingray C, Haffen E, Yrondi A. Psychotropics and COVID-19: An analysis of safety and prophylaxis. L'ENCEPHALE 2021; 47:564-588. [PMID: 34548153 PMCID: PMC8410507 DOI: 10.1016/j.encep.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022]
Abstract
The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.
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Affiliation(s)
- H Javelot
- Établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, centre de recherche en biomédecine de Strasbourg, université de Strasbourg, 1, rue Eugène-Boeckel, 67000 Strasbourg, France.
| | - C Straczek
- Département de pharmacie, CHU d'Henri-Mondor, université Paris Est Créteil (UPEC), AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France; Inserm U955, institut Mondor de recherche biomédical, neuropsychiatrie translationnelle, 8, rue du Général-Sarrail, 94000 Créteil, France
| | - G Meyer
- Service pharmacie, établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Service pharmacie, CHU de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - C Gitahy Falcao Faria
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), avenue Pedro-Calmon, 550 - Cidade Universitária da Universidade Federal do Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil
| | - L Weiner
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, 2, avenue du Professeur Léon-Bernard, CS 34317, campus santé de Villejean, 35043 Rennes cedex, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, 37, rue Michelet, 42000 Saint-Étienne, France
| | - P Fossati
- Inserm U1127, ICM, service de psychiatrie adultes, groupe hospitalier pitié Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Weibel
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - S Dizet
- Centre de ressources et d'expertise en psychopharmacologie (CREPP) Bourgogne Franche-Comté, Chalon-sur-Saône, France; Service Pharmacie, CHS de Sevrey, 55, rue Auguste-Champio, 71100 Sevrey, France
| | - B Langrée
- Service pharmacie, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; Clinique du Château de Garches, Nightingale Hospitals-Paris, 11, bis rue de la Porte-Jaune, 92380 Garches, France
| | - M Masson
- SHU, GHU psychiatrie et neurosciences, 1, rue Cabanis, 75014 Paris, France; GHU psychiatrie et neurosciences, université de Paris, Paris, France
| | - R Gaillard
- Conseil national des universités (CNU), 1, rue Cabanis, 75014 Paris, France
| | - M Leboyer
- Inserm, DMU IMPACT, IMRB, translational neuropsychiatry, fondation FondaMental, hôpitaux universitaires « H. Mondor », université Paris Est Créteil (UPEC), AP-HP, 40, rue de Mesly, 94000 Créteil, France; CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P M Llorca
- Université Clermont-Auvergne, 1, rue Lucie- et Raymond-Aubrac, 63100 Clermont-Ferrand, France; Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, 1, rue Docteur Archambault, 54520 Laxou, France
| | - C Hingray
- Département de neurologie, CHU de Nancy, 25, rue Lionnois, 54000 Nancy, France; CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - E Haffen
- Laboratoire de neurosciences, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - A Yrondi
- Unité ToNIC, UMR 1214 CHU Purpan-Pavillon Baudot, place du Dr Joseph Baylac, 31024 Toulouse cedex 3, France
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Pneumonia Risk Associated with the Use of Individual Benzodiazepines and Benzodiazepine Related Drugs among the Elderly with Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179410. [PMID: 34501996 PMCID: PMC8431585 DOI: 10.3390/ijerph18179410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/02/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022]
Abstract
Most patients with Parkinson's disease (PD) gradually develop oropharyngeal dysphagia which is often associated with pneumonia risk. The possible association of benzodiazepine (BZD) and benzodiazepine related drugs (BZRD) use with pneumonia risk has received increasing attention but remains controversial. We investigated pneumonia risk associated with the use of BZDs and BZRDs in older adult patients with PD. This case-control study analyzed data of 551,975 older adult patients with PD between 2001 and 2018 in Taiwan. To minimize potential confounding, we used 1:4 propensity score matching to include older adult patients without pneumonia as controls. Incident pneumonia risk was significantly higher in current (adjusted odds ratio (aOR) = 1.25, 95% CI = 1.23-1.27) and past (aOR = 1.13, 95% CI = 1.11-1.15) users of BZDs. Regarding BZRDs, recent (aOR = 1.08, 95% CI = 1.06-1.11) and past (aOR = 0.89, 95% CI = 0.88-0.91) users had higher and lower risks of incident pneumonia, respectively. Pneumonia risk varied based on their use of BZDs and BZRDs. In these individuals, incident pneumonia risk was high in users of BZDs, such as midazolam, lorazepam, flunitrazepam, estazolam, and clonazepam. Regarding the use of BZRDs, zopiclone increased incident pneumonia risk.
