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Hendrix MRS, Yasar M, Mohammad AK, Hugtenburg JG, Vanhommerig JW, Gündoğan-Yilmaz R, van den Bemt PMLA, Denig P, Karapinar-Carkıt F. Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide. BMC Med Res Methodol 2024; 24:8. [PMID: 38212730 PMCID: PMC10782776 DOI: 10.1186/s12874-023-02108-y] [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: 04/13/2023] [Accepted: 11/20/2023] [Indexed: 01/13/2024] Open
Abstract
Prescribing cascades occur when patients are prescribed medication to treat the adverse drug reaction of previously prescribed medication. Prescription sequence symmetry analysis (PSSA) can be used to assess the association between two medications in prescription or dispensing databases and thus the potential occurrence of prescribing cascades. In this article, a step-by-step guide is presented for conducting PSSA to assess prescribing cascades. We describe considerations for medication data collection and setting time periods for relevant parameters, including washout window, exposure window, continued exposure interval and blackout period. With two examples, we illustrate the impact of changes in these parameters on the strengths of associations observed. Given the impact seen, we recommend that researchers clearly specify and explain all considerations regarding medication included and time windows set when studying prescribing cascades with PSSA, and conduct subgroup and sensitivity analyses.
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Affiliation(s)
- Mandy R S Hendrix
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Mustafa Yasar
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Atiya K Mohammad
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Joost W Vanhommerig
- Department of Research and Epidemiology, OLVG Hospital, Amsterdam, The Netherlands
| | | | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Amsterdam, The Netherlands
| | - Fatma Karapinar-Carkıt
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Center +, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
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Adrien O, Mohammad AK, Hugtenburg JG, McCarthy LM, Priester-Vink S, Visscher R, van den Bemt PMLA, Denig P, Karapinar-Carkıt F. Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review. Drugs Aging 2023; 40:1085-1100. [PMID: 37863868 PMCID: PMC10682291 DOI: 10.1007/s40266-023-01072-y] [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] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND To reduce prescribing cascades occurring in clinical practice, healthcare providers require information on the prescribing cascades they can recognize and prevent. OBJECTIVE This systematic review aims to provide an overview of prescribing cascades, including dose-dependency information and recommendations that healthcare providers can use to prevent or reverse them. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Relevant literature was identified through searches in OVID MEDLINE, OVID Embase, OVID CINAHL, and Cochrane. Additionally, Web of Science and Scopus were consulted to analyze reference lists and citations. Publications in English were included if they analyzed the occurrence of prescribing cascades. Prescribing cascades were included if at least one study demonstrated a significant association and were excluded when the adverse drug reaction could not be confirmed in the Summary of Product Characteristics. Two reviewers independently extracted and grouped similar prescribing cascades. Descriptive summaries were provided regarding dose-dependency analyses and recommendations to prevent or reverse these prescribing cascades. RESULTS A total of 95 publications were included, resulting in 115 prescribing cascades with confirmed adverse drug reactions for which at least one significant association was found. For 52 of these prescribing cascades, information regarding dose dependency or recommendations to prevent or reverse prescribing cascades was found. Dose dependency was analyzed and confirmed for 12 prescribing cascades. For example, antipsychotics that may cause extrapyramidal syndrome followed by anti-parkinson drugs. Recommendations focused on dosage lowering, discontinuing medication, and medication switching. Explicit recommendations regarding alternative options were given for three prescribing cascades. One example was switching to ondansetron or granisetron when extrapyramidal syndrome is experienced using metoclopramide. CONCLUSIONS In total, 115 prescribing cascades were identified and an overview of 52 of them was generated for which recommendations to prevent or reverse them were provided. Nonetheless, information regarding alternative options for managing prescribing cascades was scarce.
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Affiliation(s)
- Oriane Adrien
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Atiya K Mohammad
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | - Lisa M McCarthy
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Leslie Dan Faculty of Pharmacy and Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Robbert Visscher
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fatma Karapinar-Carkıt
- Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- CARIM School for Cardiovascular Disease, Maastricht University, Maastricht, The Netherlands.
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Brieler JA, Salas J, Amick ME, Sheth P, Keegan-Garrett EA, Morley JE, Scherrer JF. Anxiety disorders, benzodiazepine prescription, and incident dementia. J Am Geriatr Soc 2023; 71:3376-3389. [PMID: 37503956 DOI: 10.1111/jgs.18515] [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: 11/18/2022] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Prescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent. It is unknown if anxiety treated with a benzodiazepine, compared to anxiety disorder alone is associated with dementia risk. METHODS A retrospective cohort study (n = 72,496) was conducted using electronic health data from 2014 to 2021. Entropy balancing controlled for bias by indication and other confounding factors. PARTICIPANTS Eligible patients were ≥65 years old, had clinic encounters before and after index date and were free of dementia for 2 years prior to index date. Of the 72,496 eligible patients, 85.6% were White and 59.9% were female. Mean age was 74.1 (SD ± 7.1) years. EXPOSURE Anxiety disorder was a composite of generalized anxiety disorder, anxiety not otherwise specified, panic disorder, and social phobia. Sustained benzodiazepine use was defined as at least two separate prescription orders in any 6-month period. MAIN OUTCOME AND MEASURES ICD-9 or ICD-10 dementia diagnoses. RESULTS Six percent of eligible patients had an anxiety diagnosis and 3.6% received sustained benzodiazepine prescriptions. There were 6640 (9.2%) incident dementia events. After controlling for confounders, both sustained benzodiazepine use (HR 1.28, 95% CI: 1.11-1.47) and a diagnosis of anxiety (HR 1.19, 95% CI: 1.06-1.33) were associated with incident dementia in patients aged 65-75. Anxiety disorder with sustained benzodiazepine, compared to anxiety disorder alone, was not associated with incident dementia (HR 1.18, 95% CI: 0.92-1.51) after controlling for confounding. Results were not significant when limiting the sample to those ≥75 years of age. CONCLUSIONS Benzodiazepines and anxiety disorders are associated with increased risk for dementia. In patients with anxiety disorders, benzodiazepines were not associated with additional dementia risk. Further research is warranted to determine if benzodiazepines are associated with a reduced or increased risk for dementia compared to other anxiolytic medications in patients with anxiety disorders.
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Affiliation(s)
- Jay A Brieler
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Matthew E Amick
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Poorva Sheth
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Elizabeth A Keegan-Garrett
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - John E Morley
- School of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Saint Louis University School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, USA
- The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, Missouri, USA
- Department of Psychiatry and Behavioral Neuroscience, School of Medicine, Saint Louis University, St. Louis, Missouri, USA
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Koch E, Johnell K, Kauppi K. Longitudinal effects of using and discontinuing central nervous system medications on cognitive functioning. Pharmacoepidemiol Drug Saf 2023; 32:446-454. [PMID: 36357173 DOI: 10.1002/pds.5569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/23/2022] [Accepted: 11/05/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To investigate the longitudinal effect of using and discontinuing central nervous system (CNS) medications on cognitive performance. METHODS Using longitudinal cognitive data from population representative adults aged 25-100 years (N = 2188) from four test waves 5 years apart, we investigated both the link between use of CNS medications (opioids, anxiolytics, hypnotics and sedatives) on cognitive task performance (episodic memory, semantic memory, visuospatial ability) across 15 years, and the effect of discontinuing these medications in linear mixed effects models. RESULTS We found that opioid use was associated with decline in visuospatial ability whereas using anxiolytics, hypnotics and sedatives was not associated with cognitive decline over 15 years. A link between drug discontinuation and cognitive improvement was seen for opioids as well as for anxiolytics, hypnotics and sedatives. CONCLUSIONS Although our results may be confounded by subjacent conditions, they suggest that long-term use of CNS medications may have domain-specific negative effects on cognitive performance over time, whereas the discontinuation of these medications may partly reverse these effects. These results open up for future studies that address subjacent conditions on cognition to develop a more complete understanding of the cognitive effects of CNS medications.
