Artikel
Efficacy and safety of drugs commonly used in the management of chronic diseases in older adults: a compilation of systematic reviews for the development of an electronic decision support tool
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Autoren
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Thekraiat Al Qur'an
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Anna Renom-Guiteras
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Yolanda Martinez
- Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
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Christina Sommerauer
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Anna Vögele
- South Tyrolean Academy for General Practice, Bozen, Italien
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Roman Schlager
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Anja Rieckert
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Maren Meinshausen
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Barbara Faller
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Sabine Weißbach
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Germaine Stern-Kuthe
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Nik Koneczny
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
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Adrine Woodham
- Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
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Neha Kaushik
- Primary Care Research Group, University of Manchester, Manchester, Vereinigtes Königreich
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Gisela Schott
- Drug Commission of the German Medical Association, Berlin, Deutschland
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Andreas Sönnichsen
- Institute of General Practice and Family Medicine, University of Witten/Herdecke, Witten, Deutschland
| Veröffentlicht: | 3. März 2015 |
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Gliederung
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Background and aims: There is a need to carefully weigh the risks and benefits of medication in older adults with multimorbidity and polypharmacy. Aims are: 1) to identify the evidence on risks and benefits of drugs commonly used in older adults; 2) to provide recommendations on their use, which can be incorporated into an electronic decision support tool (eDS-tool) aimed at supporting general practitioners to reduce inappropriate prescriptions.
Methods: A set of systematic reviews (SR) was planned for n = 24 drugs and indications. For each SR a study protocol was developed, and the PICOS-framework was used for the development of the search terms; literature search comprised three searches, each of which being undertaken only if the previous one did not yield high quality results: searches 1 and 2 identified SRs and meta-analyses in the Cochrane Database of Systematic Reviews and DARE, and in MEDLINE, EMBASE, HTA and IPA, respectively. Search 3 identified clinical trials and observational studies from SRs not included in searches 1 and 2 but containing eligible studies, and from the databases considered in search 2. Inclusion criteria: studies evaluating the risks and benefits of the corresponding drug and indication; significant number of participants aged ≥65 or subgroup analysis of this population; clinically relevant endpoints. Selection of studies, data extraction and quality appraisal were performed by two reviewers independently. Based on the evidence found the recommendations were developed using the GRADE methodology, and integrated in the eDS-tool.
Results: Currently, n = 18 SRs are completed and n = 6 SRs are ongoing. In general, the amount of studies included and the quality of the evidence are low. So far, n = 41 recommendations for the following drugs have been developed: metformin, sulfonylureas, gliptins, glitazones, non-steroidal anti-inflammatory drugs, statins, beta-blocking agents, Vitamin K antagonists, new oral anticoagulants, nitrates, calcium channel blockers, thiazides, platelet inhibitors and high ceiling diuretics.
Discussion: Our work reflects a general lack of high quality evidence regarding drug treatment of older people with multiple conditions. Recommendations are currently checked by external review and will then be integrated in the eDS-tool. The eDS-tool will be tested in a randomised controlled trial with clinically relevant endpoints. This study is part of the 7th Framework European Project PRIMA-eDS (Grant No. 305388-2).
