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Lee EY, Gomes T, Drucker AM, Daneman N, Asaf A, Wu F, Piguet V, Juurlink DN. Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions. JAMA 2024; 332:730-737. [PMID: 39115856 PMCID: PMC11310841 DOI: 10.1001/jama.2024.11437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/27/2024] [Indexed: 08/11/2024]
Abstract
Importance Serious cutaneous adverse drug reactions (cADRs) are potentially life-threatening drug hypersensitivity reactions involving the skin and internal organs. Antibiotics are a recognized cause of these reactions, but no studies have compared relative risks across antibiotic classes. Objectives To explore the risk of serious cADRs associated with commonly prescribed oral antibiotics, and to characterize outcomes of patients hospitalized for them. Design, Setting, and Participants Nested case-control study using population-based linked administrative datasets among adults aged 66 years or older who received at least 1 oral antibiotic between 2002 and 2022 in Ontario, Canada. Cases were those who had an emergency department (ED) visit or hospitalization for serious cADRs within 60 days of the prescription, and each case was matched with up to 4 controls who did not. Exposure Various classes of oral antibiotics. Main Outcomes and Measures Conditional logistic regression estimate of the association between different classes of oral antibiotics and serious cADRs, using macrolides as the reference group. Results During the 20-year study period, we identified 21 758 older adults (median age, 75 years; 64.1% female) who had an ED visit or hospitalization for serious cADRs following antibiotic therapy and 87 025 matched controls who did not. In the primary analysis, sulfonamide antibiotics (adjusted odds ratio [aOR], 2.9; 95% CI, 2.7-3.1) and cephalosporins (aOR, 2.6; 95% CI, 2.5-2.8) were most strongly associated with serious cADRs relative to macrolides. Additional associations were evident with nitrofurantoin (aOR, 2.2; 95% CI, 2.1-2.4), penicillins (aOR, 1.4; 95% CI, 1.3-1.5), and fluoroquinolones (aOR, 1.3; 95% CI, 1.2-1.4). The crude rate of ED visits or hospitalization for cADRs was highest for cephalosporins (4.92 per 1000 prescriptions; 95% CI, 4.86-4.99) and sulfonamide antibiotics (3.22 per 1000 prescriptions; 95% CI, 3.15-3.28). Among the 2852 case patients hospitalized for cADRs, the median length of stay was 6 days (IQR, 3-13 days), 9.6% required transfer to a critical care unit, and 5.3% died in the hospital. Conclusion and Relevance Commonly prescribed oral antibiotics are associated with an increased risk of serious cADRs compared with macrolides, with sulfonamides and cephalosporins carrying the highest risk. Prescribers should preferentially use lower-risk antibiotics when clinically appropriate.
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Affiliation(s)
- Erika Y. Lee
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
| | - Tara Gomes
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Aaron M. Drucker
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Vincent Piguet
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David N. Juurlink
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Division of General Internal Medicine and Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Inglis JM, Medlin S, Bryant K, Mangoni AA, Phillips CJ. The Clinical Impact of Hospital-Acquired Adverse Drug Reactions in Older Adults: An Australian Cohort Study. J Am Med Dir Assoc 2024; 25:105083. [PMID: 38878799 DOI: 10.1016/j.jamda.2024.105083] [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: 12/05/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Hospital-acquired adverse drug reactions (HA-ADRs) are common in older adults. However, there is limited knowledge regarding the association between HA-ADRs and adverse clinical outcomes. OBJECTIVE To investigate the incidence and characteristics of HA-ADRs in older adults, and any association with mortality, length of stay, and readmissions. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Flinders Medical Centre, a large tertiary referral hospital in Adelaide, South Australia. Older adults admitted under the General Medicine and Acute Care of the Elderly units with no previous diagnosis of dementia. METHODS All patients had a Multidimensional Prognostic Index (MPI) assessment performed within 3 days of the admission. Data collected included age, gender, estimated glomerular filtration rate (eGFR), length of stay, readmissions, and mortality. HA-ADRs were identified by review of individual discharge summaries. Univariate and multivariate analyses were performed to investigate associations with clinical outcomes including mortality, length of stay, and readmissions. Exploratory analyses were performed for HA-ADR groups based on Medical Dictionary for Regulatory Activities System Organ Class and World Health Organization Anatomical Therapeutic Chemical classifications that accounted for ≥10% of all HA-ADRs. RESULTS There were 737 patients in the cohort with 72 having experienced a HA-ADRs (incidence = 9.8%). Patients with an HA-ADR had increased length of stay and 30-day readmissions compared with those without an HA-ADR. In multivariate analysis, the number of HA-ADRs was associated with in-hospital mortality and length of stay but not post-discharge mortality or readmissions within 30 days. In exploratory analyses, patients with an HA-ADR to antibacterial drugs had significantly higher rates of in-hospital mortality compared with those without these reactions. CONCLUSIONS AND IMPLICATIONS The number of HA-ADRs are associated with in-hospital mortality and length of stay in older Australian inpatients. The occurrence of HA-ADRs may be a trigger to offer advice to prescribers to prevent future ADRs to similar agents and proactively manage disease to improve health outcomes.