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Affiliation(s)
- Elise Koch
- Department of Integrative Medical Biology, Umeå University, Sweden
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Norway
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karolina Kauppi
- Department of Integrative Medical Biology, Umeå University, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Full KM, Pusalavidyasagar S, Palta P, Sullivan KJ, Shin JI, Gottesman RF, Spira AP, Pase MP, Lutsey PL. Associations of Late-Life Sleep Medication Use With Incident Dementia in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2023; 78:438-446. [PMID: 35421897 PMCID: PMC9977227 DOI: 10.1093/gerona/glac088] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep medications may contribute to dementia development or indicate sleep disturbances that are markers of or contributors to neurologic disease. The objective of this study was to examine the use of sleep medications and incident dementia in a community-based cohort of older adults. We hypothesize late-life sleep medication use is associated with a greater risk of dementia. METHODS The Atherosclerosis Risk in Communities (ARIC) study is an ongoing community-based cohort study. ARIC participants taking barbiturates, benzodiazepines, antidepressants, non-benzodiazepine receptor agonists (Z-drugs), or other hypnotics in 2011-2013 were categorized as sleep medication users. Participants were followed through 2019 for incident dementia. Logistic regression propensity scores were used to match sleep medication users with nonusers (1:2). Cox proportional hazards regression models were used to estimate hazard ratios (HR) for time to dementia diagnosis with adjustment for demographics, lifestyle characteristics, and cardiovascular risk factors. RESULTS One-quarter of the eligible ARIC participants used sleep medications. In the matched sample (N = 4 197; 69% female; mean age 75.3 + 5.0 years), 632 dementia cases were ascertained over a median follow-up of 6.5 years. In the fully adjusted model, sleep medication use compared to nonuse was associated with a 48% greater risk of dementia (HR: 1.48; 95% confidence interval (CI): 1.26-1.74). CONCLUSION To expand on these findings, studies with longer follow-up and earlier assessment of sleep medication use are needed. Furthermore investigation of the potential dose-response association of multiple sleep medications and the potential causal role of sleep medications in the development of dementia may be clinically meaningful.
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Affiliation(s)
- Kelsie M Full
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Snigdha Pusalavidyasagar
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Priya Palta
- Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kevin J Sullivan
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jung-Im Shin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,USA
| | - Rebecca F Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Adam P Spira
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Center on Aging and Health, Baltimore, Maryland,USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Early Detection of Adverse Drug Reaction Signals by Association Rule Mining Using Large-Scale Administrative Claims Data. Drug Saf 2023; 46:371-389. [PMID: 36828947 PMCID: PMC10113351 DOI: 10.1007/s40264-023-01278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are a leading cause of mortality worldwide and should be detected promptly to reduce health risks to patients. A data-mining approach using large-scale medical records might be a useful method for the early detection of ADRs. Many studies have analyzed medical records to detect ADRs; however, most of them have focused on a narrow range of ADRs, limiting their usefulness. OBJECTIVE This study aimed to identify methods for the early detection of a wide range of ADR signals. METHODS First, to evaluate the performance in signal detection of ADRs by data-mining, we attempted to create a gold standard based on clinical evidence. Second, association rule mining (ARM) was applied to patient symptoms and medications registered in claims data, followed by evaluating ADR signal detection performance. RESULTS We created a new gold standard consisting of 92 positive and 88 negative controls. In the assessment of ARM using claims data, the areas under the receiver-operating characteristic curve and the precision-recall curve were 0.80 and 0.83, respectively. If the detection criteria were defined as lift > 1, conviction > 1, and p-value < 0.05, ARM could identify 156 signals, of which 90 were true positive controls (sensitivity: 0.98, specificity: 0.25). Evaluation of the capability of ARM with short periods of data revealed that ARM could detect a greater number of positive controls than the conventional analysis method. CONCLUSIONS ARM of claims data may be effective in the early detection of a wide range of ADR signals.
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Li B. DESIGN OF EARLY WARNING SYSTEM FOR MENTAL HEALTH PROBLEMS BASED ON DATA MINING AND DATABASE. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329012022_0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Introduction: Data mining technology is mainly employed in the era of big data to evaluate the acquired information. Subsequently, reasoning about the data inductively is fully automated to discover possible patterns. Objective: Recently, data mining technology in the national mental health database has deepened and can be effectively used to solve various mental health early warning problems. Methods: For example, it can be applied to mine psychological data and extract the most important features and information. Results: This paper presents the design of an early warning system for mental health problems based on data mining techniques to offer some thoughts on early warning of mental health problems, including data preparation, data mining, results in analysis, and decision tree algorithm. Conclusion: The experimental results indicate that the results of the early warning system in this paper can achieve an accuracy rate of more than 96% with a high accuracy rate. Level of evidence II; Therapeutic studies - investigating treatment outcomes.
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Affiliation(s)
- Baodong Li
- Henan University of Economics and Law, China
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Doherty AS, Shahid F, Moriarty F, Boland F, Clyne B, Dreischulte T, Fahey T, Kennelly SP, Wallace E. Prescribing cascades in community-dwelling adults: A systematic review. Pharmacol Res Perspect 2022; 10:e01008. [PMID: 36123967 PMCID: PMC9485823 DOI: 10.1002/prp2.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022] Open
Abstract
The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre-registered with PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: community-dwelling adults; risk-prescription medication; outcomes-initiation of new medicine to "treat" or reduce ADR risk; study type-cohort, cross-sectional, case-control, and case-series studies. Title/abstract screening, full-text screening, data extraction, and methodological quality assessment were conducted independently in duplicate. A narrative synthesis was conducted. A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11 593 989 participants and 15 studies examined older adults specifically (≥60 years). Seventy-eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic (n = 5), amiodarone to levothyroxine (n = 5), inhaled corticosteroid to topical antifungal (n = 4), antipsychotic to anti-Parkinson drug (n = 4), and acetylcholinesterase inhibitor to urinary incontinence drugs (n = 4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months.
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Affiliation(s)
- Ann S. Doherty
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Faiza Shahid
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Frank Moriarty
- School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Fiona Boland
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
- Data Science CentreRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Barbara Clyne
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Tobias Dreischulte
- Institute of General Practice and Family MedicineUniversity Hospital of Ludwig‐Maximilians‐University MunichMunichGermany
| | - Tom Fahey
- Department of General PracticeRCSI University of Medicine and Health SciencesDublin 2Ireland
| | - Seán P. Kennelly
- Department of Medical GerontologyTrinity College DublinDublin 2Ireland
- Department of Age‐related HealthcareTallaght University HospitalDublin 24Ireland
| | - Emma Wallace
- Department of General PracticeUniversity College CorkCorkIreland
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Ohyama K, Shindo J, Takahashi T, Takeuchi H, Hori Y. Pharmacovigilance study of the association between dipeptidyl peptidase-4 inhibitors and angioedema using the FDA Adverse Event Reporting System (FAERS). Sci Rep 2022; 12:13122. [PMID: 35907939 PMCID: PMC9338932 DOI: 10.1038/s41598-022-17366-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Dipeptidyl peptidase-4 (DPP-4) plays a minor role in degrading vasoactive peptides that cause angioedema when angiotensin-converting enzyme (ACE) is present and fully functional. This study investigated the association between DPP-4 inhibitors (DPP-4Is) and angioedema, including cases where the concomitant use of ACE inhibitors (ACEIs) was absent. We obtained data from the US Food and Drug Administration Adverse Event Reporting System and performed a disproportionality analysis, using the reporting odds ratio (ROR) and information component (IC) for signal detection in patients aged ≥ 40 years, stratified by age group and sex. No signal was detected for DPP-4Is when the entire dataset was analyzed. However, a signal was detected for the entire female subset group, the three stratified female groups aged ≥ 60 years, and males in their 40 s. After excluding the data of concomitant ACEI users, most ROR and IC values were lower and significant only for females in their 60 s and males aged ≥ 80 years. Regarding individual DPP-4Is signals, those detected for saxagliptin and sitagliptin in some age groups disappeared after excluding the data of ACEI users. Notably, linagliptin was the only DPP-4I where signals were detected in most female groups, regardless of age and without concomitant ACEI use. Our findings suggest that some DPP-4Is were associated with a higher reporting of angioedema as per age and sex, even in the absence of concomitant ACEI use.
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Affiliation(s)
- Katsuhiro Ohyama
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, Japan.
| | - Junichiro Shindo
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, Japan
| | - Tomohiro Takahashi
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, Japan
| | - Hironori Takeuchi
- Hospital Pharmacy, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Yusuke Hori
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, Japan
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Said ES, Elsayed AM, Rashed LA, Nadwa EH, Alsuhaibani NA, Alfuraih BS, Mahmoud RH. Evaluation of nootropic activity of telmisartan and metformin on diazepam-induced cognitive dysfunction in mice through AMPK pathway and amelioration of hippocampal morphological alterations. Eur J Pharmacol 2021; 912:174511. [PMID: 34547248 DOI: 10.1016/j.ejphar.2021.174511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
Cognitive impairments such as dementia are considered the biggest challenges for public health. Benzodiazepines are often prescribed for treatment of anxiety disorder but they are associated with elevated risk of dementia. The present study has been designed to evaluate the neuroprotective effect of telmisartan and metformin on diazepam-induced cognitive dysfunction in mice. Piracetam was used as an established nootropic agent. Mice were divided into 8 groups, group1; control group which received normal saline. groups 2, 3 and 4 were received telmisartan 0.3 mg/kg/day, metformin 100 mg/kg/day and piracetam 200 mg/kg/day respectively. group 5; DZP group that injected with diazepam 2.5 mg/kg, groups 6, 7 and 8 were received diazepam 2.5 mg/kg + telmisartan 0.3 mg/kg/day, metformin 100 mg/kg/day and piracetam 200 mg/kg/day respectively. All drugs were administrated for 15 successive days. Cognitive skills of the animals were examined with Elevated plus maze and Passive Shock Avoidance tests. Investigations of oxidative stress markers were performed. Gene expression levels of TNF-α, NFκB, Caspase 3 and AMPK were analyzed using RT-PCR. Histological and immunohistochemical techniques were performed in hippocampus using H&E, cresyl violet stain, anti GFAP and anti COX-2 immunostain. The study revealed that administration of diazepam increased initial and retention transfer latency as well as it decreased step down latency that means it caused memory impairment. There was a significant increase in hippocampal expression levels of TNF-α, NFκB, and Caspase 3 and downregulation of AMPK expression levels associated with increased neurodegeneration, astrocytes activation and COX-2 immunohistochemical staining. This study indicates that diazepam caused a decline in cognitive function depending on hippocampal activity. Telmisartan, a common antihypertensive agent and metformin, a traditional antidiabetic drug improved this cognitive dysfunction through their anti-oxidant and anti-inflammatory effect as they decreased initial and retention transfer latency as well as it increased step down latency. Also they decreased TNF-α, NFκB, and Caspase 3 and upregulated AMPK expression, moreover they ameliorated the hippocampal morphological alterations, GFAP and COX-2 immunoexpression.
