Pharmacoepidemiology and Drug Safety最新文献

{"title":"Antihypertensive Past Adherence Trajectories and Risk of Cardiotoxicity Among Adults Initiating Anthracycline Treatment.","authors":"Udim Damachi, Eberechukwu Onukwugha, Manu Murali Mysore, Wendy Camelo Castillo","doi":"10.1002/pds.70318","DOIUrl":"10.1002/pds.70318","url":null,"abstract":"<p><strong>Background: </strong>Poor blood pressure control and low adherence to antihypertensives increase the risk for anthracycline-induced cardiotoxicity (AIC) in hypertensive cancer patients. Little is known about whether past adherence to antihypertensive medications can reduce the risk of AIC in patients initiating anthracyclines. We examined adherence to antihypertensives pre-anthracycline initiation and its association with the risk of AIC.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using a 25% random sample of IQVIA PharMetrics Plus for Academics US health plan claims, 2006-2022. We identified individuals 18- 64 years old, with hypertension, diagnosed with breast cancer or lymphoma (Hodgkin's or Non-Hodgkin's) 9 months before the anthracycline treatment initiation (index date). Group-based trajectory modeling was used to estimate latent subgroups of antihypertensive adherence before the index date, using monthly proportions of days covered over the 9 months (baseline). Using Cox regression models, we examined the risk of AIC in the 12 months after the index date.</p><p><strong>Results: </strong>We identified four distinct antihypertensive adherence trajectory groups in the baseline period. In the adjusted model, the risk of AIC was higher in the early decline group (hazard ratio [HR] = 1.67, 95% CI [1.11-2.49]) and the moderate adherence (HR = 1.62, 95% CI [1.16-2.26]) groups compared to the near-perfect adherence group. Comorbidities associated with an increased risk of AIC include diabetes and chronic kidney failure.</p><p><strong>Conclusion: </strong>Poor adherence to antihypertensives prior to anthracycline use was associated with AIC. Future studies should explore whether select antihypertensive classes are more cardioprotective than others.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70318"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12815894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146003817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Polypharmacy and Socioeconomic and Demographic Factors in Adults Aged 50 Years and Older by Brazilian Macroregions.","authors":"Orlando Luiz Do Amaral Juniot, Thiago André Carniel, Vanessa da Silva Corralo, Fátima Kremer Ferretti, Clodoaldo Antônio De Sá","doi":"10.1002/pds.70307","DOIUrl":"10.1002/pds.70307","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the proportions of polypharmacy in the macroregions of Brazil, considering socioeconomic and demographic factors and their associations.</p><p><strong>Methods: </strong>A cross-sectional analysis was conducted using data from the second wave (2019-2021) of ELSI-Brazil. The outcome was self-reported polypharmacy. Independent variables included sociodemographic, health, and behavioral factors, such as diabetes and hypertension. Descriptive analyses incorporated sample weights, and Poisson regression was employed to assess associations between polypharmacy and the independent variables. Analyses were stratified by the five macroregions of Brazil: North, Northeast, Southeast, South, and Central-West.</p><p><strong>Results: </strong>The study included 6917 participants aged 50 years or older. Differences in polypharmacy prevalence were observed across Brazilian macroregions. In the Central-West, polypharmacy was less frequent among rural residents (PR = 0.84; 95% CI: 0.82-0.85) than among urban residents. In the North, polypharmacy was more frequent among non-white individuals (PR = 1.08; 95% CI: 1.02-1.15) and less frequent among Black individuals (PR = 0.92; 95% CI: 0.88-0.96) compared with white individuals. In the Southeast and South, polypharmacy was more frequent among adults aged 80 years or older (PR = 1.14; 95% CI: 1.08-1.19 and PR = 1.17; 95% CI: 1.08-1.27, respectively) than among younger groups. Although no formal statistical comparisons between regions were performed, the observed estimates and their confidence intervals indicate regional variation in polypharmacy.