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Affiliation(s)
- Joshua M Inglis
- Department of Clinical Pharmacology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Sophie Medlin
- SA Pharmacy, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
| | - Kimberley Bryant
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Arduino A Mangoni
- Department of Clinical Pharmacology, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia
| | - Cameron J Phillips
- SA Pharmacy, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Insani WN, Whittlesea C, Wei L. Prevalence of cardiovascular drug-related adverse drug reactions consultations in UK primary care: A cross-sectional study. PLoS One 2024; 19:e0307237. [PMID: 39046945 PMCID: PMC11268649 DOI: 10.1371/journal.pone.0307237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) represent a significant barrier to achieve optimal treatment outcomes. Cardiovascular drugs, including antihypertensive drugs, lipid-lowering drugs, and antithrombotic drugs, are among the most prescribed medications in the primary care setting. OBJECTIVES To estimate the prevalence of cardiovascular drug-related ADRs consultations in United Kingdom (UK) primary care and identify risk factors of these ADRs. METHODS This was a cross-sectional study of cardiovascular drug users between 2000-2019 using UK IQVIA Medical Research Data. ADRs consultations were identified using database screening method employing standardised designated codes. The overall and annual age-standardised prevalence was estimated using direct standardisation method using 2019 mid-year UK population. Risk factors of ADRs consultations were estimated using logistic regression model stratified by therapeutic areas. RESULTS The standardised prevalence of consultations related to cardiovascular drugs ADRs was 10.60 (95% CI. 10.46, 10.75) per 1000 patients. Patients aged 70-79 years had the highest occurrence of ADRs consultations. The most frequently drug classes implicated in the ADRs consultations were statins (n = 9,993 events, 27.09%), beta-blockers (n = 8,538 events, 23.15%), ACEIs/ARBs (n = 8,345 events, 22.62%), and aspirin (n = 6,482 events, 17.57%). Risk factors of ADRs consultations were previous history of cardiovascular diseases, e.g., myocardial infarction and stroke; advanced age, comorbidities; diabetes and dyslipidaemia; and polypharmacy. CONCLUSIONS The burden of cardiovascular drug-related ADRs consultations in primary care was considerable. Statins, beta-blockers, ACEIs/ARBs, and aspirin were the most frequently implicated drug classes. Closer clinical monitoring should be performed for patients affected by the ADRs to mitigate the risk of suboptimal treatment outcomes.
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Affiliation(s)
- Widya N. Insani
- Department of Pharmacology and Clinical Pharmacy, Padjadjaran University, Bandung, Indonesia
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Centre of Excellence for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Chiumia FK, Chimimba F, Nyirongo HM, Kampira EL, Muula AS, Khuluza F. Adverse Drug Reactions Related with Antibiotic Medicines in Malawi: A Retrospective Analysis of Prevalence and Associated Factors. Drug Healthc Patient Saf 2024; 16:89-101. [PMID: 39070704 PMCID: PMC11283248 DOI: 10.2147/dhps.s468966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024] Open
Abstract
Objective We aimed to assess the occurrence and characteristics of antibiotic-associated adverse drug reactions (ADRs) in Malawi. Methods We retrospectively reviewed 304 patient records from medical wards in three hospitals in Southern Malawi. A global trigger tool was applied for the detection of suspected ADRs, and we used the Naranjo scale, the World Health Organization classification and the Schumock and Thornton scale for causality, seriousness and preventability assessment respectively. ADRs were also further characterized according to anatomical systems. Statistical analysis was done in STATA 14.1. The Chi-square test was used to determine the association between categorical variables and logistic regression analysis was used to measure the strength of the association between various independent variables and the occurrence of ADRs. Results Suspected ADRs were detected in 24% (73/304) of patients, of which 1.4% were definite, 15.1% were probable and 83.6% were possible ADRs. Most of the sADRs were gastrointestinal events (42.5%), followed by: musculoskeletal (26.3%); cardiovascular (16.3%); central nervous system (13.8%; and urinary events (1.3%). About 27% of the sADRs were serious events such as convulsions. The geriatric age group (≥65 years) was more likely to experience sADRs as compared to the younger age group, with an adjusted odds ratio (aOR) of 4.53, 95% CI (2.21-9.28), P<0.001. Patients taking more than one antibiotic medicine had a higher risk of developing sADRs as compared to patients who were administered one type of antibiotic medicine, aOR 2.14, 95% CI (1.18-3.90), p < 0.012. A long hospital stay of >3days was associated with a higher risk of sADRs with aOR of 5.11, 95% CI (2.47-10.55), p < 0.001 than those who stayed ≤ 3 days in the hospital. Conclusion We found a higher prevalence of serious sADRs associated with antibiotic medicines than reported elsewhere. This may, among others, contribute to high patient mortality, poor treatment adherence, antibiotic resistance and increased cost of care.
