Sydney B Ross MSc Candidate1, Peter E Wu2,3, Anika Atique Md Candidate4, Louise Papillon-Ferland5,6, Robyn Tamblyn4,7, Todd C Lee1,4,7,8, Emily G McDonald1,4,8,9. 1. Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 2. Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada. 3. Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 4. Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. 5. Department of Pharmacy, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada. 6. Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. 7. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. 8. Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada. 9. Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, Quebec, Canada.
Abstract
OBJECTIVES: Polypharmacy is common in older adults and associated with adverse drug events (ADEs). Several methods have been described in studies to help correlate ADE causation. We performed a narrative review to identify methods for ADE adjudication. We compared their strengths and limitations to assess their applicability to deprescribing studies (of which clinical trials are a subset) and to encourage the use of a standardized method in future studies. DESIGN: We performed a review of original articles (1946-2019) using the Medline (Ovid) and Cochrane databases. We also conducted a manual reference search of review articles. Abstracts were screened for relevance. MEASUREMENTS: Adjudication methods were compared for advantages and limitations including validity, ease of use, and applicability to clinical trials with deprescribing as the primary intervention. RESULTS: The search yielded 1881 articles of which 175 articles were included for full-text review. Following in-depth review, 135 were excluded: 79 had no ADE outcome data, 35 were not specific to older adults, 9 were not relevant, 6 were review articles, 5 contained duplicate data, and 1 was not written in French or English. Forty articles remained for analysis, from which we identified 10 unique ADE adjudication methods. No method was developed originally for use in a deprescribing setting. CONCLUSION: A standard method to identify ADEs is important to capture the outcome reliably in deprescribing studies. All methods we identified had limitations in terms of capturing adverse events from the withdrawal of medications. Future work should focus on refining adjudication methods for capturing ADEs related not only to medication continuation and new drug starts but also to deprescribing and drug discontinuation. J Am Geriatr Soc 68:1594-1602, 2020.
OBJECTIVES: Polypharmacy is common in older adults and associated with adverse drug events (ADEs). Several methods have been described in studies to help correlate ADE causation. We performed a narrative review to identify methods for ADE adjudication. We compared their strengths and limitations to assess their applicability to deprescribing studies (of which clinical trials are a subset) and to encourage the use of a standardized method in future studies. DESIGN: We performed a review of original articles (1946-2019) using the Medline (Ovid) and Cochrane databases. We also conducted a manual reference search of review articles. Abstracts were screened for relevance. MEASUREMENTS: Adjudication methods were compared for advantages and limitations including validity, ease of use, and applicability to clinical trials with deprescribing as the primary intervention. RESULTS: The search yielded 1881 articles of which 175 articles were included for full-text review. Following in-depth review, 135 were excluded: 79 had no ADE outcome data, 35 were not specific to older adults, 9 were not relevant, 6 were review articles, 5 contained duplicate data, and 1 was not written in French or English. Forty articles remained for analysis, from which we identified 10 unique ADE adjudication methods. No method was developed originally for use in a deprescribing setting. CONCLUSION: A standard method to identify ADEs is important to capture the outcome reliably in deprescribing studies. All methods we identified had limitations in terms of capturing adverse events from the withdrawal of medications. Future work should focus on refining adjudication methods for capturing ADEs related not only to medication continuation and new drug starts but also to deprescribing and drug discontinuation. J Am Geriatr Soc 68:1594-1602, 2020.
Authors: Ivy O Poon; Felicia Skelton; Lena R Bean; Dominique Guinn; Terica L Jemerson; Ngozi D Mbue; Creaque V Charles; Uche Anadu Ndefo Journal: J Patient Cent Res Rev Date: 2021-04-19
Authors: Jennifer Tjia; Jennifer L Lund; Deborah S Mack; Attah Mbrah; Yiyang Yuan; Qiaoxi Chen; Seun Osundolire; Cara L McDermott Journal: Curr Epidemiol Rep Date: 2021-04-23