</p><p><strong>Conclusion: </strong>This study identified regional disparities in polypharmacy prevalence across Brazil's macroregions, influenced by factors such as age, chronic conditions, and socioeconomic status. Strengthening primary care, promoting rational medication use, addressing inequalities, and integrating prevention strategies are crucial to mitigating its negative impacts.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70307"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12859391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146093777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Effectiveness of Levonorgestrel Implant and Depot Medroxyprogesterone Acetate Injectable for Women Living With HIV on Dolutegravir-Based Antiretroviral Therapy.","authors":"Katie R Mollan, Brian W Pence, Daniel Westreich, Agatha Bula, Clara Lemani, John Chapola, Sam Phiri, Jane Chiwoko, Michael G Hudgens, Lameck Chinula, Mina C Hosseinipour, Karen Diepstra, Jennifer Winston, Jill M Hagey, Mackenzie Cottrell, Michele Jonsson Funk, Audrey Pettifor, Jennifer H Tang","doi":"10.1002/pds.70297","DOIUrl":"10.1002/pds.70297","url":null,"abstract":"<p><strong>Background: </strong>Dolutegravir (DTG)-based antiretroviral treatment (ART) is broadly prescribed to treat HIV. Effective family planning methods are important for the health of women with HIV (WWH) and their families. For WWH on DTG-based ART, we compared the typical-use effectiveness of levonorgestrel (LNG) implant and Depot-Medroxyprogesterone-Acetate (DMPA) injectable, two commonly used contraceptive methods.</p><p><strong>Methods: </strong>We analyzed a prospective cohort study conducted in Lilongwe, Malawi from 2017 to 2021. Eligible participants were WWH ages 18-40 years who desired not to get pregnant for ≥ 4 years and chose to initiate either LNG implant or provider-administered DMPA injectable 0-28 days before study enrollment. Incident pregnancies were measured by urine pregnancy testing and pregnancy diagnoses at study visits every 24 weeks. The parametric g-formula was applied to estimate the contraceptive effectiveness of LNG implant compared to provider-administered DMPA injectable, assuming the entire study cohort had used DTG-based ART throughout. Contraceptive effectiveness was measured during typical, continued use.</p><p><strong>Results: </strong>Overall, 1359 eligible participants were enrolled. At enrollment, the median age was 30 (IQR: 26, 34), and 63% were breastfeeding. With DTG-based ART, the estimated 96-week pregnancy risk was 0.5% with LNG implant and 8.9% with DMPA injectable. The estimated 192-week pregnancy risk was 2.6% with LNG implant and 16.1% with DMPA injectable (risk difference: -13.5 percentage points, 95% CI: -20.1%, -7.5%).</p><p><strong>Conclusions: </strong>For WWH on DTG-based ART who are seeking reversible contraception, the LNG implant is an effective contraceptive and has substantially higher effectiveness than provider-administered DMPA injectables.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70297"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling the Gaps in Health Data: Using a Machine Learning Approach to Augment Partially Observed Variables Such as Smoking in Claims Data.","authors":"Stefan Franzen, Evangelos Chandakas, Sam Hillman, Kirsty Rhodes, Clementine Nordon","doi":"10.1002/pds.70322","DOIUrl":"10.1002/pds.70322","url":null,"abstract":"<p><strong>Purpose: </strong>Missing information is common in real-world claims data, particularly on behavioral confounders, for example, smoking. Often one category of the variable, \"yes\" is partially observed while the other \"no\" remains completely missing-a pattern we call missing with truncation. A common way to handle these missing values is to naïvely treat missing values as absence of the risk factor, which may lead to substantial misclassification. Standard multiple imputation is impossible as only one level of the variable is observed.</p><p><strong>Methods: </strong>A case study was conducted using data from the NOVELTY study, including 12 224 people with physician diagnosed asthma and/or COPD (NCT02760329). From this cohort, 9733 patients with complete information were included. This dataset was split into two where the first part was used to train an imputation model and the second part was used to evaluate the imputations based on the model (1) when used to impute a truncated and amputated smoking variable against the naïvely classifying missing as \"no\" (2) when varying the percent smokers retained, q.