目的:药物-药物相互作用(DDI)在多类药物和多类药物的老年人中普遍存在,并且会增加药物不良反应(ADR)的风险,入院,和死亡率。这项研究描述了66例临床相关DDI的发生率和患病率,并分析了参加SENATOR试验的老年住院患者中12例相应的预定义ADR的发生率。
方法:SENATOR试验的子研究涉及1537名老年患者,2016年至2018年在比利时六家学术教学医院招募,冰岛,爱尔兰,意大利,苏格兰,分别是西班牙,并分析了66种具有潜在临床意义的DDI。描述性分析确定DDI和相应的ADR患病率/发生率。
结果:基线时(中位年龄:78[72,84],52.8%男性),DDI患者的患病率很高(50.9%),住院期间增加(55.2%),12周后减少至49.7%.最常见的DDI是:≥2种降钾药物(17.1%),≥3种中枢作用药物(9.0%),和SSRI+环/噻嗪类利尿剂(7.2%)。在所有参与者中,三分之一的人经历了普遍(36.6%)/事件(35.8%)的ADR。主要血清电解质紊乱发生率最高(10.7%)/患病率最高(11.5%)。ADR在DDI患者中更为常见(p=0.013)。新发跌倒的患病率较高(p=0.013),主要便秘(p=0.004),和主要的血清电解质紊乱(p=0.006)观察到相关的,因此潜在的因果关系DDI的患者。
结论:临床医生应该,注意DDI和涉及的药物类别,可导致老年多患住院患者的ADR发生率增加。建议定期重新评估经常开处方的药物类别的适当性,并建议明智地开处方。
OBJECTIVE: Drug-drug interactions (DDIs) are prevalent among multimorbid and polymedicated older adults and can increase the risk of adverse drug reactions (ADRs), hospital admissions, and mortality. This study describes the incidence and prevalence of 66 clinically relevant DDIs and analyses the occurrence of 12 corresponding predefined ADRs in older inpatients enrolled in the SENATOR trial.
METHODS: The sub-study of the SENATOR trial that involved 1537 multimorbid older inpatients, recruited from 2016 to 2018 in six academic teaching hospitals in Belgium, Iceland, Ireland, Italy, Scotland, and Spain respectively, and analysed 66 potentially clinically significant DDIs. Descriptive analysis determined DDI and corresponding ADR prevalence/incidence.
RESULTS: At baseline (median age: 78 [72, 84], 52.8% male), the prevalence of patients with DDIs was high (50.9%), increased during hospitalisation (55.2%) and reduced to 49.7% after 12 weeks. The most common DDIs were: ≥ 2 potassium reducing drugs (17.1%), ≥ 3 centrally acting drugs (9.0%), and SSRI + loop/thiazide diuretic (7.2%). Of all participants, one-third experienced a prevalent (36.6%)/incident (35.8%) ADR. Major serum electrolyte disturbance had the highest incidence (10.7%)/prevalence (11.5%). Incident ADRs were more common in patients with DDIs (p = 0.013). A higher prevalence of new onset falls (p = 0.013), major constipation (p = 0.004), and major serum electrolyte disturbances (p = 0.006) was observed in patients with related and thus potentially causal DDIs.
CONCLUSIONS: Clinicians should, be aware of DDIs and the involved drug classes that can lead to an increased rate of ADRs in older multimorbid inpatients. Regularly reevaluating the appropriateness of the frequently prescribed drug classes and initiating judicious deprescribing is recommended.