Exploring New Zealand prescription data using sequence symmetry analyses for predicting adverse drug reactions

Nishtala, Prasad S.; Chyou, Te‐yuan

doi:10.1111/jcpt.12491

Cited by 11 publications

(15 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As expected, we found that older adult loop diuretic initiators were over 8 times more likely to receive potassium supplementation simultaneously or after, rather than before, loop diuretic initiation, consistent with a high incidence of the “loop diuretic‐hypokalemia‐potassium supplementation” prescribing cascade. In sensitivity analyses excluding those who initiated loop diuretics and potassium supplementation on the same day, we obtained qualitatively similar results, as well as findings consistent with a previous PSSA conducted in New Zealand, which showed the new use of furosemide was associated with subsequent potassium supplementation initiation (aSR 2.9, 95% CI 2.8–3.1) 50 …”

Section: Discussionsupporting

confidence: 86%

“…In sensitivity analyses excluding those who initiated loop diuretics and potassium supplementation on the same day, we obtained qualitatively similar results, as well as findings consistent with a previous PSSA conducted in New Zealand, which showed the new use of furosemide was associated with subsequent potassium supplementation initiation (aSR 2.9, 95% CI 2.8-3.1). 50 More surprisingly, our findings suggested that as many as 1 in 3 loop diuretic initiators undergoing this prescribing cascade continued potassium supplementation during the 150-day follow-up, and the daily probability of the relic was the highest approximately 90 days after potassium supplementation initiation. Even considering a more conservative definition of the relic (>30 cumulative days of potassium supplementation after loop diuretic discontinuation), the relic occurred in up to 7.2% of patients, and 14.1% of patients refilled their potassium supplementation again after the estimated date of loop diuretic discontinuation.…”

Section: Discussionmentioning

confidence: 60%

See 1 more Smart Citation

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Wang

Morris

Smith

et al. 2022

J American Geriatrics Society

View full text Add to dashboard Cite

Background The use of a new medication (e.g., potassium supplementation) for managing a drug‐induced adverse event (e.g., loop diuretic‐induced hypokalemia) constitutes a prescribing cascade. However, loop diuretics are often stopped while potassium may be unnecessarily continued (i.e., relic). We aimed to quantify the occurrence of relics using older adults previously experiencing a loop diuretic‐potassium prescribing cascade as an example. Methods We conducted a prescription sequence symmetry analysis using the population‐based Medicare Fee‐For‐Service data (2011–2018) and partitioned the 150 days following potassium initiation by day to assess the daily treatment scenarios (i.e., loop diuretics alone, potassium alone, combination of loop diuretics and potassium, or neither). We calculated the proportion of patients developing the relic, proportion of person‐days under potassium alone, the daily probability of the relic, and the proportion of patients filling potassium after loop diuretic discontinuation. We also identified the risk factors of the relic. Results We identified 284,369 loop diuretic initiators who were 8 times more likely to receive potassium supplementation simultaneously or after (i.e., the prescribing cascade), rather than before, loop diuretic initiation (aSR 8.0, 95% CI 7.9–8.2). Among the 66,451 loop diuretic initiators who subsequently (≤30 days) initiated potassium, 20,445 (30.8%) patients remained on potassium after loop diuretic discontinuation, and 9365 (14.1%) patients subsequently filled another potassium supplementation. Following loop diuretic initiation, 4.0% of person‐days were for potassium alone, and daily probability of the relic was the highest after day 90 of loop diuretic initiation (5.6%). Older age, female sex, higher diuretic daily dose, and greater baseline comorbidities were risk factors for the relic, while patients having the same prescriber or pharmacy involved in the use of both medications were less likely to experience the relic. Conclusions Our findings suggest the need for clinicians to be aware of the potential of relic to avoid unnecessary drug use.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 60%

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Wang

Morris

Smith

et al. 2022

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…Most studies ( n = 88) were retrospective cohort studies, 5 , 7 , 18 , 21 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

Section: Resultsunclassified

“…The most commonly identified prescribing cascades are summarised in Table 2 . These include; amiodarone associated with subsequent thyroid hormone prescriptions for hypothyroidism ( n = 5), 54 , 61 , 79 , 85 , 87 CCBs associated with diuretic prescriptions to treat peripheral oedema ( n = 5), 5 , 7 , 87 , 104 , 105 topical antifungals to treat oral candidiasis following inhaled corticosteroids ( n = 4), 39 , 54 , 56 , 71 anti‐Parkinson medication to treat Parkinsonian symptoms following antipsychotic initiation ( n = 4), 19 , 29 , 100 , 119 urinary anticholinergics to treat urinary incontinence following acetylcholinesterase inhibitors( n = 4), 24 , 26 , 44 , 53 and antitussives to treat cough following angiotensin‐converting enzyme inhibitors (ACEIs) ( n = 3). 18 , 73 , 87 Additional prescribing cascades identified included metoclopramide to anti‐Parkinson medication ( n = 3).…”