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Angus-Leppan H, Guiloff AE, Benson K, Guiloff RJ. Navigating migraine care through the COVID-19 pandemic: an update. J Neurol 2021; 268:4388-4395. [PMID: 34002281 PMCID: PMC8128091 DOI: 10.1007/s00415-021-10610-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
The worldwide treatment gap for migraine before COVID-19 inevitably widens as attention focuses on an international emergency. Migraine hits people particularly in their early and middle years, potentially reduces quality of life and productivity, and remains a common emergency presentation. This article examines the impact of COVID-19 on migraine, and changing aspects of migraine care during and after the pandemic. Many risk factors for severe COVID-19—older age, male gender, cardiac and respiratory diseases, diabetes, obesity, and immunosuppression—are less frequent in migraineurs. Telemedicine is effective for migraine follow-up, and needs ongoing evaluation. Most migraine treatments can start or continue in acute COVID-19, with care to avoid drug interactions. Close contact procedures (botulinum toxin, acupuncture and steroid injections) are avoided in lockdown or in the vulnerable. Secondary effects of COVID-19, including long COVID and its economic impact, are probably equal or greater in people with migraine. Migraine and other long-term conditions need adequate resourcing to prevent personal, social and economic suffering. Treating migraine, a sequel of COVID, potentially reduces the impact of long COVID.
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Affiliation(s)
- Heather Angus-Leppan
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK.
- Department of Clinical Neurosciences, Royal Free London NHS Foundation Trust, Pond Street, London, NW32QG, UK.
| | - Angelica E Guiloff
- Northern Medical Centre, Archway, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | | | - Roberto J Guiloff
- Faculty of Medicine, University of Chile, Santiago, Chile
- Imperial College Healthcare NHS Trust, London, UK
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Cepaityte D, Siafis S, Egberts T, Leucht S, Kouvelas D, Papazisis G. Exploring a Safety Signal of Antipsychotic-Associated Pneumonia: A Pharmacovigilance-Pharmacodynamic Study. Schizophr Bull 2021; 47:672-681. [PMID: 33289848 PMCID: PMC8084433 DOI: 10.1093/schbul/sbaa163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
An association between antipsychotic drugs and pneumonia has been demonstrated in several studies; however, the risk for pneumonia caused by specific antipsychotics has not been extensively studied. The underlying mechanism is still unknown, and several receptor mechanisms have been proposed. Therefore, using a combined pharmacovigilance-pharmacodynamic approach, we aimed to investigate safety signals of US Food and Drug Administration (FDA)-approved antipsychotics for reporting pneumonia and the potential receptor mechanisms involved. A disproportionality analysis was performed to detect a signal for reporting "infective-pneumonia" and "pneumonia-aspiration" and antipsychotics using reports submitted between 2004 and 2019 to the FDA adverse events spontaneous reporting system (FAERS) database. Disproportionality was estimated using the crude and the adjusted reporting odds ratio (aROR) and its 95% confidence interval (CI) in a multivariable logistic regression. Linear regressions investigated the relationship between aROR and receptor occupancy, which was estimated using in vitro receptor-binding profiles. Safety signals for reporting infective-pneumonia were identified for clozapine (LL = 95% 3.4, n = 546 [aROR: 4.8]) as well as olanzapine (LL = 95% 1.5, n = 250 [aROR: 2.1]) compared with haloperidol, while aRORs were associated with higher occupancies of muscarinic receptors (beta = .125, P-value = .016), yet other anti-muscarinic drugs were not included as potential confounders. No safety signals for reporting pneumonia-aspiration were detected for individual antipsychotics. Multiple antipsychotic use was associated with both reporting infective-pneumonia (LL 95%: 1.1, n = 369 [aROR:1.2]) and pneumonia-aspiration (LL 95%: 1.7, n = 194 [aROR: 2.0]). Considering the limitations of disproportionality analysis, further pharmacovigilance data and clinical causality assessment are needed to validate this safety signal.
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Affiliation(s)
- Dainora Cepaityte
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyridon Siafis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Toine Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Division of Pharmacoepidemiology and Clinical Pharmacology, The Netherlands & Utrecht Institute of Pharmaceutical Science, Faculty of Science, Utrecht University, The Netherlands
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dimitrios Kouvelas
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Huang KH, Kuo WY, Kuan YH, Chang YC, Tsai TH, Lee CY. Risk of Pneumonia is associated with Antipsychotic Drug Use among older patients with Parkinson's Disease: A Case-control Study. Int J Med Sci 2021; 18:3565-3573. [PMID: 34522183 PMCID: PMC8436093 DOI: 10.7150/ijms.63246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the risk of pneumonia associated with the use of antipsychotic drugs in older-adult patients with Parkinson's disease (PD) in Taiwan. Methods: This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 51,158 older patients with PD for the period between 2001 and 2016. To reduce the potential confounding caused by unbalanced covariates in nonexperimental settings, we used propensity score matching to include older patients without pneumonia to serve as the control group. Results: Compared with patients who had never taken antipsychotics, current (adjusted odds ratios [aOR] =1.63, 95% confidence interval [CI] = 1.51-1.75), recent (aOR = 1.63, 95% CI = 1.52-1.74), and past (aOR = 1.89, 95% CI = 1.80-2.00) users of antipsychotics had a higher risk of incident pneumonia. Among typical and atypical antipsychotics, haloperidol and clozapine were associated with higher risks of incident pneumonia, respectively. By contrast, aripiprazole was not associated with a higher risk of pneumonia. Conclusion: Older patients with PD receiving typical antipsychotics or atypical antipsychotics had a higher risk of pneumonia. Among these antipsychotics, clozapine had the highest risk of pneumonia. Clinicians should pay attention to the risk of pneumonia in older patients with PD who receive typical antipsychotics and atypical antipsychotics.