</p><p><strong>Results: </strong>The accuracy of approaches (1) and (2) was 0.79 and 0.43, respectively; for q = 90%, the accuracy of approaches (1) and (2) was 0.89 and 0.94, respectively. Transfer learning showed better accuracy than the naïve approach when the percentage of true smokers being recorded as smokers was < 80%.</p><p><strong>Conclusions: </strong>The added value of transfer learning was greatest when low proportions of true ever-smokers were recorded, with its advantage depending on both the true prevalence of true smokers and the predictive model's performance.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70322"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 Restrictions on Nationwide Antipsychotic Use: Results From the Trends in Drug Utilization During COVID-19 Pandemic in Turkey (PANDUTI-TR) Study.","authors":"Caner Vizdiklar, Volkan Aydin, Hakan Yilmaz, Ahmet Akici","doi":"10.1002/pds.70336","DOIUrl":"https://doi.org/10.1002/pds.70336","url":null,"abstract":"<p><strong>Introduction: </strong>The extraordinary circumstances due to the COVID-19 pandemic and related restrictions altered the management of mental health disorders, including the use of antipsychotics. We aimed to examine the changes in antipsychotic utilization and expenditure in Turkey throughout pandemic-associated restriction periods.</p><p><strong>Methods: </strong>Nationwide drug sales and projected prescribing data from 01.03.2018 to 31.12.2022 were obtained from IQVIA Turkey. We assessed average monthly consumption, expenditure, and quarterly prescribing levels across three periods: \"before restrictions\" (BfR, 01.03.2018-31.03.2020), \"during restrictions\" (DuR, 01.04.2020-31.03.2022), and \"after restrictions\" (AfR, 01.04.2022-31.12.2022). Consumption and prescribing levels were measured using \"defined daily dose/1000 inhabitants/day\" (DID) parameter.</p><p><strong>Results: </strong>Antipsychotic consumption throughout periods increased from 8.4 ± 0.6 DID in BfR to 9.9 ± 1.6 DID in DuR (p < 0.001), and to 10.1 ± 0.9 DID in AfR (p < 0.001 vs. BfR). Atypical antipsychotics followed the overall trend, whereas typical antipsychotics remained stable from DuR to AfR, deviating from this pattern. Antipsychotic expenditure rose from €16.7 m ± 1.1 m in BfR to €19.0 m ± 2.7 m in DuR (p < 0.001), then shifted to €18.3 m ± 1.9 m in AfR (p > 0.05 vs. BfR and DuR). High-cost antipsychotic use increased after the pandemic onset (p < 0.001) and remained elevated in AfR (p < 0.001). Prescribing for schizophrenia declined from 2.2 ± 0.3 DID in BfR to 1.3 ± 0.2 DID in DuR (p < 0.001), then escalated to 1.8 ± 0.3 DID in AfR (p = 0.015 vs. DuR).</p><p><strong>Conclusions: </strong>Our study revealed an upsurge in antipsychotic utilization in Turkey with the start of the pandemic. A range of factors may have contributed, notably the impact of policies facilitating the dispensing of chronic medications without prescription or a tendency towards polypharmacy.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70336"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitudes and Sources of Information About Adverse Drug Reactions-A Survey Study Among Patients and Healthcare Professionals in Poland.","authors":"Magdalena Niedzielko, Iwona Kiersnowska, Lucyna Kwiećkowska, Agata Maciejczyk, Marcin Kruk, Anna Arcab, Monika Trojan, Anastazja Markowska, Alicja Baranowska, Dagmara Mirowska-Guzel","doi":"10.1002/pds.70312","DOIUrl":"10.1002/pds.70312","url":null,"abstract":"<p><strong>Purpose: </strong>Our study aimed to investigate the knowledge, attitudes, and information sources about adverse drug reactions (ADRs) among healthcare professionals (HCPs) and non-healthcare professionals (non-HCPs) in Poland.</p><p><strong>Methods: </strong>A self-administered questionnaire was designed in two versions (non-HCPs and HCPs). The questionnaire, available in electronic and paper format, was distributed between August 2023 and April 2024 using various means, including HCP and patient organisations, senior citizens centres, and community pharmacies. The anonymous survey included a series of statements regarding ADRs and single- and multiple-choice questions.