Secondary data analysis of Adverse Drug Reactions reported by healthcare professionals and patients: interventions to manage ADRs of ACE inhibitors and ARBs

PURPOSE: Prescribing cascades occur when an adverse drug reaction (ADR) of a first medication is treated with a second medication, potentially leading to polypharmacy and harm. While various interventions are recommended to prevent harm, it is unknown which are implemented in daily practice. This study aims to assess the interventions implemented for ADRs of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB). METHODS: This cross-sectional study analysed secondary data from spontaneous ADR reports submitted to the Netherlands Pharmacovigilance Center Lareb. Reports were included if the ADR was suspected to be caused by an ACE inhibitor or ARB and an intervention was documented. The primary outcome was the proportion of ADRs treated with (1) dose reduction, (2) discontinuation of the suspected medication, (3) discontinuation followed by medication to treat the ADR, (4) switching to alternative medication, or (5) addition of marker medication (prescribing cascade). The secondary outcome was the proportion of ADRs resolved at the time of the ADR report. RESULTS: A total of 902 ADR reports were included. The most frequent intervention was discontinuing the suspected medication, followed by introducing medication to treat the ADR (42.5%), resulting in a large proportion of resolved ADRs (46.5%). However, 11.9% of reports included prescribing cascades, resolving the ADR in only 25.2% of reports. CONCLUSION: Using real-world pharmacovigilance data, this study offers valuable insights into the treatment of ADRs of ACE inhibitors and ARBs in daily practice. Further research is needed to establish the most effective interventions for specific types of ADRs.