Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls

Pier Mannuccio Mannucci, Alessandro Nobili, Emanuela Marchesini, Emily Oliovecchio, Laura Cortesi, Antonio Coppola, Elena Santagostino, Paolo Radossi, Giancarlo Castaman, Lelia Valdrè, Cristina Santoro, Annarita Tagliaferri, Cosimo Ettorre, Ezio Zanon, Giovanni Barillari, Isabella Cantori, Teresa Maria Caimi, Gianluca Sottilotta, Flora Peyvandi, Alfonso Iorio

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more. Patients and methods: S + PHERA is a multicentre observational study, with the broad goal to evaluate prospectively the health status and medication intake in 102 older patients with severe haemophilia A or B compared with 204 age- and residence-matched controls chosen randomly from the same general practices of PWHs. The rate of potential drug-drug interactions (PDDI) was evaluated as a proxy of prescription appropriateness. Results: After excluding replacement therapies and antiviral drugs, PWHs took in average less daily drugs than controls (2.4 ± 2.5 vs 3.0 ± 2.4) and had a lower rate of polypharmacy. Moreover, their prevalence of PDDI was lower (16.7% vs 27%). Conclusions: The rate of polypharmacy and the appropriateness of medications other than those for haemophilia and related comorbidities are acceptable in Italian PWHs, and better than those in their age peers without haemophilia, perhaps owing to drug tailoring and deprescribing by the specialized haemophilia centres at the time of regular visits. However, the PWHs investigated herewith were relatively young and the rate of polypharmacy and related PDDIs may become more prominent and crucial when older ages are reached, suggesting the need of continuous surveillance on prescribed drugs and the risk of drug-drug interactions.

Original languageEnglish
Pages (from-to)726-732
JournalHaemophilia
Volume24
Issue number5
DOIs
Publication statusPublished - 2018

Fingerprint

Polypharmacy
Hemophilia A
Drug Interactions
Pharmaceutical Preparations
Prescriptions
Comorbidity
Hemophilia B
Joint Diseases
Drug and Narcotic Control
Proxy
General Practice
Health Status
Multicenter Studies
Observational Studies
Antiviral Agents
Liver Diseases

Keywords

  • comorbidity
  • deprescribing
  • drug appropriateness
  • drug interactions
  • haemophilia
  • polypharmacy

ASJC Scopus subject areas

  • Hematology
  • Genetics(clinical)

Cite this

Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls. / Mannucci, Pier Mannuccio; Nobili, Alessandro; Marchesini, Emanuela; Oliovecchio, Emily; Cortesi, Laura; Coppola, Antonio; Santagostino, Elena; Radossi, Paolo; Castaman, Giancarlo; Valdrè, Lelia; Santoro, Cristina; Tagliaferri, Annarita; Ettorre, Cosimo; Zanon, Ezio; Barillari, Giovanni; Cantori, Isabella; Caimi, Teresa Maria; Sottilotta, Gianluca; Peyvandi, Flora; Iorio, Alfonso.

In: Haemophilia, Vol. 24, No. 5, 2018, p. 726-732.

Research output: Contribution to journalArticle

Mannucci, PM, Nobili, A, Marchesini, E, Oliovecchio, E, Cortesi, L, Coppola, A, Santagostino, E, Radossi, P, Castaman, G, Valdrè, L, Santoro, C, Tagliaferri, A, Ettorre, C, Zanon, E, Barillari, G, Cantori, I, Caimi, TM, Sottilotta, G, Peyvandi, F & Iorio, A 2018, 'Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls', Haemophilia, vol. 24, no. 5, pp. 726-732. https://doi.org/10.1111/hae.13595
Mannucci, Pier Mannuccio ; Nobili, Alessandro ; Marchesini, Emanuela ; Oliovecchio, Emily ; Cortesi, Laura ; Coppola, Antonio ; Santagostino, Elena ; Radossi, Paolo ; Castaman, Giancarlo ; Valdrè, Lelia ; Santoro, Cristina ; Tagliaferri, Annarita ; Ettorre, Cosimo ; Zanon, Ezio ; Barillari, Giovanni ; Cantori, Isabella ; Caimi, Teresa Maria ; Sottilotta, Gianluca ; Peyvandi, Flora ; Iorio, Alfonso. / Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls. In: Haemophilia. 2018 ; Vol. 24, No. 5. pp. 726-732.
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T1 - Rate and appropriateness of polypharmacy in older patients with hemophilia compared with age-matched controls