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Affiliation(s)
- Kuang-Hua Huang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wei-Yin Kuo
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan.,Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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21
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Matera MG, Page CP, Calzetta L, Rogliani P, Cazzola M. Pharmacology and Therapeutics of Bronchodilators Revisited. Pharmacol Rev 2020; 72:218-252. [PMID: 31848208 DOI: 10.1124/pr.119.018150] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bronchodilators remain the cornerstone of the treatment of airway disorders such as asthma and chronic obstructive pulmonary disease (COPD). There is therefore considerable interest in understanding how to optimize the use of our existing classes of bronchodilator and in identifying novel classes of bronchodilator drugs. However, new classes of bronchodilator have proved challenging to develop because many of these have no better efficacy than existing classes of bronchodilator and often have unacceptable safety profiles. Recent research has shown that optimization of bronchodilation occurs when both arms of the autonomic nervous system are affected through antagonism of muscarinic receptors to reduce the influence of parasympathetic innervation of the lung and through stimulation of β 2-adrenoceptors (β 2-ARs) on airway smooth muscle with β 2-AR-selective agonists to mimic the sympathetic influence on the lung. This is currently achieved by use of fixed-dose combinations of inhaled long-acting β 2-adrenoceptor agonists (LABAs) and long-acting muscarinic acetylcholine receptor antagonists (LAMAs). Due to the distinct mechanisms of action of LAMAs and LABAs, the additive/synergistic effects of using these drug classes together has been extensively investigated. More recently, so-called "triple inhalers" containing fixed-dose combinations of both classes of bronchodilator (dual bronchodilation) and an inhaled corticosteroid in the same inhaler have been developed. Furthermore, a number of so-called "bifunctional drugs" having two different primary pharmacological actions in the same molecule are under development. This review discusses recent advancements in knowledge on bronchodilators and bifunctional drugs for the treatment of asthma and COPD. SIGNIFICANCE STATEMENT: Since our last review in 2012, there has been considerable research to identify novel classes of bronchodilator drugs, to further understand how to optimize the use of the existing classes of bronchodilator, and to better understand the role of bifunctional drugs in the treatment of asthma and chronic obstructive pulmonary disease.
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Affiliation(s)
- M G Matera
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - C P Page
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - L Calzetta
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - P Rogliani
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
| | - M Cazzola
- Unit of Pharmacology, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy (M.G.M.); Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, United Kingdom (C.P.P.); and Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (L.C., P.R., M.C.)
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22
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The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176260. [PMID: 32872121 PMCID: PMC7503732 DOI: 10.3390/ijerph17176260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
Anticholinergic drugs may increase the risk of serious respiratory infection, especially in the elderly. The study aims to investigate the prevalence of anticholinergic drugs and the correlation of incident pneumonia associated with the use of anticholinergic drugs among the elderly in Taiwan. The study population was 275,005 elderly patients aged ≥65 years old, selected from the longitudinal health insurance database (LHID) in 2016. Among all the elderly patients, about 60% had received anticholinergic medication at least once. Furthermore, the study selected elderly patients who had not been diagnosed with pneumonia and had not received any anticholinergic drugs in the past year in order to evaluate the correlation between pneumonia and anticholinergic drugs. The study excluded elderly patients who died or had received related drugs of incident pneumonia during the study period and selected elderly patients receiving anticholinergic drugs as the case group. Propensity score matching (PSM) on a 1:1 scale was used to match elderly patients that were not receiving any anticholinergic drugs as the control group, resulting in a final sample of 32,215 patients receiving anticholinergic drugs and 32,215 patients not receiving any anticholinergic drugs. Conditional logistic regression was used to estimate the association between anticholinergic drugs and pneumonia after controlling for potential confounders. Compared with patients not receiving anticholinergic drugs, the adjusted odds ratio of patients receiving anticholinergic drugs was 1.33 (95% confidence interval: 1.18 to 1.49). Anticholinergic medication is common among elderly patients in Taiwan. Elderly patients receiving anticholinergic drugs may increase their risk of incident pneumonia. The safety of anticholinergic drugs in the elderly should be of concern in Taiwan.