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Affiliation(s)
- Francis Kachidza Chiumia
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Frider Chimimba
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Happy Magwaza Nyirongo
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Elizabeth Lusungu Kampira
- Department of Medical Laboratory Sciences, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Adamson Sinjani Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Felix Khuluza
- Department of Pharmacy, School of Life Sciences and Allied Health Professions, Kamuzu University of Health Sciences, Blantyre, Malawi
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Durand M, Castelli C, Roux-Marson C, Kinowski JM, Leguelinel-Blache G. Evaluating the costs of adverse drug events in hospitalized patients: a systematic review. HEALTH ECONOMICS REVIEW 2024; 14:11. [PMID: 38329561 PMCID: PMC10851489 DOI: 10.1186/s13561-024-00481-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Adverse drug events (ADEs) are not only a safety and quality of care issue for patients, but also an economic issue with significant costs. Because they often occur during hospital stays, it is necessary to accurately quantify the costs of ADEs. This review aimed to investigate the methods to calculate these costs, and to characterize their nature. METHODS A systematic literature review was conducted to identify methods used to assess the cost of ADEs on Medline, Web of Science and Google Scholar. Original articles published from 2017 to 2022 in English and French were included. Economic evaluations were included if they concerned inpatients. RESULTS From 127 studies screened, 20 studies were analyzed. There was a high heterogeneity in nature of costs, methods used, values obtained, and time horizon chosen. A small number of studies considered non-medical (10%), indirect (20%) and opportunity costs (5%). Ten different methods for assessing the cost of ADEs have been reported and nine studies did not explain how they obtained their values. CONCLUSIONS There is no consensus in the literature on how to assess the costs of ADEs, due to the heterogeneity of contexts and the choice of different economic perspectives. Our study adds a well-deserved overview of the existing literature that can be a solid lead for future studies and method implementation. TRIAL REGISTRATION PROSPERO registration CRD42023413071.
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Affiliation(s)
- Maxime Durand
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France.
| | - Christel Castelli
- Department of Law and Health Economics, Faculty of Pharmacy, Univ Montpellier, Montpellier, France
- Department of Innovation, Communication and Market, Univ Montpellier, Montpellier, France
- Department of Clinical Research, AESIO SANTE Méditerranée Beau Soleil Clinic, Montpellier, France
| | - Clarisse Roux-Marson
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Jean-Marie Kinowski
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nîmes University Hospital, Univ Montpellier, Nîmes, France
- Department of Law and Health Economics, Faculty of Pharmacy, Univ Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, Montpellier, France
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Seo B, Yang MS, Park SY, Park BY, Kim JH, Song WJ, Kwon HS, Chang YS, Cho YS, Kim SH, Kim TB. Incidence and Economic Burden of Adverse Drug Reactions in Hospitalization: A Prospective Study in Korea. J Korean Med Sci 2023; 38:e56. [PMID: 36852852 PMCID: PMC9970790 DOI: 10.3346/jkms.2023.38.e56] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) are escalating, and their socioeconomic burden is increasing. However, large-scale prospective studies investigating ADRs during hospitalization are rare in Korea. We prospectively investigated the incidence, characteristics, and economic burden of ADRs in hospitalized patients based on electronic medical records (EMRs). METHODS Among patients admitted to three hospitals from October 2016 to October 2017, 5,000 patients were randomly selected and prospectively observed during hospitalization. Research nurses monitored and detected patients who had symptoms, signs, or laboratory findings suspicious for ADRs using an EMR-based detection protocol. Next, allergy and ADR specialists reviewed the medical records to determine the relationship between adverse reactions and drugs. Cases in which a causal relationship was certain, probable/likely, or possible were included in the ADR cases. Clinically meaningful ADR cases or those leading to prolonged hospitalization were defined as significant ADRs. RESULTS ADRs occurred in 510 (10.2%) patients. The mean length of hospital stay was approximately 5 days longer in patients with ADRs. Opioids accounted for the highest percentage of total ADRs. Significant ADRs were observed in 148 (3.0%) patients. Antibiotics accounted for the highest percentage of significant ADRs. Drug hypersensitivity reactions (DHRs) occurred in 88 (1.8%) patients. Antibiotics accounted for the highest percentage of DHRs. The average medical expenses for one day of hospitalization per patient were highest in significant ADRs, followed by non-significant ADRs, and non-ADRs. CONCLUSION ADRs in hospitalized patients are an important clinical issue, resulting in a substantial socioeconomic burden. EMR-based strategy could be a useful tool for ADR monitoring and early detection.
