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Metabolites
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Clinical Utility of Applying PGx and Deprescribing-Based Decision Support in...
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Clinical Utility of Applying PGx and Deprescribing-Based Decision Support in Polypharmacy

A special issue of Metabolites (ISSN 2218-1989). This special issue belongs to the section "Pharmacology and Drug Metabolism".

Deadline for manuscript submissions: closed (15 March 2021) | Viewed by 10381

Special Issue Editors

Dr. Niels Westergaard

E-Mail Website
Guest Editor
University Colleges Absalon, Parkvej 190, 4700 Naestved, Denmark
Interests: drug consumption; cytochrome P450; polypharmacy; pharmacogenomics, drug–drug and drug‐gene interactions
Special Issues, Collections and Topics in MDPI journals
Dr. Charlotte Vermehren

E-Mail Website
Guest Editor
Department of Clinical Pharmacology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
Interests: polypharmacy; multimorbidity; medication review; deprescribing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Polypharmacy is a necessary and important aspect of drug treatment, but it becomes a challenge when the medication risks outweigh the benefits for the individual patient. Drug‐drug interactions and the introduction of prescribing cascades are common features of polypharmacy, which can lead to a lack of effect and increased risk of adverse drug reactions (ADR). Genes encoding CYP450 isozymes and other drug-related biomarkers have attracted considerable attention as targets for pharmacogenomics (PGx) testing due to their impact on drug metabolism and response. This Special Issue is devoted to exploring the status and initiatives taken to circumvent lack of effect and increase in ADRs in polypharmacy patients. Specific areas include, but are not limited to, drug–drug interactions on the metabolism of drugs and consequences on therapeutic management including PK and PD-profiling, the application of PGx-based guiding and/or decision tools for drug‐gene and drug‐drug gene interactions, development of drug interaction trackers dealing with these issues, drivers and barriers to overcoming these issues for successful implementation in the healthcare system and cost-effectiveness of PGx guided treatment. The use, development, and application of deprescribing tools in focused medication reviews are also welcome. Finally, we also invite manuscripts with innovative and new approaches to deal with the challenges of polypharmacy within the frame of this Special Issue.

Dr. Niels Westergaard
Dr. Charlotte Vermehren
Guest Editors

Manuscript Submission Information

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Keywords

  • polypharmacy
  • drug‐gene and drug‐drug gene interactions
  • PGx based biomarkers in drug metabolism and response
  • drug metabolism
  • pharmacokinetic and pharmacodynamic profiling and interactions
  • PGx-testing
  • deprescribing
  • cost-effectiveness of PGx-guided treatments

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Published Papers (3 papers)