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Affiliation(s)
- Eman S Said
- Department of Clinical Pharmacology, Faculty of Medicine, Fayoum University, Fayoum 63511, Egypt; Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah 52571, Saudi Arabia.
| | - Asmaa M Elsayed
- Department of Histology, Faculty of Medicine, Fayoum University, Egypt
| | - Laila A Rashed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Egypt
| | - Eman H Nadwa
- Department of Pharmacology and Therapeutics, College of Medicine, Jouf University, Sakaka, Saudi Arabia; Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | | | - Rania H Mahmoud
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Egypt
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AlDawsari A, Bushell TJ, Abutheraa N, Sakata S, Al Hussain S, Kurdi A. Use of sedative-hypnotic medications and risk of dementia: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 88:1567-1589. [PMID: 34679196 DOI: 10.1111/bcp.15113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS Growing evidence suggests an association between the use of sedative-hypnotic medications and risk of dementia. The aim of this study is to examine this association using a meta-analysis approach. METHODS MEDLINE (PubMed) and Scopus were systematically searched for studies published in English only. The quality of studies was evaluated using the Newcastle-Ottawa scale, and an overall odds ratio was pooled using a random-effects model. RESULTS A total of 35 articles were included in the analysis. Pooled odds ratios (ORs) for dementia from all records were (OR; 1.33, 95% CI 1.19-1.49) for benzodiazepine (BZD) combined use (Subgroup-1), (OR: 1.46, 95% CI 1.23-1.73) for short-acting BZD use (Subgroup-2), (OR: 1.72, 95% CI 1.48-1.99) for long-acting BZD use (Subgroup-3), (OR: 1.13, 95% CI 0.97-1.32) for BZDs without specification of duration of action (Subgroup-4), (OR: 1.64, 95% CI 1.13-2.38) for the combined BZDs and Z-drugs, (OR: 1.43, 95% CI 1.17-1.74) for Z-drugs only, (OR: 1.14, 95% CI 0.88-1.46) for antidepressant use, (OR: 0.97, 95% CI 0.68-1.39) for antipsychotic use and (OR: 0.98, 95% CI 0.85-1.13) for anticonvulsant use. When sensitivity analysis was performed, association between overall use of BZDs and short-acting BZDs with the increased risk of dementia disappeared after exclusion of studies that were not adjusted for age covariate (OR: 1.2, 95% CI 1.0-1.44) and (OR: 1.22, 95% CI 0.75-2.01), respectively. Adjustment for protopathic bias by introduction of a lag period showed no evidence of increased risk of dementia with the use of BZDs (Subgroup-1) (OR: 1.14, 95% CI 0.82-1.58), Z-drugs (OR: 1.29, 95% CI 0.78-2.13), and combined BZDs and Z-drugs (OR: 1.51, 95% CI 0.91-2.53). Combined use of BZDs and Z-drugs showed more positive association when only studies of non-user design were analysed (OR: 2.75, 95% CI 2.23-3.39). CONCLUSIONS All the investigated sedative-hypnotics showed no association with increased risk of dementia except for BZDs. However, the observed association with BZDs did not persist after exclusion of studies with potential reverse causation and confounding by indication. Therefore, this association needs to be assessed carefully in future research.
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Affiliation(s)
- Asma AlDawsari
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Ministry of Health, AlKharj Maternity and Children Hospital, Riyadh, Saudi Arabia
| | - Trevor J Bushell
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Nouf Abutheraa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Shuzo Sakata
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Sarah Al Hussain
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Hofuf, Saudi Arabia
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Division of Public Health and Pharmacy Management, School of Pharmacy, SefakoMakgatho Health Sciences University, South Africa
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12
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Morris EJ, Hollmann J, Hofer AK, Bhagwandass H, Oueini R, Adkins LE, Hallas J, Vouri SM. Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review. Res Social Adm Pharm 2021; 18:3079-3093. [PMID: 34376366 DOI: 10.1016/j.sapharm.2021.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The (prescription) sequence symmetry analysis (PSSA) design has been used to identify potential prescribing cascade signals by assessing the prescribing sequence of an index drug relative to a marker drug presumed to treat an adverse drug event provoked by the index drug. OBJECTIVES This review aimed to explore the use of the PSSA design as a pharmacovigilance tool with a particular focus on the breadth of identified signals and advances in PSSA methodology. METHODS We searched Embase, PubMed/Medline, Google Scholar, Web of Science and grey literature to identify studies that used the PSSA methodology. Two reviewers independently extracted relevant data for each included article. Study characteristics including signals identified, exposure time window, stratified analyses, and use of controls were extracted. RESULTS We identified 53 studies which reported original results obtained using PSSA methodology or quantified the validity of components of the PSSA design. Of those, nine studies provided validation metrics showing reasonable sensitivity and high specificity of PSSA to identify prescribing cascade signals. We identified 340 unique index drug - marker drug signals published in the PSSA literature, representing 281 unique index - marker pharmacological class dyads (i.e., unique fourth-level Anatomical Therapeutic Chemical [ATC] classification dyads). Commonly observed signals were identified for index drugs acting upon the nervous system (34%), cardiovascular system (21%), and blood and blood-forming organs (15%), and many marker drugs were related to the nervous system (25%), alimentary tract and metabolism (23%), cardiovascular system (17%), and genitourinary system and sex hormones (14%). Negative controls and positive controls were utilized in 21% and 13% of studies, respectively. CONCLUSIONS The PSSA methodology has been used in 53 studies worldwide to detect and evaluate over 300 unique prescribing cascades signals. Researchers should consider sensitivity analyses incorporating negative and/or positive controls and additional time windows to evaluate time-varying biases when designing PSSA studies.
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Affiliation(s)
- Earl J Morris
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Josef Hollmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ann-Kathrin Hofer
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Razanne Oueini
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lauren E Adkins
- Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark; Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
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13
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Meraya AM, Banji OJ, Khobrani MA, Alhossan A. Evaluation of psychotropic medications use among elderly with psychiatric disorders in Saudi Arabia. Saudi Pharm J 2021; 29:603-608. [PMID: 34194267 PMCID: PMC8233536 DOI: 10.1016/j.jsps.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 04/13/2021] [Indexed: 12/02/2022] Open
Abstract
AIMS Potentially inappropriate psychotropic medications (PIPMs) prescribed to older adults with psychiatric disorders can inadvertently affect their health. The use of standards and guidelines can ensure prudent prescribing and minimize the risk of morbidities. This study assessed the pattern and prevalence of prescription of PIPMs to older individuals in outpatient psychiatric settings in Saudi Arabia, using the updated 2015 Beers criteria, as well as the probability of polypharmacy. METHODS The study was conducted in the outpatient psychiatric clinics of the only psychiatric hospital in Jazan region of Saudi Arabia. A retrospective cross-sectional review of electronic medical records was undertaken during 2018 to assess PIPM use and psychotropic polypharmacy. Descriptive statistics were generated and associations between PIPM use and baseline characteristics were assessed using multivariable logistic regression. RESULTS Overall, 68% of 1300 older adults received PIPMs, and 77.7% were on psychotropic polypharmacy. Amitriptyline, chlorpromazine, and trifluoperazine were extensively prescribed. Paroxetine (1.2%) and benzodiazepines were prescribed to a smaller proportion of the patients. Elderly with schizophrenia (AOR = 0.046, p < 0.001) and anxiety (AOR = 0.530, p = 0.036) were significantly less likely to have PIPMs than those with dementia. Likewise, elderly with depression and anxiety were less likely to have psychotropic polypharmacy as compared to those with dementia. CONCLUSION A substantial number of the elderly received PIPMs possibly based on implicit criteria. It is therefore important to provide mental health care providers in the region with educational programs to increase their awareness of PIPMs.
