Department of Geriatric Medicine, CHU UCL Namur, Avenue Dr Gaston Therasse, 1, 5530, Yvoir, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
Drugs Aging. 2023 Jun;40(6):551-561. doi: 10.1007/s40266-023-01029-1. Epub 2023 May 23.
Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk-benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes.
We conducted a secondary analysis of a cluster randomized controlled trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]), comparing usual care and in-hospital pharmacotherapy optimization in adults aged 70 years or over with multimorbidity and polypharmacy in four European countries. BZRA cessation was defined as taking one or more BZRA before hospitalization and not taking any BZRA at the 6-month follow-up. Multivariable logistic regression was performed to identify factors associated with BZRA use before hospitalization and with cessation at 6 months.
Among 1601 participants with complete 6-month follow-up data, 378 (23.6%) were BZRA users before hospitalization. Female sex (odds ratio [OR] 1.52 [95% confidence interval 1.18-1.96]), a higher reported level of depression/anxiety (OR up to 2.45 [1.54-3.89]), a higher number of daily drugs (OR 1.08 [1.05-1.12]), use of an antidepressant (OR 1.74 [1.31-2.31]) or an antiepileptic (OR 1.46 [1.02-2.07]), and trial site were associated with BZRA use. Diabetes mellitus (OR 0.60 [0.44-0.80]) was associated with a lower probability of BZRA use. BZRA cessation occurred in 86 BZRA users (22.8%). Antidepressant use (OR 1.74 [1.06-2.86]) and a history of falling in the previous 12 months (OR 1.75 [1.10-2.78]) were associated with higher BZRA cessation, and chronic obstructive pulmonary disease (COPD) (OR 0.45 [0.20-0.91]) with lower BZRA cessation.
BZRA prevalence was high among included multimorbid older adults, and BZRA cessation occurred in almost a quarter of them within 6 months after hospitalization. Targeted BZRA deprescribing programs could further enhance cessation. Specific attention is needed for females, central nervous system-acting co-medication, and COPD co-morbidity.
ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.
尽管苯二氮䓬受体激动剂（BZRA）的风险效益比不理想，但仍广泛用于老年患者。住院可能是开始停止使用 BZRA 的独特机会，但对于住院期间和出院后的停药情况却知之甚少。我们旨在测量住院前 BZRA 的使用频率，并确定 6 个月后停药的比例，同时识别与这些结果相关的因素。
我们对一项在四个欧洲国家进行的、比较 70 岁及以上伴有多种合并症和多种药物治疗的患者常规护理和住院药物治疗优化的多中心随机对照试验（OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]）进行了二次分析。将住院前服用一种或多种 BZRA 且在 6 个月随访时未服用任何 BZRA 的患者定义为 BZRA 停药。采用多变量逻辑回归分析来识别与住院前使用 BZRA 以及 6 个月停药相关的因素。
在 1601 名完成 6 个月随访的参与者中，有 378 名（23.6%）在住院前使用 BZRA。女性（比值比 [OR] 1.52 [95%置信区间 1.18-1.96]）、报告的抑郁/焦虑程度较高（OR 最高达 2.45 [1.54-3.89]）、每日服用药物数量较多（OR 1.08 [1.05-1.12]）、使用抗抑郁药（OR 1.74 [1.31-2.31]）或抗癫痫药（OR 1.46 [1.02-2.07]）和试验地点与 BZRA 使用相关。糖尿病（OR 0.60 [0.44-0.80]）与 BZRA 使用的可能性较低有关。在 86 名 BZRA 使用者中，有 86 名（22.8%）停药。使用抗抑郁药（OR 1.74 [1.06-2.86]）和在过去 12 个月内有跌倒史（OR 1.75 [1.10-2.78]）与较高的 BZRA 停药相关，而慢性阻塞性肺疾病（COPD）（OR 0.45 [0.20-0.91]）与较低的 BZRA 停药相关。
患有多种合并症的老年患者中 BZRA 的使用率较高，其中近四分之一的患者在住院后 6 个月内停药。有针对性的 BZRA 药物逐渐减量方案可能会进一步促进停药。女性、中枢神经系统作用的合并用药和 COPD 合并症需要特别注意。
临床试验.gov 标识符：NCT02986425。2016 年 12 月 8 日。
