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Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study

Author

Listed:
  • Patricia Amoros-Reboredo

    (Pharmacy Service Hospital Clínic de Barcelona, 08036 Barcelona, Spain)

  • Dolors Soy

    (Pharmacy Service Division of Medicines Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain)

  • Marta Hernandez-Hernandez

    (School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain)

  • Sabela Lens

    (Liver Unit Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, 08036 Barcelona, Spain
    Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain)

  • Conxita Mestres

    (School of Health Sciences Blanquerna, University Ramon Llull, 08025 Barcelona, Spain)

Abstract

Aim : Older patients with chronic hepatitis C infection starting direct-acting antivirals (DAAs) are frequently prescribed multiple medications that may be categorized as inappropriate. Anticholinergic burden has been shown to be a predictor of adverse health and functional outcomes. Different scales are available to calculate anticholinergic burden. The aim of this study was to determine the prevalence of anticholinergic medication among older patients treated with DAAs and the risk factors associated using the Anticholinergic Cognitive Burden (ACB) scale, the Anticholinergic Risk Scale (ARS) and the Anticholinergic Drug Scale (ADS) and analyze the resulting safety consequences. Methods : Observational, retrospective cohort study of consecutive patients ≥65 years old receiving DAAs and taking concomitant medication. This study was conducted in accordance with the Strengthening the Reporting of observational studies in Epidemiology Statement. Results : 236 patients were included. The average age was 71.7 years, 73.3% cirrhotic, and 47% patients took ≥5 medicines. According to the ACB, ARS and ADS scales, 35.2% ( n = 83), 10.6% ( n = 25) and 34.3% ( n = 81) of the patients were treated with anticholinergic medication. Two hundred-and-six (86%) patients presented any adverse events (AEs) during therapy. ARS scale showed a significant relationship between presence of anticholinergic medication and AEs. A large number of patients suffered anticholinergic events, with more events per patient in patients taking anticholinergic drugs. Conclusions : Older hepatitis C chronic patients are exposed to potentially inappropriate polypharmacy and anticholinergic risk, according to the ACB, ARS and ADS scales. The three scales showed different results. Only the ARS scale was associated with AEs, but the rate of anticholinergic effects per patient was significantly higher in patients with anticholinergic drugs, regardless of the scale used. Consider quality of pharmacotherapy when starting DAA with a multidisciplinary approach could improve health outcomes.

Suggested Citation

  • Patricia Amoros-Reboredo & Dolors Soy & Marta Hernandez-Hernandez & Sabela Lens & Conxita Mestres, 2020. "Anticholinergic Burden and Safety Outcomes in Older Patients with Chronic Hepatitis C: A Retrospective Cohort Study," IJERPH, MDPI, vol. 17(11), pages 1-14, May.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:11:p:3776-:d:363204
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    References listed on IDEAS

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    1. Donna M Evon & Paul W Stewart & Jipcy Amador & Marina Serper & Anna S Lok & Richard K Sterling & Souvik Sarkar & Carol E Golin & Bryce B Reeve & David R Nelson & Nancy Reau & Joseph K Lim & K Rajender, 2018. "A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results ," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-26, August.
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