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Affiliation(s)
- Abdulkarim M. Meraya
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Otilia J.F. Banji
- Department of Clinical Pharmacy, Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Saudi Arabia
| | - Moteb A. Khobrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Saudi Arabia
- Corporate of Pharmacy Services, King Saud University Medical City, Saudi Arabia
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14
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Margolis SA, Kelly DA, Daiello LA, Davis J, Tremont G, Pillemer S, Denby C, Ott BR. Anticholinergic/Sedative Drug Burden and Subjective Cognitive Decline in Older Adults at Risk of Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:1037-1043. [PMID: 32886748 DOI: 10.1093/gerona/glaa222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), has been linked to cognitive impairment in older adults. Subjective cognitive decline (SCD) may be among the first symptoms patients with Alzheimer's disease (AD) experience. We examined whether DBI values are associated with SCD in older adults at risk of AD. We hypothesized that increased DBI would be associated with greater SCD at older ages. METHOD Two-hundred-six community-dwelling, English-speaking adults (age = 65 ± 9 years) at risk of AD (42% apolipoprotein ε4 carriers; 78% with AD family history) were administered a single question to ascertain SCD: "Do you feel like your memory is becoming worse?" Response options were "No"; "Yes, but this does not worry me"; and "Yes, this worries me." DBI values were derived from self-reported medication regimens using older adult dosing recommendations. Adjusting for relevant covariates (comorbidities and polypharmacy), we examined independent effects of age and DBI on SCD, as well as the moderating effect of age on the DBI-SCD association at mean ± 1 SD of age. RESULTS Both SCD and anticholinergic/sedative drug burden were prevalent. Greater drug burden was predictive of SCD severity, but age alone was not. A significant DBI*Age interaction emerged with greater drug burden corresponding to more severe SCD among individuals age 65 and older. CONCLUSION Anticholinergic/sedative drug exposure was associated with greater SCD in adults 65 and older at risk for AD. Longitudinal research is needed to understand if this relationship is a pre-clinical marker of neurodegenerative disease and predictive of future cognitive decline.
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Affiliation(s)
- Seth A Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Dana A Kelly
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Lori A Daiello
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jennifer Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Sarah Pillemer
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital, Providence
| | - Charles Denby
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence
| | - Brian R Ott
- Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital, Providence.,Department of Neurology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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15
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Wu B, Hu Q, Tian F, Wu F, Li Y, Xu T. A pharmacovigilance study of association between proton pump inhibitor and dementia event based on FDA adverse event reporting system data. Sci Rep 2021; 11:10709. [PMID: 34021217 PMCID: PMC8139970 DOI: 10.1038/s41598-021-90108-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/04/2021] [Indexed: 02/08/2023] Open
Abstract
Proton pump inhibitor (PPI) was widely used around the world. Studies suggested conflicting results between PPI treatment and dementia event. This study examined the association between six PPI agents and dementia event by mining the US FDA Adverse Event Reporting System (FAERS) database from 2004 to 2020. We employed proportional reporting ratio (PRR) and information element (IC) methods to detect the signals of dementia relevant to PPI. We also analyzed characteristics of PPI and positive control reports, compared dementia event between long- and short-duration of PPI treatment. Finally, we identified 2396 dementia cases with PPI treatment. We did not detect significant signal between PPI and dementia event: PRR = 0.98, 95%CI 0.94 to 1.02, IC = −0.03, 95%CI − 0.17 to 0.10, even in gastroesophageal reflux disease cases: PRR = 0.65, 95%CI 0.59 to 0.72, IC = −0.62, 95%CI − 0.97 to − 0.27. No significant differences of dementia event were detected between long- and short- duration groups, the OR (95%CI) of the 3 years, 5 years and 10 years comparison were 0.70 (0.48 to 1.02), 0.72 (0.45 to 1.15) and 1.65 (0.75 to 3.63), respectively. Based on the current FAERS data mining, we discovered no association between PPI use and dementia event, even in long-term PPI therapy case.
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Affiliation(s)
- Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Qiaozhi Hu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Yuwen Li
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou, Chengdu, 610041, Sichuan, China. .,West China School of Pharmacy, Sichuan University, Chengdu, 610041, Sichuan, China.
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16
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Abstract
ABSTRACT Despite the lack of evidence on the long-term effectiveness of benzodiazepines and their potential harmful effects, prescriptions of the drug have significantly increased in the US over the past decade. This article reviews best practices regarding primary care benzodiazepine prescriptions and how providers can best prevent and treat benzodiazepine use disorder and other harmful effects.
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17
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Pereira ML, de Vasconcelos THF, de Oliveira AAR, Campagnolo SB, Figueiredo SDO, Guimarães AFBC, Barbosa MT, de Miranda LFJR, Caramelli P, de Souza LC. Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization. Dement Neuropsychol 2021; 15:88-97. [PMID: 33907601 PMCID: PMC8049577 DOI: 10.1590/1980-57642021dn15-010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
There are different causes of memory complaints in the elderly, such as
subjective cognitive decline (SCD), mild cognitive impairment (MCI) or
dementia.
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Affiliation(s)
- Marcos Leandro Pereira
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Patos de Minas, MG, Brazil.,Curso de Medicina, Centro Universitário de Patos de Minas - Patos de Minas, MG, Brazil
| | | | | | | | | | | | - Maira Tonidandel Barbosa
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | | | - Paulo Caramelli
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Patos de Minas, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais - Patos de Minas, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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18
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Gayete S, Giné A, Miret M, Ayuso-Mateos JL, Haro JM, Olaya B. Cognitive function associated with different diagnoses of anxiety disorders over the lifespan: Results from a Spanish representative sample. J Anxiety Disord 2020; 75:102296. [PMID: 32866758 DOI: 10.1016/j.janxdis.2020.102296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Previous research suggests an association between anxiety disorders and worse cognitive function. However, this association may vary depending on the type of disorder and age. We analysed the association of panic attack, 12-month and lifetime panic disorder (PD), and generalized anxiety disorder (GAD), with cognitive function in a representative sample of Spanish adults, and compared three age groups (18-49, 50-64, and 65+). METHODS Some 4,582 participants were interviewed with an adapted CIDI interview. Unadjusted and adjusted linear regression models were calculated by age group, using T scores of verbal fluency and episodic memory as the outcomes. RESULTS In young adults, 12-month GAD was associated with significantly lower scores of memory performance and verbal fluency, and 12-month PD with worse verbal fluency. In middle-aged participants, lifetime panic attack was related to better performance in verbal fluency, whereas having a diagnosis of lifetime PD was associated with lower scores. However, only participants aged 18-49 with 12-month GAD showed lower memory and verbal fluency, at almost one standard deviation below participants without 12-month GAD. LIMITATIONS Low prevalence rates of anxiety disorder could have led to biased results. CONCLUSIONS In young adults, a concurrent GAD might be particularly associated with memory and verbal fluency deficits, whereas only verbal fluency is affected in middle-aged adults with a history of PD, although this association is small. In older adults, anxiety disorders are not clearly associated with worse cognition, probably because in this age group other confounder variables might be attenuating this link. Overall, our findings suggest that cognitive interventions for anxiety disorders may be relevant, especially for young and middle-aged adults.
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Affiliation(s)
- Silvia Gayete
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Anna Giné
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain
| | | | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, CIBER of Mental Health (CIBERSAM), Madrid, Spain.
