Background/Purpose: Polypharmacy, typically defined as ≥ 5 medications (meds),  is a strong risk factor for adverse clinical outcomes, including delirium, falls, hospitalization, and death, especially in older adults. Previously, we presented novel data on the prevalence and risk factors for polypharmacy and potentially inappropriate medications (PIMs), such as benzodiazepines and other sedative-hypnotics (BZD/Z-drugs), in older adults with SLE.  In this study we evaluate and compare polypharmacy and PIM use in all adults with SLE. Specific aims: 1.  Compare prevalence of polypharmacy [a) ≥5 and b) ≥10 meds] and PIM use [a) opioids, b) BZD/Z-drugs] between age groups (< 40 vs. ≥65, < 40 vs. ≥40, and < 65 vs. ≥65 years).   2.  Assess any association between polypharmacy, PIM use, and their potential risk factors, including age, sex, SLE duration, and rural residence.

Methods: Population:  Adults aged ≥18 years meeting ACR/SLICC SLE criteria and seen in our rheumatology clinic < 2 years ago.  For age < 50 years, every 3rd patient included. Patients lacking data in the Manitoba Drug Program Information Network (DPIN) were excluded.  Procedures:  All demographic and clinical variables were determined using data from electronic medical records. For unadjusted bi-variate analyses, we chose alpha of 5%.  Multivariable logistic regression models were constructed with inclusion of explanatory variables based on a priori clinical reasoning rather than stepwise selection.

Results: 271 patients included: 92% female, 13% < 3y SLE duration, 40% rural, 68% on ≥5 and 31% on ≥10 meds, 28% on BZD/Z-drugs, and 24% on opioids (Table 1). Prevalence of polypharmacy (≥5 meds) rose with age group (< 40 vs. 40-64 vs. ≥65 years), and was higher in women, rural residents, and SLE duration ≥3 years. Observations on ≥10 meds were similar except that sex difference was reversed (with fewer men).  Prevalence of BZD/Z-drugs increased with age, whereas opioid use peaked in 40-64 year-olds.  Prevalence of BZD/Z-drugs was higher in women, but opioid use higher in men.  Rural residents had higher prevalence of PIMs compared to urban dwellers.  The proportion of patients on BZD/Z-drugs was increased with SLE duration ≥3 years.  However, the null hypotheses that these inter-group differences are due to chance were not rejected based on our alpha (i.e. p > 0.05). In multivariable models, polypharmacy was associated with older age (OR 2.27, 95% CI 1.16-6.31 for  ≥40 vs. < 40 years for ≥5 meds ).  Opioids and BZD/Z-drugs were associated with polypharmacy (any definition) [OR 7.90 (95% CI 3.02-20.67) and 6.05 (2.63-13.96), respectively, for ≥5 meds].

Conclusion: This is the first study to investigate the prevalence and potential risk factors of polypharmacy and PIMs in SLE patients, including young adults.  According to this study, polypharmacy and PIM use are highly prevalent in SLE, and the prevalence of polypharmacy and BZD/Z-drugs appears to increase with age.  Moreover, PIM use is strongly associated with polypharmacy, independent of other patient characteristics. 

Our future goals are to include all eligible clinic patients in these analyses and to evaluate impact of polypharmacy and PIM use on SLE clinical outcomes.

Table 1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/polypharmacy-and-potentially-inappropriate-medication-use-in-young-versus-older-adults-with-sle/