Medication-related hospitalisations in patients with SLE.

IF 3.7 2区医学 Q1 RHEUMATOLOGY

Lupus Science & Medicine Pub Date : 2025-01-30 DOI:10.1136/lupus-2024-001362

Michèle Stanciu, Joo-Young Esther Lee, Emily G McDonald, Gregory Clark, Christian A Pineau, Fares Kalache, Louis-Pierre Grenier, Évelyne Vinet, Sasha Bernatsky, Arielle Mendel

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Abstract

Objectives: Patients with SLE take multiple medications. Within a large prospective longitudinal SLE cohort, we characterised medication-related hospitalisations and their preventability.

Methods: We identified consecutive admissions to our tertiary hospitals between 2015 and 2020. Two independent adjudicators evaluated if medication-related events contributed to the hospitalisation, considering (1) adverse drug events (ADEs) and (2) events from medication non-adherence, using the Leape and Bates method. We classified ADEs as potentially preventable/ameliorable if we identified modifiable factors. Logistic regressions with generalised estimating equations evaluated associations between participant characteristics and medication-related hospitalisations, accounting for repeat hospitalisations within the same participant.

Results: We studied 68 hospitalisations among 45 participants (91% female). At first hospitalisation, the median age was 38 years (IQR 26.5-53.0) and median SLE duration was 12 years (IQR 5.5-19.5). One or more ADEs contributed to 20 (29%) hospitalisations (11/23 (48%) ADEs being preventable/ameliorable), and SLE flares associated with medication non-adherence contributed to 7 (10%) hospitalisations. Adjusting for age and sex, current prednisone use (adjusted OR (aOR) 3.7, 95% CI 1.1 to 13.0) or ≥1 current immunosuppressant (aOR 11.5, 95% CI 2.7 to 50.0), renal involvement at SLE diagnosis (aOR 6.5, 95% CI 2.7 to 15.7) and polypharmacy (≥5 medications; aOR 11.3, 95% CI 1.2 to 103.8) were associated with having an ADE-related (vs non-ADE) hospitalisation. Age at SLE diagnosis<18 years (OR 5.9, 95% CI 1.3 to 26.6) was associated with hospitalisation for a flare related to non-adherence.

Conclusion: Forty per cent of SLE hospitalisations were medication-related, while half were potentially preventable/ameliorable. Renal involvement, polypharmacy, prednisone and immunosuppressant use were associated with hospitalisation related to an ADE, highlighting a vulnerable group.

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SLE患者的药物相关住院

目的：SLE患者需要多种药物治疗。在一个大型前瞻性纵向SLE队列中，我们描述了与药物相关的住院治疗及其可预防性。方法：选取2015 - 2020年在我院三级医院连续就诊的患者。两名独立评审员使用Leape和Bates方法评估药物相关事件是否导致住院，考虑(1)药物不良事件（ADEs）和(2)药物不依从性事件。如果我们确定了可改变的因素，我们将ade分类为潜在的可预防/可改善的。使用广义估计方程的Logistic回归评估了参与者特征与药物相关住院之间的关联，并考虑了同一参与者的重复住院。结果：我们研究了45名参与者中68名住院患者（91%为女性）。首次住院时，患者年龄中位数为38岁（IQR为26.5-53.0），SLE病程中位数为12年（IQR为5.5-19.5）。一个或多个不良反应导致20例（29%）住院（11/23例（48%）不良反应是可预防/可改善的），与药物依从性不相关的SLE发作导致7例（10%）住院。调整年龄和性别、目前使用强的松（调整后的OR (aOR) 3.7, 95% CI 1.1至13.0）或≥1种当前免疫抑制剂（aOR 11.5, 95% CI 2.7至50.0）、SLE诊断时肾脏受累（aOR 6.5, 95% CI 2.7至15.7）和多种药物(≥5种药物；aOR 11.3, 95% CI 1.2 - 103.8)与ade相关（与非ade相关）住院相关。结论：40%的SLE住院与药物有关，而一半是可以预防/改善的。肾脏受累、多药、强的松和免疫抑制剂的使用与ADE相关的住院相关，突出了一个弱势群体。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lupus Science & Medicine RHEUMATOLOGY-

CiteScore

5.30

自引率

7.70%

发文量

审稿时长

15 weeks

期刊介绍： Lupus Science & Medicine is a global, peer reviewed, open access online journal that provides a central point for publication of basic, clinical, translational, and epidemiological studies of all aspects of lupus and related diseases. It is the first lupus-specific open access journal in the world and was developed in response to the need for a barrier-free forum for publication of groundbreaking studies in lupus. The journal publishes research on lupus from fields including, but not limited to: rheumatology, dermatology, nephrology, immunology, pediatrics, cardiology, hepatology, pulmonology, obstetrics and gynecology, and psychiatry.