COVID-SAFER: Deprescribing Guidance for Hydroxychloroquine Drug Interactions in Older Adults

被引：24

作者：

Ross, Sydney B. ^{[1
,2
]}

Wilson, Marnie Goodwin ^{[3
]}

Papillon-Ferland, Louise ^{[4
]}

Elsayed, Sarah ^{[2
]}

Wu, Peter E. ^{[5
]}

Battu, Kiran ^{[6
]}

Porter, Sandra ^{[6
]}

Rashidi, Babak ^{[7
]}

Tamblyn, Robyn ^{[2
]}

Pilote, Louise ^{[2
,8
]}

Downar, James ^{[9
]}

Bonnici, Andre ^{[10
]}

Huang, Allen ^{[11
]}

Lee, Todd C. ^{[1
,12
,13
]}

McDonald, Emily G. ^{[1
,2
,8
,12
]}

机构：

[1] McGill Univ, Div Expt Med, Fac Med, Montreal, PQ, Canada

[2] McGill Univ, Ctr Outcomes Res & Evaluat, Hlth Ctr, Montreal, PQ, Canada

[3] Univ British Columbia, Div Gen Internal Med, Vancouver, BC, Canada

[4] Inst Univ Geriatr Montreal, Dept Pharm, Montreal, PQ, Canada

[5] Univ Hlth Network, Div Gen Internal Med, Toronto, ON, Canada

[6] Univ Hlth Network, Dept Pharm, Toronto, ON, Canada

[7] Ottawa Hosp, Div Gen Internal Med, Ottawa, ON, Canada

[8] McGill Univ, Div Gen Internal Med, Hlth Ctr, Montreal, PQ, Canada

[9] Ottawa Hosp, Div Palliat Med, Ottawa, ON, Canada

[10] McGill Univ, Dept Pharm, Hlth Ctr, Montreal, PQ, Canada

[11] Ottawa Hosp, Div Geriatr Med, Ottawa, ON, Canada

[12] McGill Univ, Clin Practice Assessment Unit, Hlth Ctr, Montreal, PQ, Canada

[13] McGill Univ, Div Infect Dis, Dept Med, Montreal, PQ, Canada

来源：

JOURNAL OF THE AMERICAN GERIATRICS SOCIETY | 2020年 / 68卷 / 08期

关键词：

polypharmacy; potentially inappropriate medications; hydroxychloroquine; COVID-19; deprescribing; MEDICATIONS; CRITERIA; EVENTS;

D O I：

10.1111/jgs.16623

中图分类号：

R592 [老年病学]; C [社会科学总论];

学科分类号：

03 ; 0303 ; 100203 ;

摘要：

BACKGROUND/OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes high morbidity and mortality in older adults with chronic illnesses. Several trials are currently underway evaluating the antimalarial drug hydroxychloroquine as a potential treatment for acute infection. However, polypharmacy predisposes patients to increased risk of drug-drug interactions with hydroxychloroquine and may render many in this population ineligible to participate in trials. We aimed to quantify the degree of polypharmacy and burden of potentially inappropriate medications (PIMs) that older hospitalized adults are taking that would interact with hydroxychloroquine. METHODS We reanalyzed data from the cohort of patients 65 years and older enrolled in the MedSafer pilot study. We first identified patients taking medications with potentially harmful drug-drug interactions with hydroxychloroquine that might exclude them from participation in a typical 2019 coronavirus disease (COVID-19) therapeutic trial. Next, we identified medications that were flagged by MedSafer as potentially inappropriate and crafted guidance around medication management if contemplating the use of hydroxychloroquine. RESULTS The cohort contained a total of 1,001 unique patients with complete data on their home medications at admission. Of these 1,001 patients, 590 (58.9%) were receiving one or more home medications that could potentially interact with hydroxychloroquine, and of these, 255 (43.2%) were flagged as potentially inappropriate by the MedSafer tool. Common classes of PIMs observed were antipsychotics, cardiac medications, and antidiabetic agents. CONCLUSION The COVID-19 pandemic highlights the importance of medication optimization and deprescribing PIMs in older adults. By acting now to reduce polypharmacy and use of PIMs, we can better prepare this vulnerable population for inclusion in trials and, if substantiated, pharmacologic treatment or prevention of COVID-19.

引用

页码：1636 / 1646

页数：11

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