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14 pages, 280 KiB  
Article
A Collaborative Deprescribing Intervention in a Subacute Medical Outpatient Clinic: A Pilot Randomized Controlled Trial
by Anissa Aharaz, Jens Henning Rasmussen, Helle Bach Ølgaard McNulty, Arne Cyron, Pia Keinicke Fabricius, Anne Kathrine Bengaard, Hayley Rose Constance Sejberg, Rikke Rie Løvig Simonsen, Charlotte Treldal and Morten Baltzer Houlind
Metabolites 2021, 11(4), 204; https://doi.org/10.3390/metabo11040204 - 30 Mar 2021
Cited by 12 | Viewed by 3030
Abstract
Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention [...] Read more.
Medication deprescribing is essential to prevent inappropriate medication use in multimorbid patients. However, experience of deprescribing in Danish Subacute Medical Outpatient Clinics (SMOCs) is limited. The objective of our pilot study was to evaluate the feasibility and sustainability of a collaborative deprescribing intervention by a pharmacist and a physician to multimorbid patients in a SMOC. A randomized controlled pilot study was conducted, with phone follow-up at 30 and 365+ days. A senior pharmacist performed a systematic deprescribing intervention using the Screening Tool of Older Persons’ potentially inappropriate Prescriptions (STOPP) criteria, the Danish deprescribing list, and patient interviews. A senior physician received the proposed recommendations and decided which should be implemented. The main outcome was the number of patients having ≥1 medication where deprescribing status was sustained 30 days after inclusion. Out of 76 eligible patients, 72 (95%) were included and 67 (93%) completed the study (57% male; mean age 73 years; mean number of 10 prescribed medications). Nineteen patients (56%) in the intervention group and four (12%) in the control group had ≥1 medication where deprescribing status was sustained 30 days after inclusion (p = 0.015). In total, 37 medications were deprescribed in the intervention group and five in the control group. At 365+ days after inclusion, 97% and 100% of the deprescribed medications were sustained in the intervention and control groups, respectively. The three most frequently deprescribed medication groups were analgesics, cardiovascular, and gastrointestinal medications. In conclusion, a collaborative deprescribing intervention for multimorbid patients was feasible and resulted in sustainable deprescribing of medication in a SMOC. Full article
(This article belongs to the Special Issue Clinical Utility of Applying PGx and Deprescribing-Based Decision Support in Polypharmacy)
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11 pages, 425 KiB  
Article
Use of Clopidogrel and Proton Pump Inhibitors Alone or in Combinations in Persons with Diabetes in Denmark; Potential for CYP2C19 Genotype-Guided Drug Therapy
by Niels Westergaard, Lise Tarnow and Charlotte Vermehren
Metabolites 2021, 11(2), 96; https://doi.org/10.3390/metabo11020096 - 10 Feb 2021
Cited by 8 | Viewed by 3400
Abstract
Background: Clopidogrel and proton pump inhibitors (PPIs) are among the most used drugs in Denmark for which there exists pharmacogenomics (PGx)-based dosing guidelines and FDA annotations. In this study, we further scrutinized the use of clopidogrel and PPIs when prescriptions were redeemed from [...] Read more.
Background: Clopidogrel and proton pump inhibitors (PPIs) are among the most used drugs in Denmark for which there exists pharmacogenomics (PGx)-based dosing guidelines and FDA annotations. In this study, we further scrutinized the use of clopidogrel and PPIs when prescriptions were redeemed from Danish Pharmacies alone or in combination in the Danish population and among persons with diabetes in Denmark. The focus deals with the potential of applying PGx-guided antiplatelet therapy taking both drug–drug interactions (DDI) and drug–gene interactions (DGI) into account. Methods: The Danish Register of Medicinal Product Statistics was the source to retrieve consumption data. Results: The consumption of PPIs and clopidogrel in terms of prevalence (users/1000 inhabitants) increased over a five-year period by 6.3% to 103.1 (PPIs) and by 41.7% to 22.1 (clopidogrel), respectively. The prevalence of the use of clopidogrel and PPIs in persons with diabetes are 3.8 and 2.1–2.8 times higher compared to the general population. When redeemed in combination, the prevalence increased to 4.7. The most used combination was clopidogrel and pantoprazole. Conclusions: The use of clopidogrel and PPIs either alone or in combination is quite widespread, in particular among the elderly and persons with diabetes. This further supports the emerging need of accessing and accounting for not only DDI but also for applying PGx-guided drug therapy in clinical decision making for antiplatelet therapy with clopidogrel having a particular focus on persons with diabetes and the elderly. Full article
(This article belongs to the Special Issue Clinical Utility of Applying PGx and Deprescribing-Based Decision Support in Polypharmacy)
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12 pages, 497 KiB  
Systematic Review
The Barriers and Facilitators of Different Stakeholders When Deprescribing Benzodiazepine Receptor Agonists in Older Patients—A Systematic Review
by Anja Fog Rasmussen, Sarah Sonne Poulsen, Lykke Ida Kaas Oldenburg and Charlotte Vermehren
Metabolites 2021, 11(4), 254; https://doi.org/10.3390/metabo11040254 - 20 Apr 2021
Cited by 16 | Viewed by 3219
Abstract
Treatment of older patients with benzodiazepines and Z-drugs (BZRA) is associated with an increased risk of side effects. However, this treatment is still used among these patients. Deprescribing can be a tool to reduce inappropriate medication. This review aims to identify and compare [...] Read more.
Treatment of older patients with benzodiazepines and Z-drugs (BZRA) is associated with an increased risk of side effects. However, this treatment is still used among these patients. Deprescribing can be a tool to reduce inappropriate medication. This review aims to identify and compare barriers and facilitators of stakeholders involved in BZRA deprescribing in older patients and uncover potential gaps in the research field. The search was conducted in PubMed, EMBASE, PsycINFO, and Cochrane Library. Ten articles based on qualitative data on BZRA deprescribing in older patients (≥65 years) published between 2005–2020 were included. Six articles referred to patients as stakeholders, two referred to physicians, and one to nurses and caregivers, respectively, indicating a need for more studies in the field. More barriers than facilitators were identified. Important findings were the patient willingness to deprescribe BZRA compared to physicians, who did not mention deprescribing to patients due to barriers such as expected patient resistance. Nurses mentioned barriers like lack of knowledge and the feeling that their options were not valued by physicians; education was found to be a shared deprescribing facilitator among the stakeholders. Being aware of deprescribing barriers and facilitators can be helpful in future successful deprescribing interventions. Full article
(This article belongs to the Special Issue Clinical Utility of Applying PGx and Deprescribing-Based Decision Support in Polypharmacy)
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