Analgesic drug use in elderly persons: A population-based study in Southern Italy
Autoři:
Ylenia Ingrasciotta aff001; Janet Sultana aff001; Francesco Giorgianni aff002; Enrica Menditto aff003; Angelo Scuteri aff004; Michele Tari aff005; Daniele Ugo Tari aff005; Giorgio Basile aff001; Gianluca Trifiro’ aff001
Působiště autorů:
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
aff001; Unit of Clinical Pharmacology A.O.U. ‘G. Martino’ Hospital’, Messina, Italy
aff002; CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy
aff003; HSR Pisana IRCCS, Rome, Italy
aff004; Local Health Unit of Caserta, Caserta, Italy
aff005; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands
aff006
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222836
Souhrn
Introduction
Analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), weak and strong opioids are commonly used among elderly persons. The aim of this study was to describe the demographic and clinical characteristics of elderly analgesic users and to measure the frequency of analgesic use, including the frequency of potentially inappropriate analgesic use.
Methods
The Arianna database was used to carry out this study. This database contains prescription data with associated indication of use for 1,076,486 inhabitants registered with their general practitioners (GPs) in the Caserta Local Health Unit (Caserta district, Campania region in Italy). A cohort of persons aged ≥65 years old with >1 year of database history having at least one analgesic drug (NSAIDs, strong or weak opioids) between 2010 and 2014 were identified. The date of the first analgesic prescription in the study period was considered the index date (ID).
Results
From a source population of 1,076,486 persons, 116,486 elderly persons were identified. Of these, 94,820 elderly persons received at least one analgesic drug: 36.6% were incident NSAID users (N = 36,629), while 13.2% were incident weak opioid users (N = 12,485) and 8.1% were incident strong opioid users (N = 7,658). In terms of inappropriate analgesic use, 9.2% (N = 10,763) of all elderly users were prescribed ketorolac/indomethacin inappropriately, since these drugs should not be prescribed to elderly persons. Furthermore, at least half all elderly persons with chronic kidney disease or congestive heart failure were prescribed NSAIDs, while these drugs should be avoided.
Conclusion
Analgesics are commonly used inappropriately among elderly persons, suggesting that prescribing practice in the catchment area may yet be improved.
Klíčová slova:
Medicine and health sciences – Pharmacology – Drugs – Analgesics – Opioids – NSAIDs – Pain management – Geriatrics – Pharmaceutics – Drug therapy – Antiplatelet therapy – Neurology – Cognitive neurology – Cognitive impairment – People and places – Population groupings – Age groups – Elderly – Ethnicities – European people – Italian people – Biology and life sciences – Neuroscience – Cognitive science – Cognitive neuroscience
Zdroje
1. Kaye AD, Baluch A, Scott JT. Pain management in the elderly population: a review. Ochsner J. 2010 Fall;10(3):179–87. 21603375
2. Blondell RD, Azadfard M, Wisniewski AM. Pharmacologic therapy for acute pain. Am Fam Physician. 2013 Jun 1;87(11):766–72. 23939498
3. Bacchi S, Palumbo P, Sponta A, Coppolino MF. Clinical pharmacology of non-steroidal anti-inflammatory drugs: a review. Antiinflamm Antiallergy Agents Med Chem. 2012;11(1):52–64. 22934743
4. Onder G, Bonassi S, Abbatecola AM, Folino-Gallo P, Lapi F, Marchionni N et al. High prevalence of poor quality drug prescribing in older individuals: a nationwide report from the Italian Medicines Agency (AIFA). J Gerontol A Biol Sci Med Sci. 2014;69(4):430–7. doi: 10.1093/gerona/glt118 23913935
5. Sultana J, Fontana A, Giorgianni F, Basile G, Patorno E, Pilotto A et al. Can information on functional and cognitive status improve short-term mortality risk prediction among community-dwelling older people? A cohort study using a UK primary care database. Clin Epidemiol. 2017;10:31–39. doi: 10.2147/CLEP.S145530 29296099
6. McLachlan AJ, Bath S, Naganathan V, Hilmer SN, Le Couteur DG, Gibson SJ et al. Clinical pharmacology of analgesic medicines in older people: impact of frailty and cognitive impairment. Br J Clin Pharmacol. 2011; 71(3):351–64. doi: 10.1111/j.1365-2125.2010.03847.x 21284694
7. Skolnick P. The Opioid Epidemic: Crisis and Solutions. Annu Rev Pharmacol Toxicol. 2018 Jan 6;58:143–159. doi: 10.1146/annurev-pharmtox-010617-052534 28968188
8. Routledge PA, O'Mahony MS, Woodhouse KW. Adverse drug reactions in elderly patients. Br J Clin Pharmacol. 2004;57(2):121–6. doi: 10.1046/j.1365-2125.2003.01875.x 14748810
9. American Geriatrics Society 2012 Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2012;60(4):616–31. doi: 10.1111/j.1532-5415.2012.03923.x 22376048
10. Miller M, Stürmer T, Azrael D, Levin R, Solomon DH. Opioid analgesics and the risk of fractures in older adults with arthritis. J Am Geriatr Soc. 2011;59(3):430–8. doi: 10.1111/j.1532-5415.2011.03318.x 21391934
11. Kocoglu H, Oguz B, Dogan H, Okuturlar Y, Hursitoglu M, Harmankaya O et al. NSAIDs and ASA Cause More Upper Gastrointestinal Bleeding in Elderly than Adults? Gastroenterol Res Pract. 2016:8419304. doi: 10.1155/2016/8419304 26880898
12. Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med. 2010;170(22):1968–76. doi: 10.1001/archinternmed.2010.391 21149752
13. Ungprasert P, Cheungpasitporn W, Crowson CS, Matteson EL. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med. 2015;26(4):285–91. doi: 10.1016/j.ejim.2015.03.008 25862494
14. Ingrasciotta Y, Sultana J, Giorgianni F, Fontana A, Santangelo A, Tari DU et al. Association of individual non-steroidal anti-inflammatory drugs and chronic kidney disease: a population-based case control study. PLoS One. 2015;10(4):e0122899. doi: 10.1371/journal.pone.0122899 25880729
15. Abdulla A, Adams N, Bone M, Elliott AM, Gaffin J, Jones D et al. Guidance on the management of pain in older people.Age Ageing. 2013 Mar;42 Suppl 1:i1–57.
