肌萎缩侧索硬化症老年临终患者的药物使用情况
Drug Use in Older Adults with Amyotrophic Lateral Sclerosis Near the End of Life.
作者信息
Grande Giulia, Morin Lucas, Vetrano Davide Liborio, Fastbom Johan, Johnell Kristina
机构信息
Aging Research Center, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330, Stockholm, Sweden.
Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, "Luigi Sacco" Hospital, University of Milan, Milan, Italy.
出版信息
Drugs Aging. 2017 Jul;34(7):529-533. doi: 10.1007/s40266-017-0469-3.
BACKGROUND
Amyotrophic lateral sclerosis (ALS), with its certain prognosis and swift progression, raises concerns regarding the adequacy of pharmacological treatment, including the risk-benefit profiles of prescribed drugs.
OBJECTIVE
Our objective was to evaluate the use of prescription drugs over the course of the last year of life in older adults with ALS.
METHODS
We conducted a nationwide retrospective cohort study of older adults who died with ALS in Sweden between 2007 and 2013. The primary outcome was the number of prescription drugs to which individuals were exposed during the last 12 months before death.
RESULTS
The overall proportion of individuals receiving ten or more different prescription drugs increased from 19% at 12 months before death to 37% during the last month of life. Institutionalization was independently associated with polypharmacy near the end of life (odds ratio 1.84; 95% confidence interval 1.42-2.39).
CONCLUSION
Future research is needed to assess the time to benefit of treatments and to develop guidelines for medication discontinuation in advanced ALS.
背景
肌萎缩侧索硬化症（ALS）预后明确且进展迅速，引发了对药物治疗充分性的担忧，包括处方药的风险效益情况。
目的
我们的目的是评估老年ALS患者生命最后一年中处方药的使用情况。
方法
我们对2007年至2013年期间在瑞典死于ALS的老年人进行了一项全国性回顾性队列研究。主要结局是个体在死亡前最后12个月内接触的处方药数量。
结果
接受十种或更多不同处方药的个体总体比例从死亡前12个月的19%增至生命最后一个月的37%。入住机构与临终时的多重用药独立相关（比值比1.84；95%置信区间1.42 - 2.39）。
结论
需要开展进一步研究以评估治疗的获益时间，并制定晚期ALS停药指南。
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