</p><p><strong>Results: </strong>Answers collected from 981 non-HCPs and 481 HCPs were analysed. Most respondents correctly identified the essential aspect of the ADR definition regardless of their medical education (non-HCP, n = 700 (71.36%) vs. HCP, n = 346 (71.93%) p = 0.818). Still, few respondents in both groups identified additional elements of the definition, with less than one-third of HCP respondents believing an ADR can result from improper medication use (non-HCP, n = 338 (34.45%) vs. HCP, n = 128 (26.61%) p = 0.002). Most respondents did not identify a \"common ADR\" as defined in the current rules of communicating about the frequency of ADRs. Most respondents indicate a lack of specific information in summary of product characteristics or package leaflet, with only 15.46% (n = 226) stating that they believe nothing is missing from those resources.</p><p><strong>Conclusions: </strong>Our survey results show the need to effectively educate HCPs and non-HCPs on ADRs. Exploring ways to communicate about ADRs may help patients and HCPs better understand the risks of pharmacotherapy and their role in the pharma covigilance system.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70312"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146086685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Demystifying Clone-Censor-Weighting to Studying Treatment Initiation Windows: An Example Using Publicly Available Synthetic Medicare Claims Data\".","authors":"","doi":"10.1002/pds.70334","DOIUrl":"https://doi.org/10.1002/pds.70334","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70334"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-Dimensional Propensity Scores for Mitigating Confounding: Implementation Using Primary and Secondary Care Data in Hong Kong.","authors":"Edmund C L Cheung, Min Fan, Celine S L Chui, Angel Y S Wong, John Tazare","doi":"10.1002/pds.70326","DOIUrl":"10.1002/pds.70326","url":null,"abstract":"<p><strong>Purpose: </strong>Confounding is a key concern in observational studies using healthcare databases. The high-dimensional propensity score (HDPS) algorithm is an approach for generating and prioritising proxy variables, leveraging all available information in a database to mitigate residual confounding. This study aims to implement HDPS approaches in a novel setting using primary and secondary data available from Hong Kong (HK).</p><p><strong>Methods: </strong>Using data from HK, we implemented HDPS in a cohort study investigating the use of different antihypertensive drug classes and incident dementia risk. The top 250 HDPS covariates were included in inverse probability of treatment weighting in addition to investigator-specified variables. Diagnostics evaluated the performance of the HDPS. Sensitivity analyses included varying the number of HDPS covariates and removing potentially influential or inappropriate covariates.</p><p><strong>Results: </strong>434 506 new-users of antihypertensives were included. With a traditional PS approach, no evidence for an association was observed for each antihypertensive comparison. After HDPS implementation, the estimate for beta-blockers shifted from no evidence (Hazard ratio (HR): 0.93, 95% confidence interval (CI): 0.86-1.02) to moderate evidence of a reduced hazard of incident dementia compared to angiotensin-converting enzyme inhibitors (HR: 0.90, 95% CI: 0.82-0.98). A greater overall covariate balance between comparison groups was achieved after the inclusion of HDPS covariates and potential frailty markers were identified as influential.</p><p><strong>Conclusions: </strong>We successfully implemented the HDPS in HK data, observing improved covariate balance across a wider set of potential confounders. HDPS also identified possible database-specific frailty markers which could be considered more widely when specifying adjustment variables in this setting.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 2","pages":"e70326"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12833473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GP Consultations for Venous Thromboembolism (VTE) After mRNA and Adeno-Vector-Based COVID-19 Vaccination-An Exposure-Anchored Self-Controlled Cohort Study Based on Primary Healthcare Data From the Netherlands.","authors":"R Jajou, E P van Puijenbroek, K Hek, J A Overbeek, F P A M van Hunsel, Erik Mulder, A C Kant","doi":"10.1002/pds.70317","DOIUrl":"10.1002/pds.70317","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) is labeled as an adverse effect of the adeno-vector-based vaccines AstraZeneca and Johnson & Johnson. We aimed to study whether there was an increase in general practitioner (GP) consultations for VTE after COVID-19 vaccination.