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23
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Mate KE, Barnett M, Kerr KP, Pond CD, Magin PJ. Stability of anticholinergic load in Australian community-dwelling older people: a longitudinal analysis. Fam Pract 2020; 37:314-320. [PMID: 31784733 DOI: 10.1093/fampra/cmz076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is recommended that anticholinergic medication is avoided in older people, especially those with cognitive impairment. OBJECTIVE To investigate anticholinergic load (ACL) over time in older primary care patients with and without cognitive impairment. METHODS Community-dwelling general practice patients at baseline (n = 1768), at year one (n = 1373) and a restricted cohort (with possible or definite cognitive impairment) at year two (n = 370) had medication regimens documented by a research nurse during a home visit. Anticholinergic medicines were categorized as levels 1-3 (low-high potency) and summed for each participant as a measure of their ACL. RESULTS Most participants had no change in ACL over time, but there was some turnover in the anticholinergic medications used. The mean change in ACL was 0.012 ± 0.99 from baseline to 12 months and -0.04 ± 1.3 from baseline to 24 months. Cardiovascular drugs were the most commonly used level 1 anticholinergics, followed by antidepressants and opioids. Antidepressants and urologicals were the most commonly used level 3 anticholinergics. The rate of anticholinergic deprescribing was equivalent to the rate of anticholinergic initiation, and commonly involved the level 1 drugs warfarin, furosemide and temazepam, and the level 3 drugs amitriptyline and oxybutynin. People with dementia had a higher ACL at baseline and year one compared with other participants. CONCLUSION ACL of community-dwelling older people was very stable over time. This may represent lost opportunities for deprescribing as well as potentially inappropriate prescribing, particularly in those with cognitive impairment.
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Affiliation(s)
- Karen E Mate
- School of Biomedical Sciences and Pharmacy and, Callaghan, Australia
| | - Michelle Barnett
- School of Biomedical Sciences and Pharmacy and, Callaghan, Australia
| | - Karen P Kerr
- School of Biomedical Sciences and Pharmacy and, Callaghan, Australia
| | - C Dimity Pond
- Discipline of General Practice, School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
| | - Parker J Magin
- Discipline of General Practice, School of Medicine & Public Health, University of Newcastle, Callaghan, Australia
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Risk of Mortality Associated with Non-selective Antimuscarinic medications in Older Adults with Dementia: a Retrospective Study. J Gen Intern Med 2020; 35:2084-2093. [PMID: 32026255 PMCID: PMC7351941 DOI: 10.1007/s11606-020-05634-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/23/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Selective antimuscarinics may offer a favorable safety profile over non-selective antimuscarinics for the management of overactive bladder (OAB) in patients with dementia. OBJECTIVE To test the hypothesis that non-selective antimuscarinics are associated with increased risk of mortality compared to selective antimuscarinics in older adults with dementia and OAB. DESIGN Propensity score-matched retrospective new-user cohort design among Medicare beneficiaries in community settings. PATIENTS Older adults with dementia and OAB with incident antimuscarinic use. MAIN MEASURES The primary exposure was antimuscarinic medications classified as non-selective (oxybutynin, tolterodine, trospium, fesoterodine) and selective (solifenacin, darifenacin) agents. All-cause mortality within 180 days of incident antimuscarinic use formed the outcome measure. New users of non-selective and selective antimuscarinics were matched on propensity scores using the Greedy 5 → 1 matching technique. Cox proportional-hazards model stratified on matched pairs was used to evaluate the risk of mortality associated with the use of non-selective versus selective antimuscarinics in the sample. KEY RESULTS The study identified 16,955 (77.6%) non-selective antimuscarinic users and 4893 (22.4%) selective antimuscarinic users. Propensity score matching yielded 4862 patients in each group. The unadjusted mortality rate at 180 days was 2.6% (126) for non-selective and 1.6% (78) for selective antimuscarinic users in the matched cohort (p value < 0.01). The Cox model stratified on matched pairs found 50% higher risk of 180-day mortality with non-selective antimuscarinics as compared to selective ones (hazard ratio (HR) 1.50; 95% confidence interval (CI) 1.04-2.16). The study findings remained consistent across multiple sensitivity analyses. CONCLUSIONS Use of non-selective antimuscarinics was associated with a 50% increase in mortality risk among older adults with dementia and OAB. Given the safety concerns regarding non-selective antimuscarinic agents, there is a significant need to optimize their use in the management of OAB for older patients with dementia.
