October 5, 2020Open Access

Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Drug-drug interactions. Intervention: ACE-inhibitors/diuretics plus glucocorticoids vs. No exposure to DDI. Primary outcome: Hospitalization due to DDI-related conditions (OR 2.36, 95% CI 1.94-2.87, p=<0.001).

Resultado clave

Current concomitant use of ACE-inhibitors or diuretics plus glucocorticoids significantly increased the risk of hospitalization (OR 2.36) in patients aged 65 and older.

Diseño del estudio

Tipo

Case-Control

PICO estructurado

Does concomitant prescription of highly prevalent drug-drug interactions increase the risk of hospitalization in individuals aged ≥65?

Población

Individuals aged ≥65 residing in Bologna's area, Italy. Population sizes ranged from 146,418 for antihypertensives to 7,249 for NOACs. Mean age of cases was 82.2±7.6 years.

Intervención

Concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs), evaluated as current (last month) and past (≥30 days before) exposure.

Comparador

Matched controls without exposure to the specific drug-drug interaction.

Resultado

Risk of hospitalization due to DDI-related conditions.hard clinical

Concomitant use of ACE-inhibitors/diuretics with glucocorticoids, and antidiabetics with fluoroquinolones, significantly increases the risk of hospitalization in older adults.

Resultado numérico

Estimación del efecto: OR 2.36 (95% CI 1.94-2.87)

valor p: p=<0.001

Limitaciones

Data from dispensing databases is subject to measurement error as a dispensed package does not indicate full consumption
Prescribed daily doses could differ from the Defined Daily Doses (DDDs)
Administrative data do not allow differentiating between high- and low-dosage or between long- and short-term medication use
Use of NSAIDs could be underestimated due to over-the-counter (OTC) use
Lack of data on other patient characteristics that could influence the outcome, such as smoking habits, lifestyle, blood pressure, or severity of diseases

Resumen

The aim of this study was to assess the risk of hospitalization associated with the concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs) among all individuals aged ≥65 residing in Bologna's area, Italy. We used incidence density sampling, and the effect of current (last month) and past (≥30 days before) exposure to DDI was investigated through conditional multivariable logistic regression analysis. Two DDIs were associated with increased hospitalization due to DDI related conditions: ACE-inhibitors/ diuretics plus glucocorticoids (current DDI: OR 2.36, 95% CI 1.94-2.87; past DDI: OR 1.36, 95% CI 1.12-1.65) and antidiabetic therapy plus current use of fluoroquinolones (OR 4.43, 95% CI 1.61-11.2). Non-Steroidal Anti-inflammatory Drugs (NSAIDs) increased the risk of re-bleeding in patients taking Selective Serotonin Reuptake Inhibitors (OR 5.56, 95% CI 1.24-24.9), while no significant effect was found in those without a history of bleeding episodes. Concomitant prescription of NSAIDs and ACE-inhibitors/diuretics in patients with a history of high-risk conditions was infrequent. Within the pattern of drug prescriptions in the older population of Bologna's area, we distinguished DDIs with actual clinical consequences from others that might be considered generally safe. Observed prescribing habits of clinicians reflect awareness of potential interactions in patients at risk.

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Cite This Study

Swart et al. (Mon,) conducted a case-control in Drug-drug interactions. ACE-inhibitors/diuretics plus glucocorticoids vs. No exposure to DDI was evaluated on Hospitalization due to DDI-related conditions (OR 2.36, 95% CI 1.94-2.87, p=<0.001). Current concomitant use of ACE-inhibitors or diuretics plus glucocorticoids significantly increased the risk of hospitalization (OR 2.36) in patients aged 65 and older.

synapsesocial.com/papers/6a1c50554ebd09f3dfa9b1f8 https://doi.org/https://doi.org/10.18632/aging.104018

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