不列颠哥伦比亚省老年患者不当使用质子泵抑制剂:长期不良事件有哪些?

IF 1.1 Q4 PHARMACOLOGY & PHARMACY
Mohamed Ben-Eltriki, Manik Chhabra, Alan Cassels, James M Wright
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引用次数: 0

摘要

背景:质子泵抑制剂(PPIs)是使用最多的药物类别之一。对于大多数适应症,PPIs 仅被推荐使用至 8 周。然而,PPI 的使用范围仍在不断扩大。由于存在不良反应的风险,应避免定期和长期使用 PPIs:本研究的主要目的是:(1)调查加拿大不列颠哥伦比亚省(BC)65 岁及以上老年人使用 PPI 的情况;(2)概述长期使用 PPIs 的相关危害:我们利用不列颠哥伦比亚省的配药数据库 PharmaNet(社区药剂师可通过该数据库获取信息)研究了不列颠哥伦比亚省自 2009 年以来 PPIs 的使用趋势。我们进行了全面的文献检索,以查找报道长期使用 PPIs 相关危害的相关综述。检索时间为 2014 年 1 月至 2022 年 6 月:2000 年至 2018 年间,不列颠哥伦比亚省的人口增长了 20%,但 PPIs 的使用率却上升了 257%。在这些年长的不列颠哥伦比亚人中,62%的人累计暴露时间超过2年,42%的人超过5年。这种情况令人担忧,因为对于反流性食管炎、十二指肠溃疡和胃溃疡等常见适应症,建议的治疗时间为 4-12 周。仅有 13.5% 的患者 PPI 的配药时间为 90 天或更短。应重新评估长期接受 PPI 治疗的患者。使用 PPI 的不良反应在老年人中很常见。我们发现,在过去 8 年中,有超过 217 篇系统综述发表了与长期每日使用 PPIs 相关的特定危害。这些危害包括增加死亡、心血管疾病、急性肾损伤、慢性肾病、痴呆、骨折、低镁血症、缺铁、维生素 B12 缺乏、肠道感染(包括艰难梭菌)、肺炎、肿瘤(胃癌、类癌和结肠癌)和药物相互作用的风险:本研究揭示了加拿大不列颠哥伦比亚省老年人群中 PPI 的高使用率。过度使用 PPIs 通常是由于没有重新评估继续治疗的必要性。已发表的研究发现了长期服用 PPI 会造成严重危害的信号。医护人员和患者可以通过讨论预期的益处和潜在的危害来扭转长期服用 PPI 的趋势。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Inappropriate Use of Proton Pump Inhibitor Among Elderly Patients in British Columbia: What are the Long-term Adverse Events?

Background: Proton pump inhibitors (PPIs) are one of the most used classes of drugs. For most indications, PPIs are only recommended up to 8 weeks duration. However, PPI use continues to expand. Regular and prolonged use of PPIs should be avoided because of the risk of adverse events.

Objectives: The main objective of this study was to (1) investigate the extent of PPI usage in people aged 65 or older in the province of British Columbia (BC), Canada, (2) provide an overview of the harms associated with the long-term use of PPIs.

Methods: We examined utilization trends of the PPIs in BC since the year 2009 using PharmaNet, BC's medication dispensing database where the information is accessible to community pharmacists. We performed a comprehensive literature search for relevant reviews reporting harms associated with long-term use of PPIs. A search was conducted from January 2014 to June 2022.

Results: Between 2000 and 2018 BC's population grew by 20%, but the use of PPIs escalated to 257%. Of these older British Columbians, 62% had a cumulative exposure exceeding 2 years and 42% exceeded 5 years. This is alarming because the recommended treatment duration is 4-12 weeks for common indications including reflux esophagitis, and duodenal and gastric ulcers. Only 13.5% were dispensed PPIs for 90 days or less. Patients on long-term PPI therapy should be reassessed. Adverse events of PPI use are common among older adults. We identified over 217 systematic reviews published during the last 8 years of specific harms associated with long-term daily usage of PPIs. These harms include increased risks of death, cardiovascular disease, acute renal injury, chronic kidney disease, dementia, fractures, hypomagnesemia, iron deficiency, vitamin B12 deficiency, enteric infection (including C. difficile), pneumonia, and neoplasia (gastric cancer, carcinoids, and colon cancer), and drug interactions.

Conclusion: This study revealed a high prevalence of PPI use among elderly populations in BC, Canada. The overutilization of PPIs is often a result of failure to re-evaluate the need for continuation of therapy. Published studies identified signals of serious harm from long-term PPI exposure. Healthcare providers with patients can reverse the relentless expansion of long-term PPI exposure by discussing the expected benefits and potential harms.

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来源期刊
Current drug safety
Current drug safety PHARMACOLOGY & PHARMACY-
CiteScore
2.10
自引率
0.00%
发文量
112
期刊介绍: Current Drug Safety publishes frontier articles on all the latest advances on drug safety. The journal aims to publish the highest quality research articles, reviews and case reports in the field. Topics covered include: adverse effects of individual drugs and drug classes, management of adverse effects, pharmacovigilance and pharmacoepidemiology of new and existing drugs, post-marketing surveillance. The journal is essential reading for all researchers and clinicians involved in drug safety.
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