AU - Mannucci, Pier Mannuccio

AU - Nobili, Alessandro

AU - Marchesini, Emanuela

AU - Oliovecchio, Emily

AU - Cortesi, Laura

AU - Coppola, Antonio

AU - Santagostino, Elena

AU - Radossi, Paolo

AU - Castaman, Giancarlo

AU - Valdrè, Lelia

AU - Santoro, Cristina

AU - Tagliaferri, Annarita

AU - Ettorre, Cosimo

AU - Zanon, Ezio

AU - Barillari, Giovanni

AU - Cantori, Isabella

AU - Caimi, Teresa Maria

AU - Sottilotta, Gianluca

AU - Peyvandi, Flora

AU - Iorio, Alfonso

PY - 2018

Y1 - 2018

N2 - Background: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more. Patients and methods: S + PHERA is a multicentre observational study, with the broad goal to evaluate prospectively the health status and medication intake in 102 older patients with severe haemophilia A or B compared with 204 age- and residence-matched controls chosen randomly from the same general practices of PWHs. The rate of potential drug-drug interactions (PDDI) was evaluated as a proxy of prescription appropriateness. Results: After excluding replacement therapies and antiviral drugs, PWHs took in average less daily drugs than controls (2.4 ± 2.5 vs 3.0 ± 2.4) and had a lower rate of polypharmacy. Moreover, their prevalence of PDDI was lower (16.7% vs 27%). Conclusions: The rate of polypharmacy and the appropriateness of medications other than those for haemophilia and related comorbidities are acceptable in Italian PWHs, and better than those in their age peers without haemophilia, perhaps owing to drug tailoring and deprescribing by the specialized haemophilia centres at the time of regular visits. However, the PWHs investigated herewith were relatively young and the rate of polypharmacy and related PDDIs may become more prominent and crucial when older ages are reached, suggesting the need of continuous surveillance on prescribed drugs and the risk of drug-drug interactions.

AB - Background: In older people, multiple chronic ailments lead to the intake of multiple medications (polypharmacy) that carry a number of negative consequences (adverse events, prescription and intake errors, poor adherence, higher mortality). Because ageing patients with haemophilia (PWHs) may be particularly at risk due to their pre-existing multiple comorbidities (arthropathy, liver disease), we chose to analyse the pattern of chronic drug intake in a cohort of PWHs aged 60 years or more. Patients and methods: S + PHERA is a multicentre observational study, with the broad goal to evaluate prospectively the health status and medication intake in 102 older patients with severe haemophilia A or B compared with 204 age- and residence-matched controls chosen randomly from the same general practices of PWHs. The rate of potential drug-drug interactions (PDDI) was evaluated as a proxy of prescription appropriateness. Results: After excluding replacement therapies and antiviral drugs, PWHs took in average less daily drugs than controls (2.4 ± 2.5 vs 3.0 ± 2.4) and had a lower rate of polypharmacy. Moreover, their prevalence of PDDI was lower (16.7% vs 27%). Conclusions: The rate of polypharmacy and the appropriateness of medications other than those for haemophilia and related comorbidities are acceptable in Italian PWHs, and better than those in their age peers without haemophilia, perhaps owing to drug tailoring and deprescribing by the specialized haemophilia centres at the time of regular visits. However, the PWHs investigated herewith were relatively young and the rate of polypharmacy and related PDDIs may become more prominent and crucial when older ages are reached, suggesting the need of continuous surveillance on prescribed drugs and the risk of drug-drug interactions.

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