Potentially inappropriate anticholinergic drug prescriptions for patients with Sjögren's syndrome

Abstract

Sjögren's syndrome is characterized by the involvement of exocrine glands, manifesting with xerostomia and xerophthalmia. The objective was to determine the treatment received and identify potentially inappropriate prescriptions by estimating the anticholinergic burden generated by medications in patients with Sjögren's syndrome in Colombia. This cross-sectional study was based on a population database that identified patients with Sjögren's syndrome, comorbidities, pharmacological treatment, and medications with anticholinergic properties. The anticholinergic burden was estimated using the Anticholinergic Drug Scale. A total of 4945 patients with Sjögren's syndrome were identified, with a mean age of 64.6 ± 14.04 years and 75.7% women. A total of 79.0% received a topical lubricant, with hyaluronate being the most prescribed (26.8%), while oral pilocarpine was prescribed for 7.4%. The use of biological disease-modifying antirheumatic drugs was identified in 1.3% of cases. A total of 39.1% (n = 1932) of all patients received cholinergic antagonists, especially codeine (6.5%), prednisolone (5.7%), and furosemide (5.3%). The mean anticholinergic burden was 0.91 ± 1.57 (range: 0–24), 17.2% (n = 850) had a score of 1, 7.7% (n = 381) had a score of 2, and 14.2% (n = 701) ≥3 points. Multiple comorbidities were associated with the risk of having cholinergic antagonist medication prescribed. Most patients with Sjögren's syndrome were women whose symptomatic management mainly included ocular lubricants with low use of oral pilocarpine. A large proportion of patients had at least one cholinergic antagonist drug prescribed, increasing its use risk after 40 years of age.

Patterns of use of medications used to treat urinary incontinence and potentially inappropriate prescriptions

“…In addition to the above findings, one-fifth of the patients who were prescribed antimuscarinics presented with concomitant glaucoma, constipation, sicca syndrome, dementia or prostatic hyperplasia. This is in line with other pharmacoepidemiological studies that documented that the use of antimuscarinic drugs in patients with these pathologies ranged between 22.9% and 41.0% 30 , 31 , 34 – 36 and for which drug–disease interactions could be associated with an increased risk of adverse drug reactions. 8 , 12 , 33 Therefore, the anticholinergic burden at the time of comprehensive treatment of these patients should be taken into account, 3 , 8 , 12 , 32 prolonged-release pharmaceutical forms should be preferentially used, 3 and most importantly, other therapeutic options, such as mirabegron, vaginal estrogens, or nonpharmacological interventions, should be considered.…”

Quality of Life and Oral Health in Colombian Patients with Type 2 Diabetes Mellitus

“…(8,9). It is recognized that xerostomia can cause difficulty in swallowing food, chewing, or speaking and can increase susceptibility to caries and oral infections, as well as taste disorders, halitosis, and friability of the oral mucosa in these patients (10). Regarding periodontitis, research in Colombia conrms its character as a chronic inammatory reaction to the biolm accumulated around the surfaces of the teeth, which, in the absence of adequate oral hygiene in patients with DM2, generates a greater loss of clinical attachment that contributes to the formation of periodontal pockets, is accompanied by bleeding on probing and ends with tooth loss (11).…”