medwireNews: Older adults with systemic lupus erythematosus (SLE) have substantially higher rates of polypharmacy than their peers in the general population, Canadian researchers report.
The team, led by Annaliese Tisseverasinghe from the University of Manitoba in Winnipeg, also found that prednisone use was associated with an increased odds of polypharmacy, and polypharmacy was associated with an increased likelihood of benzodiazepine, Z-drug (nonbenzodiazepine sedative-hypnotics eg, zopiclone, zolpidem), or opioid use.
Tisseverasinghe and co-investigators studied the medical records of 206 people aged 50 years and older (mean 62 years, 91% women) who were treated for SLE at a tertiary care rheumatology clinic in Manitoba.
Of these, 72% had chronic prescriptions for at least five different medications in the 4 months prior to the study and 35% were prescribed 10 or more drugs. Just under a third (31%) were using benzodiazepines or Z-drugs chronically and nearly a quarter (24%) were on opioids.
The rates were similar when the analysis was restricted to the 77 patients aged 65 years and older, at 74%, 34%, 34%, and 22%, respectively.
By comparison, the proportion of people aged 65 years or older receiving at least five and at least 10 drugs was substantially lower in the general population of Manitoba (30% and 4%, respectively) and Canada (35% and 6%).
After adjustment for potential confounders, the researchers found people who used prednisone were a significant 3.70 times more likely than nonusers to be taking five or more drugs and a significant 2.68 times more likely to be taking 10 or more drugs.
Of note, 28% of the study population were prednisone users.
Comorbidity was associated with significant 1.62-fold and 1.44-fold higher odds for polypharmacy with five or more and 10 or more medications, respectively.
In addition, people who lived in rural areas were twice as likely as those who did not to be taking at least five medications in the 4 months preceding chart review. The investigators describe this finding as “troubling, as it may reflect more indiscriminate or inappropriate prescribing of medications in patients with limited access to healthcare.”
Tisseverasinghe and team also discovered that, after adjustment, polypharmacy with five or more medications was associated with a significant 4.35-fold higher odds of benzodiazepine or Z-drug use and a significant 6.75-fold higher odds of opioid use.
Additionally, comorbidity was significantly associated with opioid use, at an adjusted odds ratio of 1.29, but the researchers note that the cross-sectional nature of the study meant it was not possible to “delineate the direction of causality between comorbidity and polypharmacy.”
Writing in Arthritis Care & Research, they conclude: “Future studies should be aimed at evaluating to what extent polypharmacy is appropriate versus inappropriate in SLE and its impact on SLE clinical outcomes.”
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