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19
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Baek YH, Kim HJ, Bae JH, Lee H, Oh IS, Kim WJ, Shin JY. Benzodiazepine-Related Cognitive Impairment or Dementia: A Signal Detection Study Using a Case/Non-Case Approach. Psychiatry Investig 2020; 17:587-595. [PMID: 32450620 PMCID: PMC7324737 DOI: 10.30773/pi.2019.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/17/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The association between benzodiazepine use and the risk of cognitive impairment or dementia has been controversial. Our study aims to detect this association through a case/non-case method using the Korea Institute of Drug Safety & Risk Management-Korea adverse event reporting system database (KIDS-KD) between 2007 and 2016. METHODS Cases were adverse event (AE)-pairs with suspected cognitive impairment or dementia. 10 non-cases were matched to each case on age and sex. Exposure was defined as use of benzodiazepines, including long-, intermediate-, and short-acting benzodiazepine. We conducted multivariable logistic regression analyses to estimate reporting odds ratios (ROR) and 95% confidence intervals (CI). RESULTS Of the 1,086,584 AE-pairs, 887 cases were suspected AE-pairs of cognitive impairment or dementia, and 775,444 non-cases were selected. Benzodiazepine use was associated with increased AE-pairs of cognitive impairment or dementia when assessed using those with certain, probable, and/or possible in causality assessments (ROR=2.69, 95% CI=1.66-4.38). Higher ROR estimates were shown in female (2.33, 1.48-3.67) and in those with polypharmacy (2.20, 1.35-3.57). Dementia safety profiles were inconsistent across individual benzodiazepine components. CONCLUSION These results suggest the potentially increased association between benzodiazepine use and cognitive impairment or dementia in female and those with polypharmacy. Inconsistent safety profiles of benzodiazepine components should be further investigated.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hye-Jun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ji-Hwan Bae
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - In-Sun Oh
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
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20
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Association between benzodiazepine use and development of dementia. Med Clin (Barc) 2020; 156:107-111. [PMID: 32434656 DOI: 10.1016/j.medcli.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/22/2020] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the association between use of benzodiazepines and incident dementia. METHODS Analytical prospective nested case-control study for which the Spanish database for pharmacoepidemiological research in primary care (BIFAP) of the Spanish Agency of Medicines and Medical Devices (AEMPS) was used. A total of 15,212 subjects diagnosed with dementia of the Alzheimer type and 62,397 controls were identified. Exposure was retrieved retrospectively with a 3-year lag time before the index date. Adjusted odd ratios (OR) were calculated. RESULTS Benzodiazepines use increased the risk of suffering Alzheimer's disease (OR=1.05, 95% CI, 1.01-1.10). No statistical differences were shown between short-acting and long-acting drugs. The risk is more evident with longer exposure times. CONCLUSIONS There seems to be a weak association between benzodiazepine use and the development of dementia, the risk increases with greater exposure.
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21
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Coteur K, Van Nuland M, Vanmeerbeek M, Henrard G, Anthierens S, Van den Broeck K, De Sutter A, Creupelandt H, Devroey D, Van Overmeire R, Offermans AM, Kacenelenbogen N, Laenen A, Mathei C. Effectiveness of a blended care programme for the discontinuation of benzodiazepine use for sleeping problems in primary care: study protocol of a cluster randomised trial, the Big Bird trial. BMJ Open 2020; 10:e033688. [PMID: 32075832 PMCID: PMC7045121 DOI: 10.1136/bmjopen-2019-033688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Problematic benzodiazepine use is a global health issue. Although the adverse side effects of long-term use of benzodiazepines are well known, it remains difficult to implement interventions for discontinuation in primary care. Considering the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, evidence suggests that a blended care approach, combining face-to-face consultations with the general practitioner with web-based self-learning by the patient, is beneficial for the discontinuation of chronic benzodiazepine use for primary insomnia in general practice. Therefore, the aim of this study is to evaluate the effectiveness of such an approach for the discontinuation of benzodiazepine and zolpidem, zopiclone and zaleplon drugs ((z-)BZD) use in the long term and evaluate the implementation process. METHODS AND ANALYSIS This study is a multicentre, pragmatic, cluster randomised controlled trial with 1200 patients, included by 120 general practitioners. Allocation to usual or blended care happens at the level of the general practice in a 1:1 ratio using a block randomisation system stratified per language. The study population consists of adult primary care patients who have been using (z-)BZD for primary insomnia on a daily basis for at least 6 months. Primary outcome measure is the proportion of patients that discontinued (z-)BZD at 12 months assessed by toxicological screening for (z-)BZD in urine. Secondary outcomes include discontinuation of (z-)BZD at 6 months, quality of life and the number of defined daily doses of (z-)BZD prescribed. Data will be collected using a study-specific online platform and analysed using the intention-to-treat approach. The process of implementing blended care will be evaluated in a nested study. ETHICS AND DISSEMINATION This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (ref. S61194). Study results will be disseminated via open-access, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03937180.
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Affiliation(s)
- Kristien Coteur
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marc Van Nuland
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marc Vanmeerbeek
- Department of General Practice, Université de Liège, Liege, Belgium
| | - Gilles Henrard
- Department of General Practice, Université de Liège, Liege, Belgium
| | - Sibyl Anthierens
- Department of General Practice, University of Antwerp, Antwerpen, Belgium
| | | | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Hanne Creupelandt
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Roel Van Overmeire
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | - Anne-Marie Offermans
- Department of General Medicine, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, Leuven, Belgium
| | - Catharina Mathei
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Mabuchi T, Hosomi K, Yokoyama S, Takada M. Polypharmacy in elderly patients in Japan: Analysis of Japanese real-world databases. J Clin Pharm Ther 2020; 45:991-996. [PMID: 31986233 DOI: 10.1111/jcpt.13122] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Polypharmacy is associated with an increased risk of adverse drug reactions (ADRs) and drug interactions, decreased adherence to medication and increased medical cost. Recently, polypharmacy has become a major problem in medical care in Japan as a result of the increase in the ageing population. The purpose of this study was to investigate the current situation of polypharmacy and the association between polypharmacy and adverse events. METHODS A retrospective data analysis was performed using two different real-world data from 2007 to 2015 in Japan. The Japanese Adverse Drug Event Report (JADER), a public spontaneous adverse drug reaction database constructed by the Pharmaceuticals and Medical Devices Agency (PMDA), and a large prescription database constructed by a database vendor (Japan Medical Information Research Institute, Inc Japan [JMIRI]) were analysed. Trends of polypharmacy during the study period were investigated. RESULTS AND DISCUSSION The mean number of drugs per report in the JADER database and per prescription in the JMIRI databases during the study period ranged from 4.8 to 5.6 and 3.5 to 3.7, respectively. The mean number of drugs increased with age in both the JADER and JMIRI databases, and the peak of the mean number of drugs was at 80-89 years (5.74 drugs) in the JADER database and at 90-99 years (4.97 drugs) in the JMIRI database. WHAT IS NEW AND CONCLUSIONS The number of drugs increased until age 90 years or more, even though adverse events are more likely to occur after the age of 80 in Japan. Therefore, polypharmacy in the elderly should be focused on the patients aged ≥80 years rather than patients aged ≥65 years from the viewpoint of the prevention of adverse events.
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Affiliation(s)
- Takayuki Mabuchi
- Division of Clinical Drug Informatics, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.,Maruzen Pharmacy, Osaka, Japan
| | - Kouichi Hosomi
- Division of Clinical Drug Informatics, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.,Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
| | - Satoshi Yokoyama
- Division of Clinical Drug Informatics, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.,Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.,Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
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Tseng LY, Huang ST, Peng LN, Chen LK, Hsiao FY. Benzodiazepines, z-Hypnotics, and Risk of Dementia: Special Considerations of Half-Lives and Concomitant Use. Neurotherapeutics 2020; 17:156-164. [PMID: 31802436 PMCID: PMC7007460 DOI: 10.1007/s13311-019-00801-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The utilization of benzodiazepines (BZDs) and z-hypnotics has substantially increased with the aging of the population, but the risk of BZDs and z-hypnotics in the development of dementia remains a strong concern. This cohort study aimed to evaluate the risk of BZDs and z-hypnotics for subsequent dementia development with a special consideration of their half-lives and the concomitant use of these medications. People aged 65 years and older who were newly prescribed oral BZDs or z-hypnotics between 2003 and 2012 were identified from Taiwan's National Health Insurance Research Database. All BZDs were categorized as long-acting drugs (≥ 20 h) or short-acting drugs (< 20 h) for further comparisons, and data were collected on a quarterly basis, starting on the first date of drug prescription and ending on the date of death, occurrence of dementia, or end of the follow-up period (December 31, 2012), whichever came first. All dementia events except vascular dementia occurring during the follow-up period were identified. Among 260,502 eligible subjects, short-acting BZDs and z-hypnotics users were at greater risk of dementia than long-acting users [adjusted odds ratio (95% confidence interval) in short-acting BZD users, 1.98 (1.89-2.07); z-hypnotic users, 1.79 (1.68-1.91); and long-acting BZD users, 1.47 (1.37-1.58)]. In addition, subjects concomitantly using 2 or more BZDs or z-hypnotics had a higher risk of dementia than those who used 1 of these drugs (4.79 (3.95-5.81)). The use of BZDs and z-hypnotics was strongly associated with the risk of dementia development, especially the short-acting BZDs, z-hypnotics, and concomitant use of multiple agents. These findings deserve further interventional studies for clarification.
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Affiliation(s)
- Li-Yen Tseng
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Tsung Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 33, Linsen S. Rd, Taipei, 10050, Taiwan
| | - Li-Ning Peng
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Department of Geriatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 33, Linsen S. Rd, Taipei, 10050, Taiwan.