Section: Resultsmentioning

confidence: 99%

“…Most studies ( n = 88) were retrospective cohort studies, 5,7,18,21,23–27,29–34,36–44,47–113 three of which incorporated a case–control study within the study design 49,85,110 and one that conducted a preliminary cross‐sectional study 112 . Five were case–control studies, 19,20 five cross‐sectional studies, 6,46,114–116 and three case‐crossover studies 45,117,118 .…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Prescribing cascades in community‐dwelling adults: A systematic review

Doherty¹,

Shahid

Moriarty³

et al. 2022

Pharmacology Res & Perspec

View full text Add to dashboard Cite

The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community‐dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre‐registered with PROSPERO. Electronic databases (Medline [Ovid], EMBASE, PsycINFO, CINAHL, Cochrane Library) and grey literature sources were searched. Inclusion criteria: community‐dwelling adults; risk‐prescription medication; outcomes‐initiation of new medicine to “treat” or reduce ADR risk; study type‐cohort, cross‐sectional, case‐control, and case‐series studies. Title/abstract screening, full‐text screening, data extraction, and methodological quality assessment were conducted independently in duplicate. A narrative synthesis was conducted. A total of 101 studies (reported in 103 publications) were included. Study sample sizes ranged from 126 to 11 593 989 participants and 15 studies examined older adults specifically (≥60 years). Seventy‐eight of 101 studies reported a potential prescribing cascade including calcium channel blockers to loop diuretic ( n = 5), amiodarone to levothyroxine ( n = 5), inhaled corticosteroid to topical antifungal ( n = 4), antipsychotic to anti‐Parkinson drug ( n = 4), and acetylcholinesterase inhibitor to urinary incontinence drugs ( n = 4). Identified prescribing cascades occurred within three months to one year following initial medication. Methodological quality varied across included studies. Prescribing cascades occur for a broad range of medications. ADRs should be included in the differential diagnosis for patients presenting with new symptoms, particularly older adults and those who started a new medication in the preceding 12 months.

show abstract

High‐throughput screening for prescribing cascades among real world statin initiators

Vouri

Morris

Walsh

et al. 2023

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

Purpose Statins are among the most prevalent medications prescribed and associated with adverse events that may prompt additional treatment (i.e., a prescribing cascade). No comprehensive assessment of statin‐related prescribing cascades has been performed to our knowledge. Methods We utilized sequence symmetry analysis to iteratively screen prescribing sequences of all therapeutic classes (“marker” classes) based on Level 4 Anatomical Therapeutic Chemical codes among adult statin initiators, using IBM Marketscan commercial and Medicare supplemental claims databases (2005–2019). Order of initiation and secular trend‐adjusted sequence ratios were calculated for each statin‐marker class dyad, among marker class initiators ±90 days of statin initiation. Among signals classified as prescribing cascades, we calculated naturalistic number needed to harm (NNTH) within 1 year as the inverse of the excess risk among exposed. Results We identified 2 265 519 statin initiators (mean ± SD age, 56.4 ± 12.0 years; 48.7% women; 7.5% with cardiovascular disease). Simvastatin (34.4% of statin initiators) and atorvastatin (33.9%) were the most commonly initiated statins. We identified 160 significant statin‐marker class dyad signals, of which 35.6% (n = 57) were classified as potential prescribing cascades. Of the top 25 strongest signals (lowest NNTH), 12 were classified as potential prescribing cascades, including osmotically acting laxatives (NNTH, 44, 95% CI 43–46), opioids + non‐opioid combination analgesics (81, 95% CI 74–91), and first‐generation cephalosporins (204, 95% CI 175–246). Conclusions Using high‐throughput sequence symmetry analysis screening, we identified previously known prescribing cascades as well as potentially new prescribing cascades based on known and unknown statin‐related adverse events.

show abstract

Exploring New Zealand prescription data using sequence symmetry analyses for predicting adverse drug reactions

Cited by 11 publications

References 23 publications

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Continued potassium supplementation use following loop diuretic discontinuation in older adults: An evaluation of a prescribing cascade relic

Prescribing cascades in community‐dwelling adults: A systematic review

High‐throughput screening for prescribing cascades among real world statin initiators

Contact Info

Product

Resources

About