Key result
Nonstandard dofetilide or sotalol dosing in patients ≥80 linked to ~370% higher odds of safety-driven discontinuation.
Why the study?
Elderly patients face an increased risk of fatal arrhythmias during dofetilide or sotalol initiation, but data describing tolerability and associated risk factors in patients ≥80 years of age are needed.
Does nonstandard initial dosing of dofetilide or sotalol increase the risk of dose reductions or discontinuations due to safety-related events in patients ≥80 years of age?
Observational (n=104)
Yes
Does nonstandard initial dosing of dofetilide or sotalol increase the risk of dose reductions or discontinuations due to safety-related events in patients ≥80 years of age?
Effect estimate: OR 4.7
In patients ≥80 years old, using nonstandard initial doses of dofetilide or sotalol significantly increases the odds of safety-related events requiring dose reduction or discontinuation compared to package insert dosing.
Supports caution with nonstandard dosing in octogenarians; leaves open need for randomized confirmation of guidelines.
Background: Dofetilide and sotalol are potassium channel antagonists that require inpatient QTc monitoring during initiation, due to increased risk of fatal arrhythmias. Elderly patients are especially subject to an increased risk of fatal arrhythmias due to polypharmacy, comorbidities, and physiologic cardiac changes with aging. This study will describe the tolerability and risk factors associated with the initiation of sotalol or dofetilide in patients ≥80 years of age. Methodology: This is a multicenter, retrospective, descriptive study of patients ≥80 years old who were initiated on either dofetilide or sotalol between May 8, 2018 and July 31, 2021 at institutions within the Mayo Clinic Health System. The percentage of patients who received nonpackage insert recommended doses was identified. Incidence of and reasons for dose reductions or discontinuations due to safety-related events or clinical concerns during the initial loading period were collected. Results: The final analysis included 104 patients. The majority of patients (75%) received nonstandard initial doses of dofetilide or sotalol based on baseline estimated creatinine clearance or QTc. Overall, 39% ( N = 41) of patients experienced a dose reduction or discontinuation due to a safety-related event or concern. Patients who received nonstandard initial doses of dofetilide or sotalol had 4.7 times greater odds of experiencing a safety-related event requiring dose reduction or discontinuation. Conclusion: Following package insert dosing in elderly patients increases safety and tolerability relative to more aggressive dosing of dofetilide or sotalol.
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Yagnala et al. (2024) conducted an observational in Arrhythmia (n=104). Nonstandard initial doses of dofetilide or sotalol vs. Package insert recommended doses was evaluated on Dose reduction or discontinuation due to a safety-related event or concern (OR 4.7). Nonstandard initial dosing of dofetilide or sotalol in patients ≥80 years old was associated with 4.7 times greater odds of dose reduction or discontinuation due to safety events.
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