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
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Uno T, Wada K, Hosomi K, Matsuda S, Ikura MM, Takenaka H, Terakawa N, Oita A, Yokoyama S, Kawase A, Takada M. Drug interactions between tacrolimus and clotrimazole troche: a data mining approach followed by a pharmacokinetic study. Eur J Clin Pharmacol 2019; 76:117-125. [PMID: 31654150 DOI: 10.1007/s00228-019-02770-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE This study investigated the effects of clotrimazole troche on the risk of transplant rejection and the pharmacokinetics of tacrolimus. METHODS The data mining approach was used to investigate whether the use of clotrimazole increased the risk of transplant rejection in patients receiving tacrolimus therapy. Patient data were acquired from the US Food and Drug Administration's Adverse Event Reporting System (FAERS) from the first quarter of 2004 to the end of 2017. Next, we retrospectively investigated the effect of clotrimazole troche on tacrolimus pharmacokinetics in seven patients who underwent heart transplantation between March and December 2017. RESULTS The FAERS subset data indicated a significant association between transplant rejection and tacrolimus with clotrimazole [reporting odds ratio 1.92, 95% two-sided confidence interval (95% CI) 1.43-2.58, information component 0.81, 95% CI 0.40-1.23]. The pharmacokinetic study demonstrated a significant correlation between trough concentration (C0) and area under the concentration-time curve of tacrolimus after discontinuation of clotrimazole (R2 = 0.60, P < 0.05) but not before its discontinuation. Furthermore, the median clearance/bioavailability of tacrolimus after discontinuation of clotrimazole was 2.2-fold greater than that before its discontinuation (0.27 vs. 0.59 L/h/kg, P < 0.05). The median C0 decreased from 10.7 ng/mL on the day after discontinuation of clotrimazole to 6.5 ng/mL at 1 day and 5.3 ng/mL at 2 days after its discontinuation. CONCLUSION Immediate dose adjustments of tacrolimus may be beneficial to avoid transplant rejection when clotrimazole troche is added or discontinued.
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Affiliation(s)
- Takaya Uno
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
- Division of Cardiovascular Drugs, Therapy, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan
| | - Kyoichi Wada
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Takatsuki, Japan
| | - Kouichi Hosomi
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
- Division of Cardiovascular Drugs, Therapy, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan
| | - Sachi Matsuda
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Megumi Morii Ikura
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiromi Takenaka
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobue Terakawa
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akira Oita
- Department of Pharmacy, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yokoyama
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan
- Division of Cardiovascular Drugs, Therapy, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan
| | - Atsushi Kawase
- Department of Pharmacy, Faculty of Pharmacy, Kindai University, Higashi-osaka, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Higashi-osaka, Japan.
- Division of Cardiovascular Drugs, Therapy, Kindai University Graduate School of Pharmacy, Higashi-osaka, Japan.
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Barus R, Béné J, Deguil J, Gautier S, Bordet R. Drug interactions with dementia-related pathophysiological pathways worsen or prevent dementia. Br J Pharmacol 2019; 176:3413-3434. [PMID: 30714122 PMCID: PMC6715604 DOI: 10.1111/bph.14607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/12/2018] [Accepted: 01/07/2019] [Indexed: 12/27/2022] Open
Abstract
Many risk factors are known to induce or precipitate dementia. Drugs acting via different mechanisms can modulate cognitive performance and exert either beneficial or deleterious effects on cognition through functional or neuropathological mechanisms. This review discusses the association between several classes of drugs and cognitive impairment and dementia risk. These drugs can be divided into drugs targeting CNS disorders (e.g., anticholinergic drugs, antiepileptics, antipsychotics, benzodiazepines, and opioids) and drugs targeting non‐CNS disorders (e.g., antidiabetics, antihypertensives, proton pump inhibitors, and statins). Furthermore, we sought to highlight the pharmacological mechanisms underlying their possible detrimental or beneficial effects on cognition. Anticholinergic and antiepileptic drugs were excluded from this review because their effects on cognition are well known. Studies investigating benzodiazepines have revealed an increased risk of dementia. Conclusions on dementia risk or cognitive impairment regarding opioids and antipsychotic drugs are difficult to draw. These different classes appear to impair cognition not by a single clear mechanism of action specific to each class but by several relatively interdependent and interconnected mechanisms (e.g., impaired neurotransmission, neuroinflammation, neuronal death, oxidative stress, or interactions with dementia‐related pathways). The dementia risk initially associated with the use of proton pump inhibitors might have been overestimated. In contrast, statins, antihypertensive medications, and antidiabetics could potentially decrease the risk of dementia and cognitive impairment by acting in ways opposite to the mechanisms cited above.Linked ArticlesThis article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc
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Affiliation(s)
- Romain Barus
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Johana Béné
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Julie Deguil
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Sophie Gautier
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
| | - Régis Bordet
- UnivLille, INSERM, CHU LilleDegenerative and Vascular Cognitive DisordersLilleFrance
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Ushida T, Matsui D, Inoue T, Yokoyama M, Takatsuna H, Matsumoto T, Takita A, Kurusu T, Sakoda H, Okuizumi K. Recent prescription status of oral analgesics in Japan in real-world clinical settings: retrospective study using a large-scale prescription database. Expert Opin Pharmacother 2019; 20:2041-2052. [PMID: 31422709 DOI: 10.1080/14656566.2019.1651840] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Information on prescriptions of oral analgesics for the treatment of pain is beneficial. However, there have been few reports on the prescription status of oral analgesics from a nation-wide, large-scale prescription database in Japan. Research design and methods: The authors analyzed the prescription data of 2,042,302 patients prescribed oral analgesics in 2017. The numbers/proportions of patients prescribed oral analgesics, adherence with approved doses, co-prescription patterns, dose changes, drug adherence, and treatment-discontinuation rates were evaluated. Results: Loxoprofen was prescribed to 32.5% of the patients, followed by celecoxib, prescribed to 16.0% of patients. Acetaminophen and pregabalin were prescribed to 10.5% and 9.4% of patients, respectively. Many analgesics were prescribed at lower doses than the approved doses. The most frequently used concomitant medication was pregabalin. For duloxetine and pregabalin, high proportions of patients were prescribed these drugs for > 90 days. Conclusions: Loxoprofen was the most prescribed of the non-steroidal anti-inflammatory drugs in Japan. The information obtained provides an overview of prescribed oral analgesics in Japan and could be useful for potential research into prescribed oral analgesics in the future.
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Affiliation(s)
- Takahiro Ushida
- Multidisciplinary Pain Center, Aichi Medical University , Aichi , Japan
| | - Daiju Matsui
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Teruyoshi Inoue
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Mizuka Yokoyama
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Hiroshi Takatsuna
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Takuyuki Matsumoto
- Quality & Safety Management Division, Safety and Risk Management Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Atsushi Takita
- R&D Division, Biostatistics & Data Management Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Takao Kurusu
- Rx Group, Data Solution Division, Japan Medical Information Research Institute, Inc ., Tokyo , Japan
| | - Hiroshi Sakoda
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
| | - Kaoru Okuizumi
- Medical Affairs Division, Medical Science Department, Daiichi Sankyo Co., Ltd ., Tokyo , Japan
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Physicians' beliefs and attitudes about Benzodiazepines: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:71. [PMID: 31128589 PMCID: PMC6535184 DOI: 10.1186/s12875-019-0965-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND In 2015, Portugal was the OECD country with the highest reported consumption of BZD. Physician's perceptions and attitudes regarding BZD are main determinants of related prescription habits. This study aimed to characterize beliefs and attitudes of Portuguese physicians regarding the prescription, management challenges, benefits, risks and withdrawal effects of BZD. METHODS A cross-sectional, observational study with online data collection through anonymous self-administered questionnaire. Physicians registered with the Portuguese Medical Association were invited to participate through direct e-mail message. Physicians were asked to give their opinion (using a 5-points Likert scale) regarding the prescription of BZD, their benefits and risks in the management of insomnia and anxiety, the possible adverse effects of chronic use and alternative non-pharmacologic approaches. Descriptive statistics were used and groups were compared through logistic regression. RESULTS A total of 329 physicians participated in the study (56% family physicians). Mean age was 44.10 ± 15.2 years, with 19.03 ± 14.9 years of clinical experience. Fifty eight percent of participants were female. Physicians reported BZD's negative impact on cognitive function (89%), association with road traffic accidents (88%) and falls (79%). Also, 58% shared the belief that chronic use is justified if the patient feels better and without adverse events. Although 68% reported to feel capable of helping patients to reduce or stop BZD, 55% recognized difficulties in motivating them. Compared to other medical specialists (altogether), family physicians were significantly more aware about the adverse effects of BZD and considered that chronic use may not be justified. Conversely, more family physicians expressed concerns about their skills to motivate patients engaging in withdrawal programs and to support them during the process. CONCLUSION Our results show that physicians' awareness about risks of BZD chronic use is adequate though their attitudes and self-perceived skills towards promoting BZD withdrawal can be improved. Interventions in primary care are needed to capacitate physicians to better motivate patients for BZD withdrawal.