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25
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Javelot H, Llorca PM, Drapier D, Fakra E, Hingray C, Meyer G, Dizet S, Egron A, Straczek C, Roser M, Masson M, Gaillard R, Fossati P, Haffen E. [Informations on psychotropics and their adaptations for patients suffering from mental disorders in France during the SARS-CoV-2 epidemic]. Encephale 2020; 46:S14-S34. [PMID: 32376004 PMCID: PMC7196532 DOI: 10.1016/j.encep.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
The 2019-20 coronavirus pandemic (SARS-CoV-2; severe acute respiratory syndrome coronavirus 2) has dramatic consequences on populations in terms of morbidity and mortality and in social terms, the general confinement of almost half of the world's population being a situation unprecedented in history, which is difficult today to measure the impact at the individual and collective levels. More specifically, it affects people with various risk factors, which are more frequent in patients suffering from psychiatric disorders. Psychiatrists need to know: (i) how to identify, the risks associated with the prescription of psychotropic drugs and which can prove to be counterproductive in their association with COVID-19 (coronavirus disease 2019), (ii) how to assess in terms of benefit/risk ratio, the implication of any hasty and brutal modification on psychotropic drugs that can induce confusion for a differential diagnosis with the evolution of COVID-19. We carried out a review of the literature aimed at assessing the specific benefit/risk ratio of psychotropic treatments in patients suffering from COVID-19. Clinically, symptoms suggestive of COVID-19 (fever, cough, dyspnea, digestive signs) can be caused by various psychotropic drugs and require vigilance to avoid false negatives and false positives. In infected patients, psychotropic drugs should be used with caution, especially in the elderly, considering the pulmonary risk. Lithium and Clozapine, which are the reference drugs in bipolar disorder and resistant schizophrenia, warrant specific attention. For these two treatments the possibility of a reduction in the dosage - in case of minimal infectious signs and in a situation, which does not allow rapid control - should ideally be considered taking into account the clinical response (even biological; plasma concentrations) observed in the face of previous dose reductions. Tobacco is well identified for its effects as an inducer of CYP1A2 enzyme. In a COVID+ patient, the consequences of an abrupt cessation of smoking, particularly related with the appearance of respiratory symptoms (cough, dyspnea), must therefore be anticipated for patients receiving psychotropics metabolized by CYP1A2. Plasma concentrations of these drugs are expected to decrease and can be related to an increase risk of relapse. The symptomatic treatments used in COVID-19 have frequent interactions with the most used psychotropics. If there is no curative treatment for infection to SARS-CoV-2, the interactions of the various molecules currently tested with several classes of psychotropic drugs (antidepressants, antipsychotics) are important to consider because of the risk of changes in cardiac conduction. Specific knowledge on COVID-19 remains poor today, but we must recommend rigor in this context in the use of psychotropic drugs, to avoid adding, in patients suffering from psychiatric disorders, potentially vulnerable in the epidemic context, an iatrogenic risk or loss of efficiency.
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Affiliation(s)
- H Javelot
- Établissement Public de Santé Alsace Nord, Brumath, France; Laboratoire de toxicologie et pharmacologie neuro-cardiovasculaire, université de Strasbourg, Strasbourg, France.
| | - P-M Llorca
- CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, Clermont-Ferrand, France
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, Rennes, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, Saint-Étienne, France
| | - C Hingray
- Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, Laxou, France; Département de neurologie, CHU de Nancy, Nancy, France
| | - G Meyer
- Service de pharmacie, Établissement Public de Santé Alsace Nord, Brumath, France; Service de pharmacie, CHU de Strasbourg, Strasbourg, France
| | - S Dizet
- Service de pharmacie, CHS de Sevrey, Chalon-sur-Saône, France
| | - A Egron
- Service de pharmacie, centre hospitalier de Cadillac, Cadillac, France
| | - C Straczek
- Département de pharmacie, CHU Henri-Mondor, Créteil, France; Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France
| | - M Roser
- Institut Mondor de recherche biomédical, Inserm U955, équipe 15 neuropsychiatrie translationnelle, Créteil, France; Service de psychiatrie sectorisée, hôpital Albert-Chenevier, Créteil, France
| | - M Masson
- Nightingale Hospitals-Paris, clinique du Château de Garches, Garches, France; SHU, GHU psychiatrie et neurosciences, Paris, France
| | - R Gaillard
- GHU psychiatrie et neurosciences, université de Paris, Paris, France; Sous-section 49-03, Conseil national des universités (CNU), Paris, France
| | - P Fossati
- Inserm U1127, service de psychiatrie adultes, ICM, groupe hospitalier Pitié-Salpêtrière, Sorbonne université, AP-HP, Paris, France
| | - E Haffen
- CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, Besançon, France; Laboratoire de neurosciences, université de Franche-Comté, Besançon, France
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Abstract
The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19-29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of pneumonia and some of these cases may be associated with adverse drug events. In this narrative review, we summarize the findings from current observational studies on the association between psychotropic drug use and pneumonia in older adults. In addition to studies assessing the use of psychotropics, we included antiepileptic drugs, as they are also central nervous system-acting drugs, whose use is becoming more common in the aging population. The use of antipsychotics, benzodiazepine, and benzodiazepine-related drugs are associated with increased risk of pneumonia in older adults (≥ 65 years of age), and these findings are not limited to this age group. Minimal and conflicting evidence has been reported on the association between antidepressant drug use and pneumonia, but differences between study populations make it difficult to compare findings. Studies regarding antiepileptic drug use and risk of pneumonia in older persons are lacking, although an increased risk of pneumonia in antiepileptic drug users compared with non-users in persons with Alzheimer's disease has been reported. Tools such as the American Geriatric Society Beers Criteria and the STOPP/START criteria for potentially inappropriate medications aids prescribers to avoid these drugs in order to reduce the risk of adverse drug events. However, risk of pneumonia is not mentioned in the current criteria and more research on this topic is needed, especially in vulnerable populations, such as persons with dementia.