</p><p><strong>Methods: </strong>An exposure-anchored self-controlled cohort study was performed among COVID-19 vaccinated persons aged ≥ 12 years who were registered in the PHARMO Data Network and Nivel Primary Care Database in the Netherlands. The focal window was set at 28 days after each COVID-19 vaccination and the referent window at all time outside the focal window. Adjusted incidence rate ratios (aIRR), adjusting for SARS-CoV-2 infection, were calculated using Poisson regression.</p><p><strong>Results: </strong>In total, 2 133 853 persons were included. The highest increase in GP consultations for VTE was observed after Johnson & Johnson vaccination (aIRR: 3.14, 95% CI: 1.50-6.57), and a slight increase after Pfizer/BioNTech dose 1 (aIRR: 1.24, 95% CI: 1.09-1.40). Risk groups were 12-60 year-olds with increased GP consultations for VTE after Johnson & Johnson (aIRR: 2.30, 95% CI: 1.44-3.69) and Pfizer/BioNTech (aIRR: 1.29, 95% CI: 1.11-1.50), and in specific groups of males aged 12-60 years. Also, females using hormone-containing contraceptives or hormone replacement therapy (HRT) showed increased GP consultations for VTE after AstraZeneca (aIRR: 2.87, 95% CI: 1.13-7.33) and Pfizer/BioNTech (aIRR: 1.48, 95% CI: 1.10-2.01).</p><p><strong>Conclusion: </strong>Increased GP consultations for VTE were observed after both vector and mRNA vaccination, in particular among males, 12-60 year olds, and females using hormone-containing contraceptives or HRT.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 1","pages":"e70317"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence of Potential Prescribing Cascades After Hospital Discharge: A Cohort Study.","authors":"Atiya K Mohammad, Johanna H M Driessen, Jacqueline G Hugtenburg, Alex Marmorale, Carl Siegert, Patricia M L A van den Bemt, Petra Denig, Fatma Karapinar-Çarkıt","doi":"10.1002/pds.70305","DOIUrl":"10.1002/pds.70305","url":null,"abstract":"<p><strong>Purpose: </strong>A prescribing cascade (PC) occurs when a medication (index) causes an adverse drug reaction (ADR), which is addressed by prescribing additional medication (marker). Medication initiated in the hospital may cause post-discharge ADRs and PCs, especially when multiple healthcare providers are involved. The study aimed to assess the cumulative incidence of potential PCs post-discharge and identify the healthcare providers involved in prescribing the marker medication.</p><p><strong>Methods: </strong>A cohort study was conducted among adult patients admitted in one hospital between 2019 and 2023, who initiated medication associated with preselected PCs (n = 20). A PC was defined as the initiation of a marker medication which may be intended to treat an ADR induced by the index medication. Data from the hospital and the Nationwide Medication Record System were used to identify potential PCs post-discharge. The primary outcome was the cumulative incidence of PCs, estimated for PCs with ≥ 10 patients initiating the index medication. The secondary outcome was the percentage of cases where the marker medication was prescribed by a healthcare provider outside the hospital, for PCs with ≥ 10 patients initiating the marker medication. Descriptive statistics were used.</p><p><strong>Results: </strong>Among 24 282 patients initiating index medication, 502 potential PCs were observed. The cumulative incidence was estimated for 17 PCs, ranging from 0% to 12.3%. Across 12 PCs with ≥ 10 patients, percentages of marker medications prescribed outside the hospital ranged from 31.8% to 92.8%.</p><p><strong>Conclusion: </strong>The cumulative incidence of potential PCs post-discharge can be substantial with marker medication often initiated by healthcare providers outside the hospital.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 1","pages":"e70305"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145906398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}