Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting

Wang, Yuanyuan; Bos, Jens; Schuiling-Veninga, Catharina C M; Boezen, H. Marike; Boven, Job F M van; Wilffert, Bob

doi:10.1136/bmjopen-2020-042417

Cited by 5 publications

(6 citation statements)

References 56 publications

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“…Figure 1 shows that of 103 articles included in our previous systematic review, 18 three used the same database to investigate a single prescribing cascade at different points in time, 24–26 of which we only selected the most recent 26 . Six further studies only reported exploratory studies, 27–32 five only reported cross‐sectional studies, 5,33–36 and nine articles did not find any significant positive associations between index and marker drugs 37–45 . The remaining 81 articles reported 99 prescribing cascades (i.e., distinct combinations of index and marker drugs).…”

Section: Resultsmentioning

confidence: 99%

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Shahid,

Doherty,

Wallace

et al. 2023

Pharmacotherapy

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ImportanceThe strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized.ObjectiveTo perform a structured, systematic, and transparent review of the l evidence supporting ambulatory care prescribing cascadesDesign, setting, and participantsNinety‐four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterise prescribing cascades.Main outcome(1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I ‐ strong evidence [i.e. multiple high‐quality studies]; Level II ‐ moderate evidence [i.e. single high‐quality study]; Level III ‐ fair evidence [no high‐quality studies but one or more moderate‐quality studies]; and Level IV ‐ poor evidence [other]. (2) Listing of the adverse event associated with the index drug in the product's United States Food and Drug Administration (FDA) label. (3) Synthesis of the evidence supporting mechanisms linking index drugs and associated adverse events.ResultsOf 99 potential cascades, 94 were supported by one or more confirmatory observational studies and were therefore included in this review. The 94 cascades related to 30 types of adverse drug reactions affecting 10 different anatomic/physiologic systems and were investigated by a total of 88 confirmatory studies, including prescription sequential symmetry analysis (n=51), cohort (n=30), and case‐control (n=7) studies. Overall, the evidence from observational studies was strong for 18 (19.1%) prescribing cascades, moderate for 61 (64.9%), fair for 13 (13.8%), and poor for 2 (2.1%). Although the evidence supporting mechanisms that link index drugs and associated adverse events was variable, FDA labels included information about the adverse event associated with the index drug for most (n=86) but not all of the 94 prescribing cascades.ConclusionsAlthough we identified 18 of 94 prescribing cascades supported by strong clinical evidence and most adverse events associated with index drugs are included in FDA label, the evidentiary basis for prescribing cascades varies, with many requiring further evidence of clinical relevance.

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Section: Resultsmentioning

confidence: 99%

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Shahid,

Doherty,

Wallace

et al. 2023

Pharmacotherapy

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“… 5 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 Thirteen studies reported analyses stratified by age. 7 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 Total study sample sizes ranged from 126 45 to 11 593 989 46 participants. (See eTable 3, Appendix S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…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

“…≥60; ≥65; ≥66 years) used across studies 5,19–32 . Thirteen studies reported analyses stratified by age 7,33–44 . Total study sample sizes ranged from 126 45 to 11 593 989 46 participants.…”

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%

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Prescribing cascades in community‐dwelling adults: A systematic review

Doherty¹,

Shahid

Moriarty³

et al. 2022

Pharmacology Res & Perspec

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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.

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Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review

Adrien,

Mohammad,

Hugtenburg

et al. 2023

Drugs Aging

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Background To reduce prescribing cascades occurring in clinical practice, healthcare providers require information on the prescribing cascades they can recognize and prevent. Objective This systematic review aims to provide an overview of prescribing cascades, including dose-dependency information and recommendations that healthcare providers can use to prevent or reverse them. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. Relevant literature was identified through searches in OVID MEDLINE, OVID Embase, OVID CINAHL, and Cochrane. Additionally, Web of Science and Scopus were consulted to analyze reference lists and citations. Publications in English were included if they analyzed the occurrence of prescribing cascades. Prescribing cascades were included if at least one study demonstrated a significant association and were excluded when the adverse drug reaction could not be confirmed in the Summary of Product Characteristics. Two reviewers independently extracted and grouped similar prescribing cascades. Descriptive summaries were provided regarding dose-dependency analyses and recommendations to prevent or reverse these prescribing cascades. Results A total of 95 publications were included, resulting in 115 prescribing cascades with confirmed adverse drug reactions for which at least one significant association was found. For 52 of these prescribing cascades, information regarding dose dependency or recommendations to prevent or reverse prescribing cascades was found. Dose dependency was analyzed and confirmed for 12 prescribing cascades. For example, antipsychotics that may cause extrapyramidal syndrome followed by anti-parkinson drugs. Recommendations focused on dosage lowering, discontinuing medication, and medication switching. Explicit recommendations regarding alternative options were given for three prescribing cascades. One example was switching to ondansetron or granisetron when extrapyramidal syndrome is experienced using metoclopramide. Conclusions In total, 115 prescribing cascades were identified and an overview of 52 of them was generated for which recommendations to prevent or reverse them were provided. Nonetheless, information regarding alternative options for managing prescribing cascades was scarce. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01072-y.

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Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting

Cited by 5 publications

References 56 publications

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Prescribing cascades in ambulatory care: A structured synthesis of evidence

Prescribing cascades in community‐dwelling adults: A systematic review

Prescribing Cascades with Recommendations to Prevent or Reverse Them: A Systematic Review

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