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Kostev K, Bohlken J, Jacob L. Analysis of the Effects of Selective Serotonin (and Noradrenaline) Reuptake Inhibitors on the Risk of Dementia in Patients with Depression. J Alzheimers Dis 2019; 69:577-583. [DOI: 10.3233/jad-190239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin, Germany
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
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Chen ST, Volle D, Jalil J, Wu P, Small GW. Health-Promoting Strategies for the Aging Brain. Am J Geriatr Psychiatry 2019; 27:213-236. [PMID: 30686664 DOI: 10.1016/j.jagp.2018.12.016] [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: 10/09/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/31/2022]
Abstract
As the world's population ages and people live longer, the changes in the aging brain present substantial challenges to our health and society. With greater longevity come age-related diseases, many of which have direct and indirect influences on the health of the brain. Although there is some degree of predictable decline in brain functioning with aging, meaningful cognitive decline is not inevitable and is perhaps preventable. In this review, we present the case that the course of aging-related brain disease and dysfunction can be modified. We present the evidence for conditions and risk factors that may contribute to cognitive decline and dementia and for interventions that may mitigate their impact on cognitive functioning later in life, or even prevent them and their cognitive sequelae from developing. Although much work remains to be done to meet the challenges of the aging brain, strategies to promote its health have been demonstrated and offer much promise, which can only be realized if we mount a vigorous public health effort to implement these strategies.
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Affiliation(s)
- Stephen T Chen
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
| | - Dax Volle
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Jason Jalil
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Pauline Wu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Gary W Small
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles; the University of California, Los Angeles, Longevity Center, Los Angeles; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
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Affiliation(s)
- Debra A Scrandis
- Debra A. Scrandis is an associate professor at the University of Maryland School of Nursing, Baltimore, Md. Ana C. Duarte is an assistant professor at the University of Maryland School of Nursing, Baltimore, Md
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Park KR, Kim KB, Baek YH, Sung HG, Park JT, Lee EK, Shin JY. Signal detection of benzodiazepine use and risk of dementia: sequence symmetry analysis using South Korean national healthcare database. Int J Clin Pharm 2018; 40:1568-1576. [DOI: 10.1007/s11096-018-0739-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
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Hosomi K, Fujimoto M, Ushio K, Mao L, Kato J, Takada M. An integrative approach using real-world data to identify alternative therapeutic uses of existing drugs. PLoS One 2018; 13:e0204648. [PMID: 30300381 PMCID: PMC6177143 DOI: 10.1371/journal.pone.0204648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 09/12/2018] [Indexed: 12/14/2022] Open
Abstract
Different computational approaches are employed to efficiently identify novel repositioning possibilities utilizing different sources of information and algorithms. It is critical to propose high-valued candidate-repositioning possibilities before conducting lengthy in vivo validation studies that consume significant resources. Here we report a novel multi-methodological approach to identify opportunities for drug repositioning. We performed analyses of real-world data (RWD) acquired from the United States Food and Drug Administration’s Adverse Event Reporting System (FAERS) and the claims database maintained by the Japan Medical Data Center (JMDC). These analyses were followed by cross-validation through bioinformatics analyses of gene expression data. Inverse associations revealed using disproportionality analysis (DPA) and sequence symmetry analysis (SSA) were used to detect potential drug-repositioning signals. To evaluate the validity of the approach, we conducted a feasibility study to identify marketed drugs with the potential for treating inflammatory bowel disease (IBD). Primary analyses of the FAERS and JMDC claims databases identified psycholeptics such as haloperidol, diazepam, and hydroxyzine as candidates that may improve the treatment of IBD. To further investigate the mechanistic relevance between hit compounds and disease pathology, we conducted bioinformatics analyses of the associations of the gene expression profiles of these compounds with disease. We identified common biological features among genes differentially expressed with or without compound treatment as well as disease-perturbation data available from open sources, which strengthened the mechanistic rationale of our initial findings. We further identified pathways such as cytokine signaling that are influenced by these drugs. These pathways are relevant to pathologies and can serve as alternative targets of therapy. Integrative analysis of RWD such as those available from adverse-event databases, claims databases, and transcriptome analyses represent an effective approach that adds value to efficiently identifying potential novel therapeutic opportunities.
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Affiliation(s)
- Kouichi Hosomi
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Kowakae, Higashi-osaka, Osaka, Japan
| | - Mai Fujimoto
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Kowakae, Higashi-osaka, Osaka, Japan
| | - Kazutaka Ushio
- Innovation and Entrepreneurship, Research, Takeda Pharmaceutical Company Limited, Muraoka-Higashi, 2- Chome, Fujisawa, Kanagawa, Japan
| | - Lili Mao
- Innovation and Entrepreneurship, Research, Takeda Pharmaceutical Company Limited, Muraoka-Higashi, 2- Chome, Fujisawa, Kanagawa, Japan
| | - Juran Kato
- Innovation and Entrepreneurship, Research, Takeda Pharmaceutical Company Limited, Muraoka-Higashi, 2- Chome, Fujisawa, Kanagawa, Japan
| | - Mitsutaka Takada
- Division of Clinical Drug Informatics, School of Pharmacy, Kindai University, Kowakae, Higashi-osaka, Osaka, Japan
- * E-mail:
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview of the published studies that have been used to generate evidence on the safety of medicine use when only medication dispensing data are available. RECENT FINDINGS Medication dispensing databases are increasingly available for research on large populations, particularly in countries that provide universal coverage for medicines. These data are often used for drug utilisation studies to identify inappropriate medicine use at the population level that may be associated with known safety issues. Lack of coded diagnoses, to identify outcomes, and lack of data on confounders can limit use of these data in practice for medication safety assessment. To overcome these issues, studies have exploited the fact that symptoms of adverse effects of medications can be treated with other medications, for example antidepressants to treat depression or oxybutynin to treat urinary incontinence. The challenge of unmeasured confounding has been addressed by implementing self-controlled study designs that use within-person comparisons and provide inherent control for confounding. Prescription sequence symmetry analysis (SSA) is a within-person study design that has been demonstrated as a useful tool for safety signal generation in dispensing data. SUMMARY Using medicine initiation as a proxy for the development of adverse events can help to generate evidence of the safety of medicines when only medication dispensing data are available. Careful consideration, however, should be given to the sensitivity and specificity of the proxy medicine for the adverse event and potential for time-varying confounding due to trends in medicine utilisation. Data-mining approaches using dispensing data have the potential to improve safety assessments; however, the challenge of unmeasured confounding with these methods remains to be investigated.
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Affiliation(s)
- Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Science, University of South Australia, Adelaide, Australia
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Lucchetta RC, da Mata BPM, Mastroianni PDC. Association between Development of Dementia and Use of Benzodiazepines: A Systematic Review and Meta-Analysis. Pharmacotherapy 2018; 38:1010-1020. [DOI: 10.1002/phar.2170] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rosa Camila Lucchetta
- Pharmacy, Federal University of Paraná; 632, Av. Prefeito Lothário Meissner Curitiba Paraná Brazil
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Lee L, Patel T, Molnar F, Seitz D. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e366-e372. [PMID: 30209109 PMCID: PMC6135142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objectif Fournir aux médecins de première ligne une approche relative à l’optimisation de la pharmacothérapie chez les personnes âgées présentant un déficit cognitif. Sources d’information L’approche est fondée sur un programme agréé de formation clinique sur la mémoire, élaboré par le Centre for Family Medicine Primary Care Collaborative Memory Clinic. Message principal La démence augmente le risque d’événements indésirables d’origine médicamenteuse, et s’ajoute à la complexité et aux difficultés déjà présentes dans la prestation de soins optimaux chez les personnes âgées atteintes de démence. Les facteurs dont il faut tenir compte sont l’observance de la pharmacothérapie, les cibles thérapeutiques appropriées pour les comorbidités, la dose minimale de médicaments dotés d’effets indésirables cognitifs potentiels, et l’usage rationnel et la surveillance des médicaments qui améliorent la cognition. Les plans de pharmacothérapie doivent être individualisés et s’appuyer sur les objectifs de soins. Conclusion Les médecins de première ligne doivent tenir compte de nombreux facteurs pour optimiser la pharmacothérapie chez les personnes aux prises avec un déficit cognitif.
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Affiliation(s)
- Linda Lee
- Médecin de famille au Center for Family Medicine à Kitchener (Ontario), titulaire de la chaire de recherche Schlegel en soins primaires chez les aînés au Schlegel-UW Research Institute for Aging et professeure clinique agrégée au Département de médecine familiale de l'Université McMaster.
| | - Tejal Patel
- Pharmacienne de l'équipe de santé familiale au Centre for Family Medicine et professeure clinique adjointe à l'École de pharmacie de l'Université de Waterloo (Ontario)
| | - Frank Molnar
- Gériatre à Ottawa, (Ontario), directeur médical du Programme gériatrique régional de l'Est de l'Ontario et professeur agrégé à la Faculté de médecine de l'Université d'Ottawa
| | - Dallas Seitz
- Psychiatre en gériatrie à Kingston, et professeur agrégé, scientifique clinique et directeur de la Division de psychiatrie gériatrique à l'Université Queen's
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Lee L, Patel T, Molnar F, Seitz D. Optimizing medications in older adults with cognitive impairment: Considerations for primary care clinicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:646-652. [PMID: 30209094 PMCID: PMC6135130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To provide primary care physicians with an approach to medication optimization in older adults with cognitive impairment. SOURCES OF INFORMATION The approach is based on an accredited memory clinic training program developed by the Centre for Family Medicine Primary Care Collaborative Memory Clinic. MAIN MESSAGE Dementia increases the risk of medication-related adverse events and adds to the complexity and challenge of providing optimal care for these older adults. Considerations include medication adherence, appropriate therapeutic targets for comorbid conditions, minimized use of medications with potentially adverse cognitive effects, and rational use and monitoring of cognition-enhancing drugs. Medication management plans must be individualized and based on goals of care. CONCLUSION Primary care physicians must consider many factors in optimizing medications for those with cognitive impairment.
