Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study
Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study
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DOI：
10.3390/ijerph17113776
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发表时间：
2020-06-01
影响因子：
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通讯作者：
Mestres, Conxita
中科院分区：
文献类型：
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作者：
Amoros-Reboredo, Patricia;Soy, Dolors;Mestres, Conxita
目的：慢性丙型肝炎感染的老年患者开始使用直接作用的抗病毒药物（DAA）经常被处方多种药物，这些药物可能被归类为不适当的。抗胆碱能负荷已被证明是不良健康和功能结果的预测因子。有不同的量表可用于计算抗胆碱能负荷。本研究的目的是使用抗胆碱能认知负担（ACB）量表、抗胆碱能风险量表（ARS）和抗胆碱能药物量表（ADS）确定接受DAA治疗的老年患者中抗胆碱能药物的患病率和相关风险因素，并分析由此产生的安全性后果。方法：对≥ 65岁的连续患者进行观察性、回顾性队列研究，这些患者接受DAA并接受合并用药。本研究是根据流行病学声明中加强观察性研究报告的要求进行的。结果：共纳入236例患者。平均年龄为71.7岁，73.3%的患者患有哮喘，47%的患者服用≥ 5种药物。根据ACB、ARS和ADS量表，35.2%（n = 83）、10.6%（n = 25）和34.3%（n = 81）的患者接受了抗胆碱能药物治疗。206例（86%）患者在治疗期间出现任何不良事件（AE）。ARS量表显示存在抗胆碱能药物与AE之间存在显著相关性。大量患者发生抗胆碱能事件，在服用抗胆碱能药物的患者中，每例患者发生的事件更多。结论：根据ACB、ARS和ADS量表，老年慢性丙型肝炎患者暴露于潜在的不适当的多药治疗和抗胆碱能药物风险。三个量表显示不同的结果。仅ARS量表与AE相关，但无论使用何种量表，抗胆碱能药物治疗患者的抗胆碱能效应发生率均显著较高。当采用多学科方法开始DAA时，考虑药物治疗的质量可以改善健康结果。
Aim: Older patients with chronic hepatitis C infection starting direct-acting antivirals (DAAs) are frequently prescribed multiple medications that may be categorized as inappropriate. Anticholinergic burden has been shown to be a predictor of adverse health and functional outcomes. Different scales are available to calculate anticholinergic burden. The aim of this study was to determine the prevalence of anticholinergic medication among older patients treated with DAAs and the risk factors associated using the Anticholinergic Cognitive Burden (ACB) scale, the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS) and analyze the resulting safety consequences. Methods: Observational, retrospective cohort study of consecutive patients >= 65 years old receiving DAAs and taking concomitant medication. This study was conducted in accordance with the Strengthening the Reporting of observational studies in Epidemiology Statement. Results: 236 patients were included. The average age was 71.7 years, 73.3% cirrhotic, and 47% patients took >= 5 medicines. According to the ACB, ARS and ADS scales, 35.2% (n = 83), 10.6% (n = 25) and 34.3% (n = 81) of the patients were treated with anticholinergic medication. Two hundred-and-six (86%) patients presented any adverse events (AEs) during therapy. ARS scale showed a significant relationship between presence of anticholinergic medication and AEs. A large number of patients suffered anticholinergic events, with more events per patient in patients taking anticholinergic drugs. Conclusions: Older hepatitis C chronic patients are exposed to potentially inappropriate polypharmacy and anticholinergic risk, according to the ACB, ARS and ADS scales. The three scales showed different results. Only the ARS scale was associated with AEs, but the rate of anticholinergic effects per patient was significantly higher in patients with anticholinergic drugs, regardless of the scale used. Consider quality of pharmacotherapy when starting DAA with a multidisciplinary approach could improve health outcomes.