Polypharmacy and potentially inappropriate medication use in older patients with multiple myeloma, related to fall risk and autonomous neuropathy

Abstract

Purpose Multiple myeloma is a chronic, uncurable hematological cancer with the involvement of multiple organ systems. As a disease affecting older patients, the treatment of multiple myeloma should be based on individual patient characteristics. Polypharmacy is an increasing problem in the care of older patients and in patients with multiple myeloma, polypharmacy is almost inevitable. We aimed to evaluate the applicability of polypharmacy definitions and the relation of polypharmacy with disease outcomes in patients with multiple myeloma. Methods Eighty patients older than 65 years and diagnosed with multiple myeloma were retrospectively enrolled. Patient files, prescriptions, evaluations for polypharmacy were determined according to Beers and START/STOPP criteria. Outcomes were recorded from files in terms of fractures, autonomous neuropathy, and renal functions. Results Polypharmacy with ≥4 drugs was observed in 65 patients while polypharmacy with ≥5 drugs was observed in 51 patients. Autonomous neuropathy, polypharmacy with more than four or five medications, and use of multiple medications in the same category were related with poor ECOG performance status in women, while prolonged use of benzodiazepines and central nervous system (CNS) affecting drugs and inappropriate polypharmacy were more frequent in men with poor ECOG performance status. The majority of patients aged 75–84 years were observed to use inappropriate polypharmacy. Autonomous neuropathy and fall risk were observed to be significantly related with inappropriate polypharmacy. Conclusions Drugs affecting balance and perception should be reconsidered in patients with multiple myeloma.

Inappropriate medications and physical function: a systematic review

“…Of the 10 studies involved in the examination of inappropriate medication use and measures of functional independence, 9 demonstrated that inappropriate medication use was significantly associated with increased impediment with functional independence. 35 , 41 – 48 PIM use was associated significantly with a decrease in the Health-Related Quality-of-Life Score. 42 In one study, a lowering in the number of PIMs was associated with a significant increase in the Functional Independence Measure.…”

“… 66 In some studies, more than one tool was used. 8 , 15 , 17 , 21 , 23 – 25 , 28 , 34 , 36 , 37 , 43 , 47 – 50 , 52 , 55 , 56 , 59 Table 2 shows the associations between inappropriate medication prescriptions and physical function. Table 3 provides an illustrative summary of the associations between inappropriate medication prescriptions and physical function.…”

“…66 In some studies, more than one tool was used. 8,15,17,21,[23][24][25]28,34,36,37,43,[47][48][49][50]52,55,56,59 Table 2 shows the associations between inappropriate medication prescriptions and physical function.…”

Frailty assessment in the care of older people with haematological malignancies

“…Polypharmacy or potentially inappropriate co-medication in people with acute myeloid leukaemia and multiple myeloma has been associated with adverse outcomes, including mortality and falls, in some studies. 25,26 Other studies were unable…”

STOPP-START Medication Review: A Non-Randomized Trial in an Indonesian Tertiary Hospital to Improve Medication Appropriateness and to Reduce the Length of Stay of Older Adults

“…Medication reviews with STOPP/START improved rational drug use, prevent adverse drug events, and improve health outcome of older adults. 27 STOPP/START criteria have been used in several hospital settings for older adults with chronic kidney diseases, 32 cardiac diseases, 33 diabetes, 34 psychiatric disorders, 35,36 or multiple myeloma. 37 Medication review with STOPP/START can minimize potential prescribing omissions (PPOs), 32,34 drug-related problems (DRPs), and potentially inappropriate medications (PIMs).…”