Klamer Therese T, Wauters Maarten, Azermai Majda, Durán Carlos, Christiaens Thierry, Elseviers Monique, Vander Stichele Robert
Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.
Basic Clin Pharmacol Toxicol. 2017 Jun;120(6):582-590. doi: 10.1111/bcpt.12699. Epub 2017 Jan 16.
Quantification of the anticholinergic exposure insufficiently or imprecisely incorporates dosage information, leading to inaccurate estimations. The aim was to construct a novel scale, including potency and dosage for the quantification of the anticholinergic exposure in older adults. Potency information was retrieved from a previous systematic review. The dosage range for each drug was delineated in minimal, maintenance and maximal dosage for adults and older adults. Dosage information was collected from authoritative sources and reviewed in an expert panel. The Muscarinic Acetylcholinergic Receptor ANTagonist Exposure (MARANTE) scale was tested for clinimetric properties using cohorts of community-dwelling older adults and nursing home residents. After three data collection rounds, data for the dosage ranges remained incomplete for 32 active substances. Remaining gaps were filled in, and 11 dosage adjustments were proposed during the expert panel meeting. We chose the values {0; 1; 2) for the categories of potency and {0; 0.5; 1; 1.5; 2) for the levels of dosage ranges, showing good clinimetric properties. Forty-one anticholinergic drugs were prescribed in the two cohorts. Most (61%) were low potency anticholinergics and used for depression (19%, e.g. citalopram). There were 31.8% (median MARANTE 1.5, IQR 1.5-2.5) and 37.6% (median 2, IQR 1.5-2.5) anticholinergic users in the community-dwelling cohort and nursing home cohort, respectively. The MARANTE scale combines potency with the dosage spectrum, to quantify the anticholinergic exposure in older adults. An open feedback system on the list of anticholinergic and proposed anticholinergic potency and dosage values is advised.
对抗胆碱能药物暴露的量化未充分或不准确地纳入剂量信息，导致估计不准确。目的是构建一种新的量表，包括效力和剂量，用于量化老年人的抗胆碱能药物暴露。效力信息来自先前的系统评价。每种药物的剂量范围根据成人和老年人的最小、维持和最大剂量进行划分。剂量信息从权威来源收集并由专家小组进行审查。使用社区居住的老年人和养老院居民队列对毒蕈碱乙酰胆碱能受体拮抗剂暴露（MARANTE）量表的临床测量特性进行了测试。经过三轮数据收集，32种活性物质的剂量范围数据仍不完整。填补了剩余的空白，并在专家小组会议上提出了11项剂量调整建议。我们为效力类别选择了{0；1；2}的值，为剂量范围水平选择了{0；0.5；1；1.5；2}的值，显示出良好的临床测量特性。两个队列中共开具了41种抗胆碱能药物。大多数（61%）是低效抗胆碱能药物，用于治疗抑郁症（19%，如西酞普兰）。社区居住队列和养老院队列中抗胆碱能药物使用者分别占31.8%（MARANTE中位数1.5，四分位距1.5 - 2.5）和37.6%（中位数2，四分位距1.5 - 2.5）。MARANTE量表将效力与剂量谱相结合，以量化老年人的抗胆碱能药物暴露。建议对抗胆碱能药物清单以及提议的抗胆碱能药物效力和剂量值建立开放的反馈系统。