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Affiliation(s)
- Bomi Seo
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pulmonary, Allergy and Critical Care Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Bo Young Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Hyun Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Patel TK, Patel PB, Bhalla HL, Dwivedi P, Bajpai V, Kishore S. Impact of suspected adverse drug reactions on mortality and length of hospital stay in the hospitalised patients: a meta-analysis. Eur J Clin Pharmacol 2023; 79:99-116. [PMID: 36399205 DOI: 10.1007/s00228-022-03419-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE To estimate the risk of mortality and length of stay in hospitalised patients who have experienced suspected adverse drug reactions (ADRs) as compared to patients who did not experience suspected ADRs. METHODS A systematic literature search was conducted on databases for observational and randomised controlled studies conducted in any inpatient setting that reported deaths and/or length of hospital stay in patients who had suspected ADRs and did not have suspected ADRs during hospitalisation. PRISMA guidelines were strictly followed during the review. The methodological quality of included studies was assessed using a tool designed by Smyth et al. for the studies of adverse drug reactions. The meta-analytic summary of all-cause mortality was estimated using odds ratio-OR (95% CI) and length of stay using mean difference-MD (95% CI). Both outcomes were pooled using a random effect model (DerSimonian and Laird method). Subgroup and meta-regression were performed based on study variables: study design, age group, study ward, study region, types of suspected ADRs (ADRAd-suspected ADRs that lead to hospitalisation and ADRIn-suspected ADRs that occur following hospitalisation), study duration, sample size and study period. The statistical analysis was conducted through the 'Review manager software version 5.4.1 and JASP (Version 0.14.1)'. RESULTS After screening 475 relevant articles, 55 studies were included in this meta-analysis. Patients having suspected ADRs had reported significantly higher odds of all-cause mortality [OR: 1.50 (95% CI: 1.21-1.86; I2 = 100%) than those patients who did not have suspected ADRs during hospitalisation. Study wards, types of suspected ADRs and sample size were observed as significant predictors of all-cause mortality (p < 0.05). Patients having suspected ADRs had reported significantly higher mean difference in hospital stay [MD: 3.98 (95% CI: 2.91, 5.05; I2 = 99%) than those patients who did not have suspected ADRs during hospitalisation. Types of suspected ADRs and study periods were observed as significant predictors of length of stay (p < 0.05). CONCLUSION Suspected ADRs significantly increase the risk of mortality and length of stay in hospitalised patients. SYSTEMATIC REVIEW REGISTRATION CRD42020176320.
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Affiliation(s)
- Tejas K Patel
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, 273008, India.
| | - Parvati B Patel
- Department of Pharmacology, GMERS Medical College, Gotri, Vadodara, Gujarat, 390021, India
| | - Hira Lal Bhalla
- Department of Pharmacology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Priyanka Dwivedi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Vijeta Bajpai
- Department of Anaesthesiology, All India Institute of Medical Sciences, Gorakhpur, 273008, India
| | - Surekha Kishore
- All India Institute of Medical Sciences, Gorakhpur, 273008, India
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Oh S, Byeon SJ, Chung SJ. Characteristics of adverse reactions among antipsychotic drugs using the Korean Adverse Event Reporting System database from 2010 to 2019. J Psychopharmacol 2022; 36:1041-1050. [PMID: 35695641 DOI: 10.1177/02698811221104055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Retrospective studies using spontaneous reporting system databases have provided a great understanding of adverse drug reactions (ADRs) in the real world, complementing the data obtained from randomized controlled trials. However, there have been few reports on large-scale epidemiological studies on the adverse effects of antipsychotics in Asia. AIM This study aimed to investigate the characteristics of antipsychotic ADRs using a nationwide pharmacovigilance database. METHODS Data were collected from the Korea Adverse Event Reporting System database between 2010 and 2019. The study subjects were selected using the International Classification of Disease codes for diseases related to psychosis and Electronic Data Interchange codes for amisulpride, aripiprazole, clozapine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone. The causality assessment of "possible," "probable," or "certain" by the World Health Organization-Uppsala Monitoring Center System causality category was selected. All data were descriptively analyzed. RESULTS In total, 5067 adverse events associated with antipsychotic drugs were reported. The antipsychotics that commonly resulted in ADRs were quetiapine (47.7%), olanzapine (11.3%), and clozapine (10.7%). Serious ADRs were most commonly observed with clozapine. Gastrointestinal and central nervous system problems occurred within a month when ADRs were classified according to the time of onset. In contrast, metabolic and bone marrow-related symptoms occurred after long-term use. Sedation and nausea were the most common ADRs in children and adolescents, whereas constipation and dizziness were common in adults and the elderly. CONCLUSIONS This study extends our knowledge of antipsychotic ADRs in the Asian population.
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Affiliation(s)
- Sanghoon Oh
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Sun-Ju Byeon
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Soo Jie Chung
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, South Korea
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Ernst M, Lundgren M, Evans MD, Miller D, Giubellino A. The Mixed Spongiotic and Interface Reaction Pattern: A Study of Clinical and Histopathologic Findings. J Cutan Pathol 2022; 49:1051-1059. [PMID: 36445270 PMCID: PMC9709294 DOI: 10.1111/cup.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/12/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Categorization of biopsy specimens into inflammatory reaction patterns is central to dermatopathologic assessment. Mixed inflammatory patterns are poorly characterized and may represent clinicopathologic challenges. The purpose of this study was to identify clinical and histopathologic findings associated with the mixed spongiotic-interface dermatitis (SID) histopathologic pattern. METHODS Fifty-one institutional biopsy specimens of SID were identified over a 2-year period by retrospective natural language search. Histopathologic and clinical features were identified. RESULTS The most common histopathologic features associated with SID were mild spongiosis (51%), focal vacuolar interface change (72%), lymphocytic exocytosis (92%), and superficial-dermal lymphocytic infiltrate (94%) with variable eosinophils (61%). Clinically, 80% of subjects presented with a symmetric morbilliform eruption. Polypharmacy (94%), immunosuppression (47%), and history of malignancy (47%) were common. The most common diagnoses were drug reaction (37%), possible drug reaction (12%), and viral exanthem (12%). Drug reaction with eosinophilia and systemic symptoms represented 25% of all confirmed cutaneous adverse drug reactions (CADR). Average time from drug initiation to symptom initiation was 20 days (SD: 22.3, range: 0-90); median disease duration was 25.5 days. Spongiotic vesicles and Langerhans cells were less common in patients with a strong clinicopathologic diagnosis of drug reaction compared to non-drug eruptions (p = 0.04). CONCLUSIONS The mixed SID pattern is commonly encountered in CADR but may represent a more subacute course, implying consideration for inciting medication(s) started before the typical 7- to 14-day window.