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Affiliation(s)
- Blair Rajamaki
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
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Reinold J, Schäfer W, Christianson L, Barone-Adesi F, Riedel O, Pisa FE. Anticholinergic burden and fractures: a protocol for a methodological systematic review and meta-analysis. BMJ Open 2019; 9:e030205. [PMID: 31439607 PMCID: PMC6707654 DOI: 10.1136/bmjopen-2019-030205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/19/2019] [Accepted: 08/02/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Medications with anticholinergic activity are used in the treatment of many diseases common in old age, including depression, psychosis, Parkinson's disease, allergies, pain and urinary incontinence. A high anticholinergic burden (ACB) is considered a major risk factor for fractures in older adults but recent studies reported inconsistent results. These inconsistencies may partly be due to differences in methodological aspects. However, no systematic review so far has addressed this association and considered study methods. Thus, we aim to conduct a systematic review and meta-analysis of observational studies addressing the association of ACB with fractures and to provide a methodological appraisal of the included studies. METHODS AND ANALYSIS We will search MEDLINE, EMBASE, the Science Citation Index, CENTRAL and grey literature using a strategy that combines the terms anticholinergic and fractures. We will hand search reference lists of articles. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Newcastle-Ottawa Quality Assessment Scale and RTI item bank. Discrepancies will be resolved by consensus or consultation with a third researcher. We will conduct a meta-analysis, either for the overall population or for specific and more homogeneous subgroups, if the number of studies retrieved and their heterogeneity allows it. ETHICS AND DISSEMINATION No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER CRD42018116737.
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Affiliation(s)
- Jonas Reinold
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Wiebke Schäfer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Oliver Riedel
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Federica Edith Pisa
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Reinold J, Palese F, Romanese F, Logroscino G, Riedel O, Pisa FE. Anticholinergic burden before and after hospitalization in older adults with dementia: Increase due to antipsychotic medications. Int J Geriatr Psychiatry 2019; 34:868-880. [PMID: 30761624 DOI: 10.1002/gps.5084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/03/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate changes in the use of antipsychotics and medications with anticholinergic activity (MACs) during hospitalization in older adults with dementia and factors associated with antipsychotic prescriptions and increased anticholinergic burden (ACB). METHODS AND DESIGN This retrospective cohort study included all patients aged 65 years or older with a discharge diagnosis of dementia hospitalized at the university hospital of Udine, Italy, from 2012 to 2014. Medications dispensed within 3 months before and after hospitalization were identified in community-pharmacy dispensations while those prescribed at discharge were collected from Hospital Electronic Medical Records (EMR). ACB was assessed using the Anticholinergic Cognitive Burden score. RESULTS Among 1908 patients included, at discharge, 37.0% used one or more antipsychotic (9.4% before and 12.6% after hospitalization), 68.6% used one or more MAC (49.1% and 45.7%, respectively), and ACB of 38.4% of patients increased at discharge mainly because of a higher use of antipsychotics with anticholinergic activity (33% at discharge vs 12% before hospitalization). Prescription of antipsychotics at discharge was associated with prior treatment with antipsychotics (adjusted odds ratio [aOR] 4.85; 95%CI, 3.37-6.97), psychiatric conditions, (4.39; 3.47-5.54) and discharge from surgical department (2.17; 1.32-3.55). An increased ACB was associated with psychiatric conditions (1.91; 1.52-2.39), discharge from surgical (1.75; 1.09-2.80) or medical department (1.50; 1.04-2.17), and with cardiac insufficiency (1.41; 1.00-1.99). CONCLUSIONS ACB was higher at discharge, and antipsychotics were the main drivers of this increase. Clinicians treating older adults with dementia should be aware of the risks associated with antipsychotics and that some of these medications may increase the risk of anticholinergic effects.
