gms | German Medical Science

27. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

26.11.2020, digital

Developing a list of anticholinergic and sedative drugs for the calculation of the Drug Burden Index in Germany

Meeting Abstract

  • author presenting/speaker Veronika Bencheva - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • author presenting/speaker Matthias Gogolin - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • author Nina-Kristin Mann - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
  • author Sven Schmiedl - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
  • corresponding author Petra A. Thürmann - Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
  • COFRAIL-Study Group

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 27. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. sine loco [digital], 26.-26.11.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20gaa06

doi: 10.3205/20gaa06, urn:nbn:de:0183-20gaa066

Veröffentlicht: 23. November 2020

© 2020 Bencheva et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Background: A large number of elderly, frail patients are exposed to polypharmacy, drug interactions and potentially inappropriate medication. Particular attention is paid to drugs with anticholinergic and sedative effects, which can lead to adverse health outcomes. The Drug Burden Index (DBI) is a tool that measures patients’ cumulative and dose-dependent exposure to anticholinergic and sedative agents [1]. In several studies, an elevated DBI was found to be associated with an increased risk of falling, frequent hospital admissions, and poorer cognitive and physical function [2]. In order to be able to calculate the DBI for drugs available in Germany, a list of all relevant drugs (COFRAIL-Drug Burden List) was developed.

Materials and methods: We performed a literature search on PubMed/MEDLINE® from inception to July 2019 to identify previously published lists of anticholinergic and sedative drugs. Anticholinergic drugs were identified on the base of the anticholinergic burden score for Germany developed by Kiesel et al. [3]. In addition, drugs with sedative effects were supplemented by review of expert information available in Germany. The minimum daily dose of all drugs was determined for each formulation. In order to ensure the consistency of the results, the list was aligned to the original work on the creation of DBI by Hilmer et al. [1]. Subsequently additional drugs were added from the list created for the DBI in the publications of Byrne et al. [4]. Finally, an expert committee consisting of two medical specialists in clinical pharmacology and two pharmacists reviewed the list and decided which drugs to include.

Results: The COFRAIL-Drug Burden List was established with a total of 197 anticholinergic and/or sedative drugs for the German drug market providing the minimum daily dose for each application form for all listed active substances as well as their Anatomical Therapeutic Chemical-Codes (ATC-Codes). Furthermore the COFRAIL-Drug Burden List contains a categorization column to support researchers and health professionals identifying the anticholinergic and/or sedative tendencies of the drugs listed.

Conclusion: The COFRAIL-Drug Burden List can be used to determine the anticholinergic and sedative drug burden for German patients. Its value in clinical practice and research will be tested in the COFRAIL study [5] and the list will be publicly available.

Funding: Funded by the innovation funds, grant number 01VSF17053.


References

1.
Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781-7.
2.
Mayer T, Meid AD, Saum KU, Brenner H, Schöttker B, Seidling HM, et al. Comparison of Nine Instruments to Calculate Anticholinergic Load in a Large Cohort of Older Outpatients: Association with Cognitive and Functional Decline, Falls, and Use of Laxatives. Am J Geriatr Psychiatry. 2017;25(5):531-40.
3.
Kiesel EK, Hopf YM, Drey M. An anticholinergic burden score for German prescribers: score development. BMC Geriatr. 2018;18(1):239.
4.
Byrne CJ, Walsh C, Cahir C, Ryan C, Williams DJ, Bennett K. Anticholinergic and sedative drug burden in community-dwelling older people: a national database study. BMJ Open. 2018;8(7):e022500.
5.
Mortsiefer A, Wilm S, Santos S, Löscher S, Wollny A, Drewelow E, et al. Family conferences and shared prioritisation to improve patient safety in the frail elderly (COFRAIL): study protocol of a cluster randomised intervention trial in primary care. Trials. 2020;21(1):285.