16. Ripamonti C, Fagnoni E, Campa T, Brunelli C, De Conno F. Is the use of transdermal fentanyl inappropriate according to the WHO guidelines and the EAPC recommendations? A study of cancer patients in Italy. Support Care Cancer. 2006 May;14(5):400–7. doi: 10.1007/s00520-005-0918-0 16485087
17. Ussai S, Miceli L, Pisa FE, Bednarova R, Giordano A, Della Rocca G et al. Impact of potential inappropriate NSAIDs use in chronic pain. Drug Des Devel Ther. 2015 Apr 9;9:2073–7. doi: 10.2147/DDDT.S80686 25926717
18. Viola E, Trifirò G, Ingrasciotta Y, Sottosanti L, Tari M, Giorgianni F et al. Adverse drug reactions associated with off-label use of ketorolac, with particular focus on elderly patients. An analysis of the Italian pharmacovigilance database and a population based study. Expert Opin Drug Saf. 2016 Dec;15(sup2):61–67. doi: 10.1080/14740338.2016.1221401 27875919
19. Lombardi N, Vannacci A, Bettiol A, Marconi E, Pecchioli S, Magni A et al. Prescribing Trends of Codeine-containing Medications and Other Opioids in Primary Care After A Regulatory Decision: An Interrupted Time Series Analysis. Clin Drug Investig. 2019 May;39(5):455–462. doi: 10.1007/s40261-019-00767-8 30852809
20. Guerriero F, Orlando V, Tari DU, Di Giorgio A, Cittadini A, Trifirò G et al. How healthy is community-dwelling elderly population? Results from Southern Italy. Transl Med UniSa. 2015; 13: 59–64. 27042434
21. Skolnick P. The Opioid Epidemic: Crisis and Solutions. Annu Rev Pharmacol Toxicol. 2018;58:143–159. doi: 10.1146/annurev-pharmtox-010617-052534 28968188
22. Società Italiana di Farmacologia. Trattamento del dolore cronico in Italia: appropriatezza terapeutica con oppiacei e timore di addiction: situazione italiana vs USA. Apr18. Available from: https://sif-website.s3.amazonaws.com/uploads/position_paper/attachment/139/sif_position_paper_dolore_oppiacei_apr18.pdf
23. Musazzi UM, Rocco P, Brunelli C, Bisaglia L, Caraceni A, Minghetti P. Do laws impact opioids consumption? A breakpoint analysis based on Italian sales data. J Pain Res. 2018 Aug 29;11:1665–1672. doi: 10.2147/JPR.S163438 30214276
24. Marras F, Leali PT. The role of drugs in bone pain. Clin Cases Miner Bone Metab. 2016 May-Aug;13(2):93–96. doi: 10.11138/ccmbm/2016.13.2.093 27920802
25. Bruera E, Paice JA. Cancer pain management: safe and effective use of opioids. Am Soc Clin Oncol Educ Book. 2015:e593–9. doi: 10.14694/EdBook_AM.2015.35.e593 25993228
26. Sultana J, Fontana A, Giorgianni F, Basile G, Patorno E, Pilotto A et al. Can information on functional and cognitive status improve short-term mortality risk prediction among community-dwelling older people? A cohort study using a UK primary care database. Clin Epidemiol. 2017 Dec 19;10:31–39. doi: 10.2147/CLEP.S145530 29296099
27. Daoust R, Paquet J, Moore L, Émond M, Gosselin S, Lavigne G et al. Recent opioid use and fall-related injury among older patients with trauma. CMAJ. 2018 Apr 23;190(16):E500–E506. doi: 10.1503/cmaj.171286 29685910
28. European Medicines Agency (EMA). Nimesulide summary. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Nimesulide/human_referral_000275.jsp&mid=WC0b01ac0580024e99
29. Agenzia Italiana del Farmaco (AIFA—Italian Drug Agency). Nota 66. Available from: http://www.aifa.gov.it/sites/default/files/determinazione_nota_66.pdf
30. European Medicines Agency (EMA). Questions and answers on the review of etoricoxib-containing medicines. Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Etoricoxib/human_referral_000104.jsp
31. Agenzia Italiana del Farmaco (AIFA—Italian Drug Agency). Domande e Risposte predisposte dall’EMEA in merito alla revisione dei medicinali contenenti ETORICOXIB (2008). Available from: http://www.aifa.gov.it/sites/default/files/faq_comunicato_etoricoxib260608.pdf
32. O'Mahony D, O'Sullivan D, Byrne S, O'Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2015;44(2):213–8. doi: 10.1093/ageing/afu145 25324330
33. Carter JL, Stevens PE, Irving JE, Lamb EJ. Estimating glomerular filtration rate: comparison of the CKD-EPI and MDRD equations in a large UK cohort with particular emphasis on the effect of age. QJM. 2011;104(10):839–47. doi: 10.1093/qjmed/hcr077 21652537
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