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Affiliation(s)
- Linda Lee
- Family physician at the Centre for Family Medicine Family Health Team in Kitchener, Ont, Schlegel Research Chair in Primary Care for Elders at the Schlegel-UW Research Institute for Aging, and Associate Clinical Professor in the Department of Family Medicine at McMaster University.
| | - Tejal Patel
- Pharmacist at the Centre for Family Medicine Family Health Team and Assistant Clinical Professor in the School of Pharmacy at the University of Waterloo in Ontario
| | - Frank Molnar
- Geriatrician in Ottawa, Ont, Medical Director of the Regional Geriatric Program of Eastern Ontario, and Associate Professor in the Department of Medicine at the University of Ottawa
| | - Dallas Seitz
- Geriatric psychiatrist in Kingston and Associate Professor, Clinician Scientist, and Chair of the Division of Geriatric Psychiatry at Queen's University
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Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research. Drugs R D 2018; 17:493-507. [PMID: 28865038 PMCID: PMC5694420 DOI: 10.1007/s40268-017-0207-7] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.
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Ohyama K, Sugiura M. [Evaluation of the Association between Topical Prostaglandin F2α Analogs and Asthma Using the JADER Database: Comparison with β-Blockers]. YAKUGAKU ZASSHI 2018; 138:559-564. [PMID: 29608006 DOI: 10.1248/yakushi.17-00162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prostaglandin F2α (PGF2α) analog formulations are the most commonly used drugs for glaucoma treatment. They are known to be superior to β-blockers for reducing intraocular pressure and can be effective all through the day. Because of the action, topical β-blockers are contraindicated for patients with bronchial asthma. PGF2α is also known to act as a constrictor of the respiratory tract. The present study aims to analyze the relationship between PGF2α analogs and asthma. In addition, we utilized β-blockers and combined formulations of both contents to evaluate for comparison with PGF2α analogs. Data from Japanese adverse drug event reports (JADERs) from April 2004 to January 2016 were used for analysis. The drugs of interest were 4 PGF2α analogs, 4 β-blockers, and 2 combined formulations of both. For quantitative signal detection, the reporting odds ratios (RORs) with Haldane-Anscombe 1/2 correction were calculated. The corrected RORs (95%CI) were detected to be 4.73 (2.30-9.75) for PGF2α analogs, 4.61 (1.82-11.7) for β-blockers, and 28.7 (12.1-68.1) for combined formulations. Our results suggest that not only topical β-blockers but also PGF2α analogs are associated with asthma, and the combined formulations have stronger associations with asthma than when administered alone. Therefore, further clinical research will be necessary, and careful attention should be paid to any glaucoma patient using PGF2α analogs for asthma symptoms.
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Affiliation(s)
- Katsuhiro Ohyama
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Science
| | - Munetoshi Sugiura
- Center for Experiential Pharmacy Practice, School of Pharmacy, Tokyo University of Pharmacy and Life Science.,Department of Drug Safety and Risk Management, School of Pharmacy, Tokyo University of Pharmacy and Life Science
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Penninkilampi R, Eslick GD. A Systematic Review and Meta-Analysis of the Risk of Dementia Associated with Benzodiazepine Use, After Controlling for Protopathic Bias. CNS Drugs 2018; 32:485-497. [PMID: 29926372 DOI: 10.1007/s40263-018-0535-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Benzodiazepine use is highly prevalent in elderly and late middle-aged populations and may be associated with an increased risk of dementia. Observational studies have suggested that benzodiazepine use may increase the risk of dementia, however there have been significant concerns regarding protopathic bias in these studies, precluding conclusive findings. OBJECTIVE The aim of our study was to investigate the risk of dementia associated with the use of benzodiazepines in elderly patients, after controlling for protopathic bias. METHODS We identified observational studies with more than 50 cases, adequate assessment of benzodiazepine exposure, and reliable dementia diagnosis ascertainment, from the MEDLINE, PubMed, EMBASE, CINAHL, LILACS and CENTRAL electronic databases through to 5 June 2018, with no language limits. The association of any current or former use of short- or long-acting benzodiazepines with incident dementia was analysed. A subgroup analysis was performed by the introduction of lag time to assess the effect of protopathic bias. We also performed analyses considering the effect of higher benzodiazepine cumulative doses and adjustment for psychiatric covariates. Study quality was investigated using the Newcastle-Ottawa Scale. RESULTS We identified 15 studies reported in 14 articles, involving 159,090 cases. Ever use of benzodiazepines was associated with a significantly increased risk of dementia [odds ratio (OR) 1.39, 95% confidence interval (CI) 1.21-1.59]. Those studies that implemented the longest lag times of ≥ 5 years, and hence most likely to overcome protopathic bias, found a risk estimate that was marginally attenuated, but still significant (OR 1.30, 95% CI 1.14-1.48). Long-acting benzodiazepines were associated with a marginally higher magnitude risk (OR 1.21, 95% CI 0.99-1.49) than short-acting benzodiazepines (OR 1.13, 95% CI 1.02-1.26), although the former failed to reach statistical significance (p = 0.059). CONCLUSIONS Our findings indicate that the association between benzodiazepine use and dementia incidence is not purely an artefact due to protopathic bias. Reduction of inappropriate benzodiazepine prescription is likely to attenuate dementia risk.
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Affiliation(s)
- Ross Penninkilampi
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 3, Clinical Building, PO Box 63, Penrith, NSW, 2751, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, Nepean Hospital, The University of Sydney, Level 3, Clinical Building, PO Box 63, Penrith, NSW, 2751, Australia.
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Poulin SP, Bergeron D, Dickerson BC. Risk Factors, Neuroanatomical Correlates, and Outcome of Neuropsychiatric Symptoms in Alzheimer's Disease. J Alzheimers Dis 2017; 60:483-493. [PMID: 28869463 PMCID: PMC5963953 DOI: 10.3233/jad-160767] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND An integrative model of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) is lacking. OBJECTIVE In this study, we investigated the risk factors, anatomy, biology, and outcomes of NPS in AD. METHODS 181 subjects were included from the Alzheimer's Disease Neuroimaging Study (ADNI). NPS were assessed with the Neuropsychiatric Inventory Questionnaire at baseline and 6 months. NPI >3 was used as a threshold for NPS positivity. Three NPS courses were characterized: 1) minimal/absent (negative at 0 and 6 months, n = 77); 2) fluctuating (positive only at one time point, n = 53); 3) persistent (positive at both time points, n = 51). We examined the association between NPS course and family history of dementia, personal history of psychiatric disorders, cerebrospinal fluid biomarkers, atrophy patterns, as well as longitudinal cognitive and functional measures at 12 and 24 months (MMSE, CDR-SOB, FAQ). RESULTS AD subjects with absent, fluctuating, or persistent NPS had similar CSF amyloid-β and tau levels. AD subjects with minimal/absent NPS had less personal history of psychiatric disorders (35%) than those with fluctuating (57%; p = 0.015) or persistent NPS (47%, not significant). At 24 months, AD subjects with persistent NPS had worse cognitive (MMSE; p = 0.05) and functional (CDR-SOB; p = 0.016) outcomes. Dorsolateral prefrontal atrophy was seen in persistent NPS, but not in fluctuating NPS. CONCLUSIONS Our results suggest that individuals with personal history of psychiatric disorders might be more vulnerable to develop NPS throughout the course of AD. The worst cognitive and functional outcomes associated with NPS in AD underscores the importance of monitoring NPS early in the disease course.
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Affiliation(s)
- Stéphane P. Poulin
- Clinique Interdisciplinaire de la Mémoire, Centre Hositalier Universitaire de Québec, Quebec City, QC, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec (CRISUMQ), QC, Canada
| | - David Bergeron
- Clinique Interdisciplinaire de la Mémoire, Centre Hositalier Universitaire de Québec, Quebec City, QC, Canada
| | - Bradford C. Dickerson
- Department of Neurology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Frontotemporal Dementia Unit, Massachusetts General Hospital, Charlestown, MA, USA
- Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital, Charlestown, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
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