Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing

Niznik, Joshua D.; Zhao, Xinhua; He, Meiqi; Aspinall, Sherrie L.; Hanlon, Joseph T.; Nace, David A.; Thorpe, Joshua M.; Thorpe, Carolyn T.

doi:10.1002/alz.12054

Cited by 12 publications

(10 citation statements)

References 48 publications

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“…Our outcome was time until the first day of a gap in ASM supply of various durations in 2016–2018 based on part D fill data. This definition used established methodology from work outside of epilepsy, which similarly used administrative claims data to evaluate the frequency of medication discontinuation [ 35 , 36 ]. Furthermore, work within epilepsy has similarly used large prescription claims to capture retention rates of ASMs [ 37 , 38 ] and patterns of ASM use [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

et al. 2022

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Background For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal. Methods This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014–2016, and no acute visit for epilepsy 2014–2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016–2018. We displayed cumulative incidence functions and identified predictors using Cox regressions. Results Among 21,819 beneficiaries, 5191 (24%) had a 30-day gap, 1753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.01–1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.37, 95% CI 1.39–4.03). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.75, 95% CI 0.60–0.95), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30–0.45), and greater baseline adherence (> 80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32–0.44). Conclusions Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.

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Section: Methodsmentioning

confidence: 99%

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

et al. 2022

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“…This de nition used established methodology from work outside of epilepsy, which similarly used administrative claims data to evaluate the frequency of medication discontinuation. (35,36) To better represent discontinuation rather than transient nonadherence,(3) we explored a range of gap durations (30,90,180, and 360 days with no re ll after the last day of the previous ASM ll).…”

Section: Variablesmentioning

confidence: 99%

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

Terman

Niznik

Slinger

et al. 2022

Preprint

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Background: For the two-thirds of patients with epilepsy who achieve seizure remission on antiseizure medications (ASMs), patients and clinicians must weigh the pros and cons of long-term ASM treatment. However, little work has evaluated how often ASM discontinuation occurs in practice. We describe the incidence of and predictors for sustained ASM fill gaps to measure discontinuation in individuals potentially eligible for ASM withdrawal.Methods: This was a retrospective cohort of Medicare beneficiaries. We included patients with epilepsy by requiring International Classification of Diseases codes for epilepsy/convulsions plus at least one ASM prescription each year 2014-2016, and no acute visit for epilepsy 2014-2015 (i.e., potentially eligible for ASM discontinuation). The main outcome was the first day of a gap in ASM supply (30, 90, 180, or 360 days with no pills) in 2016-2018. We displayed cumulative incidence functions and identified predictors using Cox regressions.Results: Among 21,819 beneficiaries, 5,191 (24%) had a 30-day gap, 1,753 (8%) had a 90-day gap, 803 (4%) had a 180-day gap, and 381 (2%) had a 360-day gap. Predictors increasing the chance of a 180-day gap included number of unique medications in 2015 (hazard ratio [HR] 1.03 per medication, 95% confidence interval [CI] 1.02-1.05) and epileptologist prescribing physician (≥25% of that physician’s visits for epilepsy; HR 2.38, 95% CI 1.42-4.00). Predictors decreasing the chance of a 180-day gap included Medicaid dual eligibility (HR 0.74, 95% CI 0.59-0.93), number of unique ASMs in 2015 (e.g., 2 versus 1: HR 0.37, 95% CI 0.30-0.45), and greater baseline adherence (>80% versus ≤80% of days in 2015 with ASM pill supply: HR 0.38, 95% CI 0.32-0.44).Conclusions: Sustained ASM gaps were rarer than current guidelines may suggest. Future work should further explore barriers and enablers of ASM discontinuation to understand the optimal discontinuation rate.

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“…For example, anti‐dementia medications were more likely to continue after hospice admission compared to other LBMs. Deprescribing anti‐dementia medications in severe dementia has been shown to be feasible with no increase of aggressive symptoms 10 . Hospice admission, which indicates that goals of care are now focused on comfort rather than prevention, may be an opportune time to evaluate the continued need of medications and consider if any are appropriate targets for deprescribing.…”

Section: Summary Of Studiesmentioning

confidence: 99%

Medication Use Quality and Safety in Older Adults: 2019 Update

Ailabouni

Marcum

Schmader

et al. 2021

J American Geriatrics Society

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Improving the quality of medication use and medication safety are important priorities for prescribers who care for older adults. The objective of this article was to identify four exemplary articles with this focus in 2019. We selected highquality studies that moved the field of research forward and were not merely replication studies. The chosen articles cover domains related to aspects of suboptimal prescribing and medication safety. The first study used a nationally representative sample of Medicare beneficiaries to examine the continuation of medications with limited benefit in patients admitted for cancer and non-cancer diagnoses in hospice (domain: potentially inappropriate medications). The second study, a retrospective cohort study of older adults in Ontario, Canada, assessed the association between prescribing oral anticoagulants in an emergency department relative to not prescribing anticoagulants in the emergency department and their persistence at 6 months (domain: underuse of medications). The third study, a cluster randomized trial in Quebec, Canada, evaluated the effect of conducting electronic medication reconciliation on several outcomes including adverse drug events and medication discrepancies (domain: medication safety). Lastly, the fourth study, a retrospective study using national inpatient and outpatient Veteran Health Administration combined with clinical and Medicare Claims data, examined the effects of intensification of antihypertensive medications on older adults' likelihood for hospital readmission and other important clinical outcomes (domain: medication safety). Collectively, this review succinctly highlights pertinent topics related to promoting safe use of medications and promotes awareness of optimizing older adults' medication regimens.

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Impact of deprescribing AChEIs on aggressive behaviors and antipsychotic prescribing

Cited by 12 publications

References 48 publications

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

Incidence of and predictors for antiseizure medication gaps in Medicare beneficiaries with epilepsy: a retrospective cohort study

Medication Use Quality and Safety in Older Adults: 2019 Update

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