为患有多种疾病的老年患者开具、停用质子泵抑制剂以及潜在的不良反应：一项观察性研究。
Prescribing, deprescribing and potential adverse effects of proton pump inhibitors in older patients with multimorbidity: an observational study.
机构信息
Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands.
出版信息
CMAJ Open. 2023 Feb 28;11(1):E170-E178. doi: 10.9778/cmajo.20210240. Print 2023 Jan-Feb.
BACKGROUND
Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population.
METHODS
We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016-2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission.
RESULTS
Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission ( = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12-1.53).
INTERPRETATION
Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population.
背景
质子泵抑制剂（PPIs）会导致多种药物并用，并与不良反应相关。由于缺乏关于老年多病患者中质子泵抑制剂长期处方模式的前瞻性数据，我们旨在评估该人群中质子泵抑制剂的使用和停用模式，以及质子泵抑制剂的使用与 1 年内住院之间的关联。
方法
我们使用来自 Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults（OPERAM）试验的数据进行了一项前瞻性、纵向队列研究，该试验是一项测试减少不适当处方的随机对照试验（2016-2018 年）。该试验纳入了年龄在 70 岁及以上、至少有 3 种慢性疾病和至少有 5 种慢性药物处方的成年人。我们通过干预组评估了住院时 PPI 使用的流行率，以及出院时、出院后 2 个月和 1 年的新处方和停用情况。我们使用竞争风险回归评估了 PPI 使用与潜在不良反应相关的再入院的关联，以及所有原因的再入院。
结果
总体而言，在 1879 名患者（平均年龄 79 岁）中，有 1080 名（57.4%）患者有 PPI 处方，包括 496 名（45.9%）患者存在潜在不适当的指征。在出院时，在干预组的 534 名患者中，有 133 名（24.9%）在服用 PPI 的患者和在对照组的 546 名患者中有 92 名（16.8%）在服用 PPI 的患者中有停用情况。在 680 名未在出院时使用 PPI 的患者中，在干预组的 321 名患者中有 47 名（14.6%）和在对照组的 359 名患者中有 40 名（11.1%）在 2 个月内开始使用 PPI。使用 PPI 与全因再入院相关（n = 770，亚分布风险比 1.31，95%置信区间 1.12-1.53）。
解释
在患有多种疾病和多种药物并用的老年人中，质子泵抑制剂的潜在不适当使用、新的质子泵抑制剂处方和质子泵抑制剂的停用情况很常见。这些数据表明，在该人群中，持续使用质子泵抑制剂可能与临床重要的不良反应相关。
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