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Affiliation(s)
- Madison Ernst
- University of Minnesota, Department of Laboratory Medicine and Pathology
- University of Minnesota, Department of Dermatology
| | - Mia Lundgren
- University of Minnesota, Department of Laboratory Medicine and Pathology
| | - Michael D. Evans
- University of Minnesota, Clinical and Translational Science Institute
| | | | - Alessio Giubellino
- University of Minnesota, Department of Laboratory Medicine and Pathology
- University of Minnesota, Masonic Cancer Center Minneapolis
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Ali S, Curtain CM, Bereznicki LR, Salahudeen MS. Actual drug-related harms in residential aged care facilities: a narrative review. Expert Opin Drug Saf 2022; 21:1047-1060. [PMID: 35634890 DOI: 10.1080/14740338.2022.2084071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Older people in residential aged care facilities (RACFs) have a high risk of safety issues and concerns about the potential quality of care received. This narrative review investigates the types of actual drug-related harms, their prevalence, reporting of any standard definitions for these harms, and their identification methods. AREAS COVERED The authors conducted a systematic search on Ovid Embase, Ovid Medline, and PubMed from March 2001 to March 2021. This narrative review included all types of studies targeting aged care residents aged 65 years and above with actual drug-related harms. EXPERT OPINION The prevalence of actual drug-related harms in residents ranged from 0.07% to 63.0%. Falls, drug-drug interactions, neuropsychiatric symptoms, anaphylaxis, urinary tract infection, hypoglycemia, hypokalaemia, and acute kidney injury are the most common drug-related harms in older residents. Psychotropic drugs are the most common drug class implicated in these harms. Evidence related to the association between individual psychotropic drugs and injury, or harm is also lacking. Due to the variation in study duration, reported prevalence, identification methods, and absence of a definition for actual drug-related harms in most studies, further research is mandated to understand the prevalence and clinical implications of drug-related harms in older residents.
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Affiliation(s)
- Sheraz Ali
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Colin M Curtain
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Luke Re Bereznicki
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Mohammed S Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Mellor R, Khoo A, Saunders-Dow E, Raguz E, Taing MW, Hanjani LS, Freeman C, Crawford D. Polypharmacy in Australian Veterans with Post-traumatic Stress Disorder upon Admission to a Mental Health Facility: A Retrospective Chart Review. Drugs Real World Outcomes 2022; 9:347-357. [PMID: 35581527 PMCID: PMC9392669 DOI: 10.1007/s40801-022-00298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/14/2022] Open
Abstract
Objective Polypharmacy increases the risk of adverse drug events and drug–drug interactions, and contributes to falls, hospital admissions, morbidity and mortality. Veterans with post-traumatic stress disorder often have psychological and physical comorbidities, increasing the likelihood of general and psychotropic polypharmacy. This study investigates the prevalence of general and psychotropic polypharmacy in inpatient veterans with post-traumatic stress disorder, and illustrates potential risks associated with polypharmacy in this population. Methods Medical records of 219 veterans admitted to a mental health facility for post-traumatic stress disorder management were retrospectively reviewed. Medication lists on admission were extracted and coded according to Anatomical Therapeutic Chemical Classification classes. The prevalence of general (five or more total medications), psychotropic (two or more N-code medications), and sedative (two or more medications with sedating effects) polypharmacy and Drug Burden Index were calculated. Class combinations were reported, and associations between demographic characteristics and polypharmacy were determined. Results Mean age was 62.5 (± 14.6) years. In addition to post-traumatic stress disorder, 90.9% had a diagnosis of at least one other psychiatric condition, and 96.8% had a diagnosis of at least one non-psychiatric medical condition. The prevalence of general polypharmacy was 76.7%, psychotropic polypharmacy was 79.9% and sedative polypharmacy was 75.3%. Drug Burden Index scores ranged from 0 to 8.2, with 66.2% of participants scoring ≥ 1. Conclusions This cohort of inpatient veterans with post-traumatic stress disorder had a high prevalence of general, psychotropic and sedative polypharmacy, and were at high risk for drug-related adverse events. This highlights the importance of increasing awareness of polypharmacy and potentially inappropriate drug combinations, and the need for improved medication review by prescribers. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00298-3.
