High‐Throughput Screening for Prescribing Cascades Among Real‐World Angiotensin‐Converting Enzyme Inhibitor Initiators DOI
Asinamai Ndai, Kayla Smith, Shailina Keshwani

и другие.

Pharmacoepidemiology and Drug Safety, Год журнала: 2025, Номер 34(3)

Опубликована: Март 1, 2025

ABSTRACT Purpose Angiotensin‐converting enzyme inhibitors (ACEIs) are commonly prescribed, but their adverse effects may prompt new drug prescription(s), known as prescribing cascades (PCs). We aimed to identify potential ACEI‐induced PCs using high‐throughput sequence symmetry analysis. Methods Using claims data from a national sample of Medicare beneficiaries (2011–2020), we identified ACEI users aged ≥ 66 years with continuous enrollment 360 days before and 180 after initiation. screened for initiation 446 other (non‐antihypertensive) “marker” classes within ±90 initiation, generating ratios (SRs) reflecting proportions starting the marker class versus Adjusted SRs (aSRs) accounted trends over time. For significant aSRs, calculated naturalistic number needed harm (NNTH), signals underwent clinical review plausibility. Results 308 579 initiators (mean age 76.1 ± 7.5 years; 59.6% female; 88.6% hypertension). Of evaluated, 81 were significant, 42 (52%) classified review. The strongest ranked by lowest NNTH included corticosteroids (NNTH 313; 95% CI, 262–392) serotonin type 3 (5‐HT ) antagonists 496; 392–689); highest aSR sympathomimetics (aSR, 1.97; 1.10–3.53) antianemic preparations 1.87; 1.31–2.67). Conclusion Identified cascade indicative possibly underrecognized events in this cohort. findings hypothesis‐generating require further investigation determine extent impact on health outcomes.

Язык: Английский

High-Throughput Screening for Prescribing Cascades Among Real-World Angiotensin-II Receptor Blockers (ARBs) Initiators DOI Creative Commons
Asinamai Ndai, Kayla Smith, Shailina Keshwani

и другие.

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2025, Номер unknown

Опубликована: Март 11, 2025

Angiotensin-II Receptor Blockers (ARBs) are commonly prescribed; however, their adverse events may prompt new drug prescription(s), known as prescribing cascades. We aimed to identify potential ARB-induced cascades using high-throughput sequence symmetry analysis. Using claims data from a national sample of Medicare beneficiaries (2011-2020), we identified ARB users aged ≥66 years with continuous enrollment ≥360 days before and ≥180 after initiation. screened for initiation 446 other (non-antihypertensive) 'marker' classes within ±90 initiation, generating ratios (SRs) reflecting proportions starting the marker class versus Adjusted SRs (aSRs) accounted trends over time, significant aSRs, calculated naturalistic number needed harm (NNTH); signals were reviewed by clinical experts plausibility. 320,663 initiators (mean ± SD age 76.0 7.2 years; 62.5% female; 91.5% hypertension). Of evaluated, 17 significant, three (18%) classified review. The strongest ranked lowest NNTH included benzodiazepine derivatives (NNTH 2130, 95% CI 1437-4525), adrenergics in combination anticholinergics, including triple combinations corticosteroids 2656, 1585-10074), antianemic preparations 9416, 6606-23784). highest aSR (aSR 1.7, 1.19-2.41), 1.18, 1.08-1.3), 1.12, 1.03-1.22). cascade reflected possibly under-recognized this cohort. These hypothesis-generating findings require further investigation determine extent impact these on patient outcomes.

Язык: Английский

Процитировано

1
Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care: a proof-of-concept study DOI Creative Commons
Atiya K. Mohammad, Jacqueline G. Hugtenburg,

Yildiz Ceylan

и другие.

International Journal of Clinical Pharmacy, Год журнала: 2025, Номер unknown

Опубликована: Фев. 15, 2025

Prescribing cascades occur in clinical practice when a medication causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication. The aim was to provide proof-of-concept for pharmacy-led interventions reverse or prevent cascades. Two community pharmacies each tested two approaches. To cascades, ten were selected from literature. Dispensing records screened identify patients with these who started medications associated five of telephoned one month after their first dispensing discuss ADRs. Pharmacists assessed the need intervene together prescribers. Primary outcome proportion treatment change initiated. Secondary outcomes time investment, potential cost-savings, and pharmacists' experiences. 24 included. For eight prescriber consulted, resulting reversal three Forty-four included Six them experienced ADR that could lead cascade. conducted this. estimated investment possibly intervention 4.5 h reversing approach 4.8 preventing approach, while follow-up actions required 1.8 0.5 h, respectively. Both approaches be cost-saving. considered both relevant but identified knowledge gap on how some Pharmacy-led may more efficient screening methods tools are needed before further implementation.

Язык: Английский

Процитировано

0
High‐Throughput Screening for Prescribing Cascades Among Real‐World Angiotensin‐Converting Enzyme Inhibitor Initiators DOI
Asinamai Ndai, Kayla Smith, Shailina Keshwani

и другие.

Pharmacoepidemiology and Drug Safety, Год журнала: 2025, Номер 34(3)

Опубликована: Март 1, 2025

ABSTRACT Purpose Angiotensin‐converting enzyme inhibitors (ACEIs) are commonly prescribed, but their adverse effects may prompt new drug prescription(s), known as prescribing cascades (PCs). We aimed to identify potential ACEI‐induced PCs using high‐throughput sequence symmetry analysis. Methods Using claims data from a national sample of Medicare beneficiaries (2011–2020), we identified ACEI users aged ≥ 66 years with continuous enrollment 360 days before and 180 after initiation. screened for initiation 446 other (non‐antihypertensive) “marker” classes within ±90 initiation, generating ratios (SRs) reflecting proportions starting the marker class versus Adjusted SRs (aSRs) accounted trends over time. For significant aSRs, calculated naturalistic number needed harm (NNTH), signals underwent clinical review plausibility. Results 308 579 initiators (mean age 76.1 ± 7.5 years; 59.6% female; 88.6% hypertension). Of evaluated, 81 were significant, 42 (52%) classified review. The strongest ranked by lowest NNTH included corticosteroids (NNTH 313; 95% CI, 262–392) serotonin type 3 (5‐HT ) antagonists 496; 392–689); highest aSR sympathomimetics (aSR, 1.97; 1.10–3.53) antianemic preparations 1.87; 1.31–2.67). Conclusion Identified cascade indicative possibly underrecognized events in this cohort. findings hypothesis‐generating require further investigation determine extent impact on health outcomes.

Язык: Английский

Процитировано

0