Pharmacy Service Hospital Clínic de Barcelona, 08036 Barcelona, Spain.
Pharmacy Service Division of Medicines Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain.
Int J Environ Res Public Health. 2020 May 26;17(11):3776. doi: 10.3390/ijerph17113776.
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.
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.
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.
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.
开始直接作用抗病毒药物（DAA）治疗的慢性丙型肝炎感染老年患者经常开有多种可能被归类为不适当的药物。已证明抗胆碱能负担是不良健康和功能结果的预测因素。有不同的量表可用于计算抗胆碱能负担。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以及相关的危险因素，并分析由此产生的安全后果。
对连续接受 DAA 治疗并同时服用药物的≥65 岁患者进行观察性、回顾性队列研究。本研究符合加强观察性研究的报告声明。
共纳入 236 例患者。平均年龄为 71.7 岁，73.3%为肝硬化，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%）患者在治疗过程中出现任何不良事件（AE）。ARS 量表显示，存在抗胆碱能药物与 AE 之间存在显著关系。大量患者出现抗胆碱能事件，服用抗胆碱能药物的患者每例患者的事件更多。
根据 ACB、ARS 和 ADS 量表，慢性丙型肝炎老年患者暴露于潜在不适当的多药治疗和抗胆碱能风险中。这三个量表给出了不同的结果。只有 ARS 量表与 AE 相关，但无论使用哪种量表，服用抗胆碱能药物的患者的抗胆碱能作用发生率都显著更高。通过多学科方法启动 DAA 治疗时考虑药物治疗质量，可以改善健康结果。