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Affiliation(s)
- Jonas Reinold
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
| | | | | | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G.Panico" Hospital Tricase, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
| | - Federica E Pisa
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology BIPS, Bremen, Germany
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Wang CH, Li CH, Hsieh R, Fan CY, Hsu TC, Chang WC, Hsu WT, Lin YY, Lee CC. Proton pump inhibitors therapy and the risk of pneumonia: a systematic review and meta‐analysis of randomized controlled trials and observational studies. Expert Opin Drug Saf 2019; 18:163-172. [DOI: 10.1080/14740338.2019.1577820] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Chih-Hung Wang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Han Li
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ronan Hsieh
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Cheng-Yi Fan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tze-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Che Chang
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ting Hsu
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Yu-Ya Lin
- Department of Pharmacy, E-Da hospital, Kaohsiung, Taiwan
| | - Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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Labed SA, Wani KA, Jagadeesan S, Hakkim A, Najibi M, Irazoqui JE. Intestinal Epithelial Wnt Signaling Mediates Acetylcholine-Triggered Host Defense against Infection. Immunity 2019; 48:963-978.e3. [PMID: 29768179 DOI: 10.1016/j.immuni.2018.04.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 02/02/2018] [Accepted: 04/17/2018] [Indexed: 12/21/2022]
Abstract
Regulated antimicrobial peptide expression in the intestinal epithelium is key to defense against infection and to microbiota homeostasis. Understanding the mechanisms that regulate such expression is necessary for understanding immune homeostasis and inflammatory disease and for developing safe and effective therapies. We used Caenorhabditis elegans in a preclinical approach to discover mechanisms of antimicrobial gene expression control in the intestinal epithelium. We found an unexpected role for the cholinergic nervous system. Infection-induced acetylcholine release from neurons stimulated muscarinic signaling in the epithelium, driving downstream induction of Wnt expression in the same tissue. Wnt induction activated the epithelial canonical Wnt pathway, resulting in the expression of C-type lectin and lysozyme genes that enhanced host defense. Furthermore, the muscarinic and Wnt pathways are linked by conserved transcription factors. These results reveal a tight connection between the nervous system and the intestinal epithelium, with important implications for host defense, immune homeostasis, and cancer.
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Affiliation(s)
- Sid Ahmed Labed
- Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA 02114, USA; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Khursheed A Wani
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Sakthimala Jagadeesan
- Department of Molecular Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA 02114, USA
| | - Abdul Hakkim
- Department of Molecular Biology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA 02114, USA
| | - Mehran Najibi
- Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA 02114, USA; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Javier Elbio Irazoqui
- Center for the Study of Inflammatory Bowel Disease, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA 02114, USA; Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01605, USA.
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Kose E, Hirai T, Seki T. Assessment of aspiration pneumonia using the Anticholinergic Risk Scale. Geriatr Gerontol Int 2018; 18:1230-1235. [DOI: 10.1111/ggi.13454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/18/2018] [Accepted: 04/25/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Eiji Kose
- Department of Pharmacotherapy, School of Pharmacy; Nihon University; Chiba Japan
| | - Toshiyuki Hirai
- Department of Pharmacy; Hitachinaka General Hospital; Ibaraki Japan
| | - Toshiichi Seki
- Department of Pharmacy; Hitachinaka General Hospital; Ibaraki Japan
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Hentzen C, Haddad R, Sheikh Ismaël S, Chesnel C, Robain G, Amarenco G. Efficacy of posterior tibial nerve stimulation (PTNS) on overactive bladder in older adults. Eur Geriatr Med 2018; 9:249-253. [PMID: 34654250 DOI: 10.1007/s41999-017-0013-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The main objective of this retrospective study is to determine the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) in older patients with overactive bladder (OAB) syndrome. The secondary objective is to look for predictive factors of efficacy of this treatment. METHODS All patients aged over 65 years with OAB syndrome for which TPTNS was introduced between 2010 and 2016 in two neuro-urology centers were included. Age, gender, etiology of OAB, urinary symptoms and detrusor overactivity (DO) were retrospectively collected. The main outcome was efficacy of TPTNS (i.e., purchase of the device between 3 and 6 months). RESULTS A total of 264 patients were included (mean age 74.1 ± 6.5 years; 63.3% of women), of whom 53% had neurogenic OAB. Urinary incontinence was reported by 83.7% of patients and DO was found on urodynamic studies in 154 patients. The overall efficacy of TPTNS was 45.1%. None of the tested factors were significantly predictive of efficacy, especially age (≥ 75 years, p = 0.62), associated stress urinary incontinence (p = 0.69) and presence of DO (p = 0.60), whether neurogenic or not. CONCLUSION TPTNS is an effective treatment in older patients with OAB syndrome. No predictive factors of efficacy were found, especially age and DO. This treatment seems to be a good alternative to antimuscarinics against overactive bladder in older adults.
