High-throughput screening for prescribing cascades among real world statin initiators.

Autor: Vouri SM; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA., Morris EJ; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA., Walsh M; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA., Agalliu J; College of Pharmacy, University of Florida, Gainesville, Florida, USA., Dempsey A; College of Pharmacy, University of Florida, Gainesville, Florida, USA., Hochleitner L; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA., Muschett MR; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA., Schmidt S; Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, Florida, USA., Pepine CJ; Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.; Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA., Smith SM; Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.; Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.; Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA.
Jazyk: angličtina
Zdroj: Pharmacoepidemiology and drug safety [Pharmacoepidemiol Drug Saf] 2023 Jul; Vol. 32 (7), pp. 773-782. Date of Electronic Publication: 2023 Mar 15.
DOI: 10.1002/pds.5607
Abstrakt: Purpose: Statins are among the most prevalent medications prescribed and associated with adverse events that may prompt additional treatment (i.e., a prescribing cascade). No comprehensive assessment of statin-related prescribing cascades has been performed to our knowledge.
Methods: We utilized sequence symmetry analysis to iteratively screen prescribing sequences of all therapeutic classes ("marker" classes) based on Level 4 Anatomical Therapeutic Chemical codes among adult statin initiators, using IBM Marketscan commercial and Medicare supplemental claims databases (2005-2019). Order of initiation and secular trend-adjusted sequence ratios were calculated for each statin-marker class dyad, among marker class initiators ±90 days of statin initiation. Among signals classified as prescribing cascades, we calculated naturalistic number needed to harm (NNTH) within 1 year as the inverse of the excess risk among exposed.
Results: We identified 2 265 519 statin initiators (mean ± SD age, 56.4 ± 12.0 years; 48.7% women; 7.5% with cardiovascular disease). Simvastatin (34.4% of statin initiators) and atorvastatin (33.9%) were the most commonly initiated statins. We identified 160 significant statin-marker class dyad signals, of which 35.6% (n = 57) were classified as potential prescribing cascades. Of the top 25 strongest signals (lowest NNTH), 12 were classified as potential prescribing cascades, including osmotically acting laxatives (NNTH, 44, 95% CI 43-46), opioids + non-opioid combination analgesics (81, 95% CI 74-91), and first-generation cephalosporins (204, 95% CI 175-246).
Conclusions: Using high-throughput sequence symmetry analysis screening, we identified previously known prescribing cascades as well as potentially new prescribing cascades based on known and unknown statin-related adverse events.
(© 2023 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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