Maria Filkova1,2, João Carvalho1,2, Sam Norton1,2, David Scott1,2, Tim Mant1,2, Mariam Molokhia1,2, Andrew Cope1,2, James Galloway3,4. 1. From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal. 2. M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London. 3. From the Academic Department of Rheumatology, and the Department of Psychology, and the Division of Health and Social Care Research, King's College London; Quintiles Drug Research Unit at Guy's Hospital, London, UK; Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic; Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo, Setúbal, Portugal. james.galloway@kcl.ac.uk. 4. M. Filkova, MD, PhD, Academic Department of Rheumatology, King's College London, and the Institute of Rheumatology and Department of Rheumatology, First Faculty of Medicine, Charles University; J. Carvalho, MD, Academic Department of Rheumatology, King's College London, and the Centro Hospitalar de Setúbal E.P.E., Hospital de São Bernardo; S. Norton, BSc, MSc, PhD, Department of Psychology, King's College London; D. Scott, Professor, MD, FRCP, Academic Department of Rheumatology, King's College London; T. Mant, Professor, MD, MBBS, FRCP, FFPM, Quintiles Drug Research Unit at Guy's Hospital; M. Molokhia, BSc, MBChB, MRCGP, PhD, Division of Health and Social Care Research, King's College London; A. Cope, Professor, BSc, PhD, FRCP, FHEA, Academic Department of Rheumatology, King's College London; J. Galloway, MBChB, MRCP, MSc, PhD, Academic Department of Rheumatology, King's College London. james.galloway@kcl.ac.uk.
Abstract
OBJECTIVE: Polypharmacy (PP), the prescribing of multiple drugs for an individual, is rising in prevalence. PP associates with an increased risk of adverse drug reactions (ADR) and hospital admissions. We investigated the relationship between PP, characteristics of rheumatoid arthritis (RA), and the risk of unplanned hospital admissions. METHODS: Patients from a hospital RA cohort were retrospectively analyzed. Information was collected from electronic medical records. Cox proportional hazards were used to compare hospitalization risk according to levels of PP. Admissions were adjudicated to determine whether an ADR was implicated. RESULTS: The study included 1101 patients; the mean number of all medications was 5. PP correlated with increasing age, disease duration, disease activity, and disability. At least 1 unplanned admission occurred for 16% of patients. Patients taking ≥ 10 medications had an adjusted HR for hospitalization of 3.1 (95% CI 2.1-4.5), compared to those taking 0-5 medications. Corticosteroid use associated with a doubling in adjusted risk of admission of 1.7 (95% CI 1.2-2.4). The most common reason for hospitalization was infection (28%). While in half of all admissions an ADR was a possible contributing factor, only 2% of admissions were found to directly result from an ADR. CONCLUSION: PP is common in RA and is a prognostic marker associated with increased risk of acute hospitalizations. Our data suggest that PP may be an indicator of comorbidity burden rather than a contributing cause of a drug-related toxicity. PP should be monitored to minimize inappropriate combination of prescribed medications. PP may be a useful predictor of clinical outcomes in epidemiologic studies.
OBJECTIVE: Polypharmacy (PP), the prescribing of multiple drugs for an individual, is rising in prevalence. PP associates with an increased risk of adverse drug reactions (ADR) and hospital admissions. We investigated the relationship between PP, characteristics of rheumatoid arthritis (RA), and the risk of unplanned hospital admissions. METHODS:Patients from a hospital RA cohort were retrospectively analyzed. Information was collected from electronic medical records. Cox proportional hazards were used to compare hospitalization risk according to levels of PP. Admissions were adjudicated to determine whether an ADR was implicated. RESULTS: The study included 1101 patients; the mean number of all medications was 5. PP correlated with increasing age, disease duration, disease activity, and disability. At least 1 unplanned admission occurred for 16% of patients. Patients taking ≥ 10 medications had an adjusted HR for hospitalization of 3.1 (95% CI 2.1-4.5), compared to those taking 0-5 medications. Corticosteroid use associated with a doubling in adjusted risk of admission of 1.7 (95% CI 1.2-2.4). The most common reason for hospitalization was infection (28%). While in half of all admissions an ADR was a possible contributing factor, only 2% of admissions were found to directly result from an ADR. CONCLUSION: PP is common in RA and is a prognostic marker associated with increased risk of acute hospitalizations. Our data suggest that PP may be an indicator of comorbidity burden rather than a contributing cause of a drug-related toxicity. PP should be monitored to minimize inappropriate combination of prescribed medications. PP may be a useful predictor of clinical outcomes in epidemiologic studies.
Authors: Odilia I Woudstra; Joey M Kuijpers; Folkert J Meijboom; Marco C Post; Monique R M Jongbloed; Anthonie L Duijnhouwer; Arie P J van Dijk; Joost P van Melle; Thelma C Konings; Aeilko H Zwinderman; Barbara J M Mulder; Berto J Bouma Journal: Eur Heart J Cardiovasc Pharmacother Date: 2019-10-01