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Affiliation(s)
- Rebecca Mellor
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, 121 Newdegate Street, Greenslopes, QLD, 4120, Australia.
| | - Andrew Khoo
- Toowong Private Hospital, Toowong, QLD, Australia
| | - Elise Saunders-Dow
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, 121 Newdegate Street, Greenslopes, QLD, 4120, Australia
| | - Ella Raguz
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, 121 Newdegate Street, Greenslopes, QLD, 4120, Australia
| | - Meng-Wong Taing
- Pharmacy Australia Centre of Excellence (PACE), School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Sciences Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Chris Freeman
- Pharmacy Australia Centre of Excellence (PACE), School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia
| | - Darrell Crawford
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, 121 Newdegate Street, Greenslopes, QLD, 4120, Australia
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Yadesa TM, Kitutu FE, Tamukong R, Alele PE. Development and Validation of ‘Prediction of Adverse Drug Reactions in Older Inpatients (PADROI)’ Risk Assessment Tool. Clin Interv Aging 2022; 17:195-210. [PMID: 35241911 PMCID: PMC8888137 DOI: 10.2147/cia.s350500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Adverse drug reactions (ADR) detection and prediction methods in hospitalized older adults remain imprecise. The identification of the risk factors for ADRs in this group of patients is crucial to develop plausible prediction models. Objective This study aimed at developing and validating a “Prediction of ADR in Older Inpatients (PADROI)” risk assessment tool in hospitalized older adults. Methods and Materials We had previously conducted a derivational study that aimed to determine the risk factors of ADRs in hospitalized older adults. We developed the PADROI model as a potential ADR risk assessment tool incorporating 8 predictors each given a score by rounding off the respective adjusted odds ratios (AORs) to the nearest whole number. Subsequently, we conducted another prospective cohort among adults aged 60 years and older admitted to Gynecology and Obstetrics, Medical, Oncology, Surgery, and Psychiatry wards at Mbarara Regional Referral Hospital (MRRH) from July 5 to September 17, 2021. Results A total of 124 participants, 70 females and 54 males aged 60–95 years, were included in this validation cohort; 62 of them experienced 90 ADRs. When applied to the derivational cohort, the area under receiver operating characteristic curve (AUROC) for the PADROI model was shown to be 0.896 (0.869–0.923; at 95% CI). In the validation study, AUROC of PADROI was 0.917 (0.864–0.971 at 95% CI; p < 0.001). Overall, PADROI correctly predicted 91.7% of those who experienced an ADR. Conclusion Using the adjusted odds ratios from our derivational cohort, we developed an ADR prediction tool (PADROI) that achieved an excellent AUROC (0.917), high sensitivity (87.1%) and specificity (90.3%). The current model demonstrated a high potential for clinical applicability which can be strengthened if similar results are reproduced in larger and multi-centered studies.
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Affiliation(s)
- Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Pharmacy, Ambo University, Ambo, Ethiopia
- Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
- Correspondence: Tadele Mekuriya Yadesa, Department of Pharmacy, Mbarara University of Science and Technology, P.O.Box 1410, Mbarara, Uganda, Tel +256753312571, Email
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University, Kampala, Uganda
- Sustainable Pharmaceutical Systems (SPS) Unit, School of Health Sciences, Makerere University, Kampala, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Edrees H, Song W, Syrowatka A, Simona A, Amato MG, Bates DW. Intelligent Telehealth in Pharmacovigilance: A Future Perspective. Drug Saf 2022; 45:449-458. [PMID: 35579810 PMCID: PMC9112241 DOI: 10.1007/s40264-022-01172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 01/28/2023]
Abstract
Pharmacovigilance improves patient safety by detecting and preventing adverse drug events. However, challenges exist that limit adverse drug event detection, resulting in many adverse drug events being underreported or inaccurately reported. One challenge includes having access to large data sets from various sources including electronic health records and wearable medical devices. Artificial intelligence, including machine learning methods, such as natural language processing and deep learning, can detect and extract information about adverse drug events, thus automating the pharmacovigilance process and improving the surveillance of known and documented adverse drug events. In addition, with the increased demand for telehealth services, for managing both acute and chronic diseases, artificial intelligence methods can play a role in detecting and preventing adverse drug events. In this review, we discuss two use cases of how artificial intelligence methods may be useful to improve the quality of pharmacovigilance and the role of artificial intelligence in telehealth practices.
