Assessment of drug–drug interaction in an elderly human immunodeficiency virus population: Comparison of 3 expert databases

Abstract

Aims Polypharmacy increase the risk of drug–drug interactions (DDIs) in the elderly population living with human immunodeficiency virus (HIV). Several expert databases can be used to evaluate DDIs. The aim of the study was to describe actual DDIs between antiretroviral drugs and comedications in an elderly population and to compare grading of the DDIs in 3 databases. Methods All treatments of HIV‐infected subjects aged 65 years and older were collected in 6 French HIV centres. Summary of Product Characteristic (SPC), French DDI Thesaurus (THES), and Liverpool HIV DDI website (LIV) were used to define each DDI and specific grade. DDIs were classified in yellow flag interaction (undefined grade in SPC and THES or potential weak interaction in LIV), amber flag interaction (to be considered/precaution of use in SPC and THES and potential interaction in LIV) and red flag interaction (not recommended/contraindication in SPC and THES and do not administer/contraindication in LIV). Results Among 239 subjects included, 60 (25.1%) had at least 1 DDI for a total of 126 DDIs: 23/126 red flag DDIs were identified in 17 patients. All these 23 DDIs were identified in LIV. THES and SPC missed 6 and 1 red flag DDIs, respectively. Seven of 23 red flag DDIs were identified in the 3 databases concomitantly. Conclusion Polypharmacy is frequent in this elderly HIV population leading to DDI in a quarter of the subjects. The discrepancies between databases can be explained by differences in analysis methods. A consensus between databases would be helpful for clinicians.

Prevalence of Potentially Clinically Significant Drug–Drug Interactions With Antiretrovirals Against HIV Over Three Decades: A Systematic Review of the Literature

“…Risk of bias analysis highlighted a few key areas of risk. Five studies [12][13][14][15][16] only selected patients older than a certain age threshold. These studies may therefore skew toward more clinically significant DDIs due to increased polypharmacy in older age groups.…”

“…The full risk of bias analysis for included articles are shown in Figure S4, Supplemental Digital Content, http://links.lww.com/QAI/B994 and funding sources in Table S5, http://links.lww.com/QAI/B994. 53 No Brazil Liverpool Ruellan 2020 15 No France Liverpool, French DDI Thesaurus, SmPC ✓ Schlaeppi 2020 54 No Tanzania Liverpool ✓ Funke 2021 55 25. The characteristics of the 34 included studies are available in Table 1.…”

“…Oreagba 2019 30 84.2 Chen 2020 20 3.0 Deutschmann 2020 23 22.5 1.7 El Moussaoui 2020 52 43.5 4.6 40. 8 4.6 Pontelo 2020 53 50.0 Ruellan 2020 15 25.1 20.1 7.1 Schlaeppi 2020 54 31.2 30.7 0.4 Funke 2021 55 41.5 1.3 Kunimoto 2021 18 62.0 Murray 2021 16 84. regimens. In addition, studies from Switzerland and the United Kingdom suggest that younger individuals (with more recent initiation of antiretroviral therapy) are more likely to be receiving first-line, integrase-containing fixed-dose formulations than older patients who were more likely to be optimally controlled on older antiviral regimens.…”

Antiretroviral drug–drug interactions: A comparison of online drug interaction databases

“…Databases for assessing DDIs are available through subscription and open‐access platforms. Previous studies have evaluated ARVs with concomitant medications and demonstrated discrepancies between online DDI databases with older ARVs 6–9 . Since these studies, newer agents have been approved for the treatment of HIV.…”

“…Previous studies have evaluated ARVs with concomitant medications and demonstrated discrepancies between online DDI databases with older ARVs. 6 , 7 , 8 , 9 Since these studies, newer agents have been approved for the treatment of HIV. The aim of our study was to compare interaction identification and severity classification for commonly used ARVs and concomitant medications between six different online DDI databases.…”