Background/Purpose: Polypharmacy is a strong risk factor for drug toxicity and adverse clinical outcomes, including delirium, falls, hospitalizations, and death. Polypharmacy is correlated with the prescribing of potentially inappropriate medications (PIMs) and of combining medications with adverse drug-drug interactions. Systemic lupus erythematosus (SLE) is an inflammatory disease associated with significant comorbidity and medication toxicities. While long-term treatment reduces flares and mortality, SLE patients have high rates of medication non-adherence due at least in part to polypharmacy. However, the extent of polypharmacy in this vulnerable population is not known.

We aim to gauge the following in older adults with SLE: 1.Prevalence of use of >5 and >10 prescription medications, 2. Prevalence of use of benzodiazepines and non-benzodiazepine sedative-hypnotics (Z-drugs), opioids, and antipsychotics, 3. Prevalence of concurrent use of opioids and benzodiazepines/Z-drugs, and 4. Compare patients ≥75 to <75 years of age with respect to polypharmacy and PIM use.

Methods: Adults ≥67 years old, meeting the ACR/SLICC classification for SLE seen at least once at the Health Sciences Centre (HSC) Rheumatology Clinic in the 2 years preceding chart review were included. Patients lacking data on prescriptions in the Manitoba Drug Program Information Network (DPIN), such as those from Ontario, were excluded. For each patient meeting study criteria, the DPIN was reviewed in April 2018 to document all unique medications dispensed in the preceding 4 months. Medication were categorized using the Anatomical Therapeutic Chemical (ATC) codes. Number of medications per patient, as well as the number of patients with prescriptions for one or more opioids, benzodiazepines, Z-drugs, and antipsychotics were calculated. The χ2 tests, or Fisher’s Exact Tests, where appropriate, were used to assess differences between groups, with statistical “significance” (α) predefined at the 5% level.

Results: The charts of 66 patients were reviewed, of whom 54 (48 female, 6 male; 24 ≥75 years old) met our study criteria. Of the 12 excluded, 6 were deceased, 4 were from outside Manitoba, and 2 did not meet ACR/SLICC classification for SLE. Almost 2/3 of the patients were dispensed ≥5 medications; of those ≥75 years old, close to 75% met this definition of polypharmacy. About 1/5 of all patients were dispensed benzodiazepines or Z-drugs. More than 5% were dispensed a combination of opioids and sedative-hypnotic medications. The prevalence of polypharmacy, using either definition, and opioid use, was higher in the older age group and in females, but the differences were not statistically significant (p >0.1). Those on >=5 medications (or >=10 medications) were more likely to be on one or more PIM compared to those on <5 medications.

Conclusion: This is the first study to assess and document the prevalence of polypharmacy and use of PIMs in older SLE patients. The rates of polypharmacy in our SLE cohort are just slightly higher than the 2012 rates reported for Canadian seniors on public drug programs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/polypharmacy-in-older-adults-with-systemic-lupus-erythematosus/