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Affiliation(s)
- Heba Edrees
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Department of Pharmacy Practice, MCPHS University, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Wenyu Song
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Ania Syrowatka
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Aurélien Simona
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA
| | - Mary G. Amato
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - David W. Bates
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA USA ,Harvard Medical School, 1620 Tremont St., 3rd Floor, Boston, MA 02120 USA ,Department of Health Policy and Management, Harvard School of Public Health, Boston, MA USA
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Yadesa TM, Kitutu FE, Tamukong R, Alele PE. Prevalence, Incidence, and Characteristics of Adverse Drug Reactions Among Older Adults Hospitalized at Mbarara Regional Referral Hospital, Uganda: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1705-1721. [PMID: 34588772 PMCID: PMC8473935 DOI: 10.2147/cia.s332251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Adverse drug reactions (ADRs) are associated with significant clinical and economic effects. Among the elderly population, the risk for ADRs is even higher. Data of ADR prevalence and incidence among the elderly population in Uganda and many low- and middle-income countries are lacking. Objective This study determined the prevalence, incidence, and characteristics of ADRs among hospitalized elderly patients at Mbarara Regional Referral Hospital (MRRH), Uganda. Methods and Materials We conducted a prospective cohort of older adults admitted to medical, oncology, and surgery wards at MRRH for consecutive 6 months. The primary data were obtained by interviewing patients and caregivers and reviewing patient medication charts, taking vital signs, and physical examinations. We used Edwards and Aronson’s definition of ADR and the Naranjo ADR Causality Scale. We conducted descriptive statistics and the Kolmogorov–Smirnov test using SPSS Version 23.0. Results We studied a total of 523 older adults 60 to 103 years of age. During their hospital stay, 256 (48.9%) of the patients experienced at least one ADR. A total of 365 ADRs were identified during 4702 person-days of follow-up. The incidence of ADRs was 78 ADRs/1000 person-days. ADRs affecting the gastrointestinal tract were the most frequently (40.6%) identified categories. Probable and type A ADRs accounted for 260 (71.2%) and 305 (83.6%) of the total incidents, respectively. Overall, 237 (64.9%) of the ADRs were rated as mild, whereas 10 (2.8%) of them as severe. Lastly, 165 (45.2%) of the ADRs were categorized as preventable. Conclusion Almost half of the hospitalized patients aged 60 to 103 years experienced at least one ADR during their hospital stay, which is higher than has been previously documented. Almost three-thirds of the ADRs were probable, about 4 out of 5 were type A and almost two-thirds were mild. Nearly half of the ADRs were preventable.
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Affiliation(s)
- Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pharmacy, Ambo University, Ambo, Ethiopia.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University, Kampala, Uganda.,Sustainable Pharmaceutical Systems (SPS), Makerere University, Kampala, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Paul E Alele
- Department of Pharmacology and Therapeutics, Mbarara University of Science and Technology, Mbarara, Uganda
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Jennings ELM, Murphy KD, Gallagher P, O’Mahony D. In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs-a systematic review and meta-analysis. Age Ageing 2020; 49:948-958. [PMID: 33022061 DOI: 10.1093/ageing/afaa188] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND the prevalence of adverse drug reactions (ADRs) in hospitalised older patients, their clinical presentations, causative drugs, severity, preventability and measurable outcomes are unclear, ADRs being an increasing challenge to older patient safety. METHODS we systematically searched PubMed, Embase, EBSCO-CINAHL, the Cochrane Library, 'rey' literature and relevant systematic review bibliographies, published from database inception to March 2020. We included any study reporting occurrence of in-hospital ADRs as primary or secondary outcomes in hospitalised older adults (mean age ≥ 65 years). Two authors independently extracted relevant information and appraised studies for bias. Study characteristics, ADR clinical presentations, causative drugs, severity, preventability and clinical outcomes were analysed. Study estimates were pooled using random-effects meta-analytic models. RESULTS from 2,399 abstracts, we undertook full-text screening in 286, identifying 27 studies (29 papers). Final analysis yielded a pooled ADR prevalence of 16% (95%CI 12-22%, I2 98%,τ2 0.8585), in a population of 20,153 hospitalised patients aged ≥65 years of whom 2,479 patients experienced ≥ one ADR. ADR ascertainment was highly heterogeneous. Almost 48.3% of all ADRs involved five presentations: fluid/electrolyte disturbances (17.3%), gastrointestinal motility/defaecation disorders (13.3%), renal disorders (8.2%), hypotension/blood pressure dysregulation disorders/shock (5.5%) and delirium (4.1%). Four drug classes accounted for 57.8% of causative medications i.e. diuretics (19.8%), anti-bacterials (14.8%), antithrombotic agents (12.2%) and analgesics (10.9%). Pooled analysis of severity was not feasible. Four studies reported the majority of ADRs as preventable (55-95%). CONCLUSIONS on average, 16% of hospitalised older patients experience significant ADRs, varying in severity and mostly preventable, with commonly prescribed drug classes accounting for most ADRs.
