Which older adults are at highest risk of prescribing cascades? A national study of the gabapentinoid-loop diuretic cascade.

Autor: Growdon ME; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA., Jing B; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA., Morris EJ; Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.; Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA., Deardorff WJ; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA., Boscardin WJ; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA., Byers AL; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA., Boockvar KS; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA., Steinman MA; Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.; San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2024 Jun; Vol. 72 (6), pp. 1728-1740. Date of Electronic Publication: 2024 Mar 28.
DOI: 10.1111/jgs.18892
Abstrakt: Background: Prescribing cascades are important contributors to polypharmacy. Little is known about which older adults are at highest risk of experiencing prescribing cascades. We explored which older veterans are at highest risk of the gabapentinoid (including gabapentin and pregabalin)-loop diuretic (LD) cascade, given the dramatic increase in gabapentinoid prescribing in recent years.
Methods: Using Veterans Affairs and Medicare claims data (2010-2019), we performed a prescription sequence symmetry analysis (PSSA) to assess loop diuretic initiation before and after gabapentinoid initiation among older veterans (≥66 years). To identify the cascade, we calculated the adjusted sequence ratio (aSR), which assesses the temporality of LD relative to gabapentinoid initiation. To explore high-risk groups, we used multivariable logistic regression with prescribing order modeled as a binary dependent variable. We calculated adjusted odds ratios (aORs), measuring the extent to which factors are associated with one prescribing order versus another.
Results: Of 151,442 veterans who initiated a gabapentinoid, there were 1,981 patients who initiated a LD within 6 months after initiating a gabapentinoid compared to 1,599 patients who initiated a LD within 6 months before initiating a gabapentinoid. In the gabapentinoid-LD group, the mean age was 73 years, 98% were male, 13% were Black, 5% were Hispanic, and 80% were White. Patients in each group were similar across patient and health utilization factors (standardized mean difference <0.10 for all comparisons). The aSR was 1.23 (95% CI: 1.13, 1.34), strongly suggesting the cascade's presence. People age ≥85 years were less likely to have the cascade (compared to 66-74 years; aOR 0.74, 95% CI: 0.56-0.96), and people taking ≥10 medications were more likely to have the cascade (compared to 0-4 drugs; aOR 1.39, 95% CI: 1.07-1.82).
Conclusions: Among older adults, those who are younger and taking many medications may be at higher risk of the gabapentinoid-LD cascade, contributing to worsening polypharmacy and potential drug-related harms. We did not identify strong predictors of this cascade, suggesting that prescribing cascade prevention efforts should be widespread rather than focused on specific subgroups.
(© 2024 The American Geriatrics Society.)
Databáze: MEDLINE
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