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Affiliation(s)
- C Hentzen
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France. .,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France.
| | - R Haddad
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - S Sheikh Ismaël
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - C Chesnel
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Robain
- Department of Physical Medicine and Rehabilitation, Rothschild Hospital, AP-HP, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
| | - G Amarenco
- Department of Neuro-urology, Tenon Hospital, AP-HP, 4 Rue de la Chine, 75020, Paris, France.,Clinical Research Group of Perineal Dysfunctions in Older Adults, GRAPPPA, Paris, France
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Lampela P, Tolppanen AM, Tanskanen A, Tiihonen J, Hartikainen S, Taipale H. Anticholinergic Exposure and Risk of Pneumonia in Persons with Alzheimer's Disease: A Nested Case-Control Study. J Alzheimers Dis 2018; 56:119-128. [PMID: 27911327 DOI: 10.3233/jad-160956] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Risk of pneumonia is increased in persons with Alzheimer's disease (AD). In some studies, anticholinergic drugs (AC) have been associated with an increased pneumonia risk. OBJECTIVE We analyzed the risk of pneumonia associated with ACs in persons with AD. METHODS We performed a nested case-control study using register-based data from a Finnish nationwide MEDALZ cohort including all community-dwelling persons diagnosed with AD during 2005-2011. Cases were identified based on pneumonia diagnoses (n = 12,442) from hospital discharge and causes of death registers. Up to two controls without pneumonia were matched based on time since AD diagnoses, age, and gender for each case; AC use was measured using Anticholinergic Drug Scale. RESULTS Use of AC was associated with an increased risk of pneumonia (adjusted odds ratio (OR) 1.36, 95% confidence interval (CI) 1.29-1.43). However, there was no increased pneumonia risk in persons using level 3 ACs. Incident use was associated with higher risk of pneumonia (OR 2.68, 95% CI 2.15-3.34) than prevalent use (OR 1.48, 95% CI 1.40-1.57). Among persons using cholinesterase inhibitors (AChEIs), risk of pneumonia was increased in persons using also ACs (OR 1.53, 95% CI 1.41-1.66). CONCLUSION ACs were associated with an increased risk of pneumonia in persons with AD, especially at the time of initiation of these drugs. AC use was associated with increased pneumonia risk also in persons using AChEIs. This risk should be carefully considered when treating AD patients.
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Affiliation(s)
- Pasi Lampela
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland
| | - Antti Tanskanen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Oral health and risk of pneumonia in asthmatic pacients with inhaled treatment. Med Clin (Barc) 2017; 150:455-459. [PMID: 28947297 DOI: 10.1016/j.medcli.2017.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/20/2017] [Accepted: 07/27/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVE Asthma is a chronic disease requiring inhaled treatment and in addition it is a risk factor (RF) of pneumonia. In the oropharyngeal cavity there are numerous species of bacteria that could be dragged to the bronco-alveolar level. OBJECTIVE to decide whether oral health is a community acquired pneumonia (CAP) RF in asthmatic patients who are taking inhaled treatment, and determining whether the frequency of use of inhalation devices and the type of inhaled drug are CAP RF. PATIENTS AND METHOD Case-control study in asthmatic population with inhaled treatment. We recruited 126 asthmatic patients diagnosed with pneumonia by clinical and radiological criteria (cases) and 252 asthmatics not diagnosed with pneumonia during the last year (controls), matched by age. The main factor of study was the General Oral Health Assessment Index (GOHAI) score. RESULTS Bivariated analysis showed a statistically significant association of CAP with a GOHAI score≤57 points (poor oral health) (OR 1.69), anticholinergic treatment (OR 2.41), 6 or more inhalations (3.23), chamber use (OR 1.62), FEV1 (OR 0.98), altered functionality (OR 2.08) and psychiatric disorders or depression (OR 0.41). The multivariated analysis shows an independent association of performing 6 or more inhalations per day (OR 2.74) and functional impairment (OR 1.67). CONCLUSIONS The results suggest that poor oral health may be a CAP RF.
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Chatterjee S, Bali V, Carnahan RM, Chen H, Johnson ML, Aparasu RR. Risk of Mortality Associated with Anticholinergic Use in Elderly Nursing Home Residents with Depression. Drugs Aging 2017; 34:691-700. [DOI: 10.1007/s40266-017-0475-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Naharci I. Quality Indicators of Drug Use and Risk of Pneumonia in Older Adults without Dementia. J Am Geriatr Soc 2017; 65:1365. [PMID: 28170081 DOI: 10.1111/jgs.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ilkin Naharci
- Division of Geriatrics, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
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Anticholinergic burden: considerations for older adults. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2016. [DOI: 10.1002/jppr.1303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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A Review of Adverse Outcomes Associated with Psychoactive Drug Use in Nursing Home Residents with Dementia. Drugs Aging 2016; 33:865-888. [DOI: 10.1007/s40266-016-0414-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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