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Affiliation(s)
- Emma L M Jennings
- School of Medicine, University College Cork National University of Ireland, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Kevin D Murphy
- School of Pharmacy, University College Cork National University of Ireland, Cork, Ireland
| | - Paul Gallagher
- School of Medicine, University College Cork National University of Ireland, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis O’Mahony
- School of Medicine, University College Cork National University of Ireland, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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Lee EJ, Ahn YC, Kim YI, Oh MS, Park YC, Son CG. Incidence Rate of Hypersensitivity Reactions to Bee-Venom Acupuncture. Front Pharmacol 2020; 11:545555. [PMID: 33117156 PMCID: PMC7577189 DOI: 10.3389/fphar.2020.545555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Bee-venom acupuncture (BVA) has been widely applied to various disorders including pain-related diseases; however, patients are often warned of adverse reactions such as anaphylaxis. This study aimed to estimate the risk of hypersensitivity reactions to BVA and to determine their clinical features. METHODS We retrospectively surveyed the medical records of patients treated by BVA between January 2010 and April 2019 in Dunsan Hospital of Daejeon University, and all cases of allergic reactions and their clinical symptoms were analyzed. RESULTS A total of 8,580 patients (males 4,081 and females 4,499) were treated with BVA which amounts to a total of 60,654 treatments (average 7.1 ± 14.8 times). A total of fifteen patients (7 males and 8 females) reported an allergic reaction (0.175%, 95% CI, 0.086-0.263) of type 1 hypersensitivity, indicating a rate of allergic reaction in 0.025% (95% CI, 0.012-0.037) of the total BVA treatments. The average number of BVA treatments in those patients was 6.9 ± 6.5 (males: 4.1 ± 3.4 and females: 9.3 ± 7.9). Among the cases of hypersensitivity reactions, 4 involved anaphylactic shock; therefore, the incidence rate of anaphylaxis was 0.047% (95% CI, 0.001-0.092) for the 8,580 subjects and 0.007% (95% CI, 0.000-0.013) for the 60,654 treatments. All grade 1 cases were recovered within 1 day, whereas others took up to 30 days for complete recovery. CONCLUSION Our results may emphasize paying attention to unforeseeable risks of anaphylaxis after bee-venom acupuncture. This study could be essential reference data for the guidelines of appropriate use of bee-venom acupuncture and bee-venom-derived interventions in clinical applications.
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Affiliation(s)
- Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, Daejeon, South Korea
| | - Young-Il Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Min-Seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Yang-Chun Park
- Division of Respiratory System, Department of Internal Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea
| | - Chang-Gue Son
- Department of Gastrobilliary System, Dunsan Hospital of Daejeon University, Daejeon, South Korea
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Liu Y, Liang J, Xia Q, Zhou X, Xie X. Effects of Lithium Combined with Second-Generation Antipsychotics for the Treatment of Manic Episodes in Patients with Bipolar Disorder: A Naturalistic Study in China. Neuropsychiatr Dis Treat 2020; 16:2623-2632. [PMID: 33177826 PMCID: PMC7649218 DOI: 10.2147/ndt.s270596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore the therapeutic effects of lithium combined with second-generation antipsychotics (SGAs) of quetiapine, clozapine, olanzapine, and risperidone for the treatment of manic episodes in patients with bipolar disorder (BD) to guide the selection of medications. METHODS We examined the case data of patients with BD who experienced manic episodes and were hospitalized in a Class 3A Psychiatric Hospital in Anhui Province from January 2015 to October 2019. The enrolled patients were rated using the Bech-Rafaelsen Mania Rating Scale (BRMS) before and after treatment, and relevant adverse effects were monitored. RESULTS Analysis of the collected case data of 182 patients showed significant differences in the BRMS scores on admission and at discharge of patients treated with lithium combined with each SGA. The chi-square test showed no obvious difference in the final therapeutic effects of lithium combined with each of the four SGAs (χ2 = 7.365, P = 0.146). However, there were differences in the incidence of adverse effects (χ 2 = 10.604, P = 0.014) and remission rate after 2 weeks of treatment (χ2 = 10.174, P = 0.017). Logistic regression analysis revealed that the incidence of adverse effects was related to the length of stay in hospital and clozapine treatment. The remission rate after 2 weeks was associated with the length of stay in hospital, clozapine treatment, and age of onset. CONCLUSION Lithium combined with SGAs (quetiapine, clozapine, olanzapine, and risperidone) effectively improves the manic symptoms of patients with BD who experience manic episodes. Lithium combined with quetiapine for the treatment of bipolar manic episode has advantages with respect to the speed of effective and incidence of adverse effects.
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Affiliation(s)
- Yang Liu
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei 230032, Anhui, People's Republic of China.,Department of Pharmacy, Hefei Fourth People's Hospital, Hefei 230000, People's Republic of China
| | - Jun Liang
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei 230000, People's Republic of China
| | - Qingrong Xia
- Department of Pharmacy, Hefei Fourth People's Hospital, Hefei 230000, People's Republic of China
| | - Xin Zhou
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei 230032, Anhui, People's Republic of China
| | - Xuefeng Xie
- Department of Basic and Clinical Pharmacology, Anhui Institute of Innovative Drugs, School of Pharmacy, Anhui Medical University, Hefei 230032, Anhui, People's Republic of China
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Just KS, Dormann H, Böhme M, Schurig M, Schneider KL, Steffens M, Dunow S, Plank-Kiegele B, Ettrich K, Seufferlein T, Gräff I, Igel S, Schricker S, Jaeger SU, Schwab M, Stingl JC. Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED). Eur J Clin Pharmacol 2019; 76:439-448. [DOI: 10.1007/s00228-019-02797-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022]
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