Pharmacoepidemiology and Prescription

European Journal of Clinical Pharmacology

, Volume 69, Issue 8, pp 1589-1597

Potentially inappropriate medication use among patients with Alzheimer disease in the REAL.FR cohort: be aware of atropinic and benzodiazepine drugs!

  • François MontastrucAffiliated withLaboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université de ToulouseLaboratoire de Santé Publique et d’Economie de la Santé, Faculté de Médecine, Université de ToulouseDépartement d’Epidémiologie, d’Economie de la Santé et de Santé Publique, Centre Hospitalier Universitaire (CHU) ToulouseService de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU Toulouse
  • , Virginie GardetteAffiliated withLaboratoire de Santé Publique et d’Economie de la Santé, Faculté de Médecine, Université de ToulouseDépartement d’Epidémiologie, d’Economie de la Santé et de Santé Publique, Centre Hospitalier Universitaire (CHU) ToulouseINSERM UMR 1027
  • , Christelle CantetAffiliated withDépartement d’Epidémiologie, d’Economie de la Santé et de Santé Publique, Centre Hospitalier Universitaire (CHU) ToulouseINSERM UMR 1027
  • , Antoine PiauAffiliated withDépartement de Médecine Interne et de Gériatrie, CHU Toulouse Purpan, Gérontopôle de Toulouse, Université de Toulouse
  • , Maryse Lapeyre-MestreAffiliated withLaboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université de ToulouseService de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU ToulouseINSERM UMR 1027
  • , Bruno VellasAffiliated withINSERM UMR 1027Département de Médecine Interne et de Gériatrie, CHU Toulouse Purpan, Gérontopôle de Toulouse, Université de Toulouse
  • , Jean-Louis MontastrucAffiliated withLaboratoire de Pharmacologie Médicale et Clinique, Faculté de Médecine, Université de ToulouseService de Pharmacologie Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d’Informations sur le Médicament, CHU ToulouseINSERM UMR 1027 Email author 
  • , Sandrine AndrieuAffiliated withLaboratoire de Santé Publique et d’Economie de la Santé, Faculté de Médecine, Université de ToulouseDépartement d’Epidémiologie, d’Economie de la Santé et de Santé Publique, Centre Hospitalier Universitaire (CHU) ToulouseINSERM UMR 1027
  • , REAL.FR Group

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Abstract

Objective

Few studies have investigated potentially inappropriate medication (PIM) use in patients with Alzheimer’s disease (AD). The aim of our study was to assess the prevalence of PIM in community-dwelling patients diagnosed with mild-to-moderate AD and identify the clinical factors associated with PIM prescriptions.

Methods

REAL.FR is a 4-year, prospective, multicenter French cohort of AD patients recruited in centers of expertise. We analyzed patient baseline data at entry into the study. PIMs were assessed using the Laroche list. A multivariate logistic regression was conducted to assess factors associated with PIMs.

Results

A total of 684 AD patients were enrolled in the study [mean age 77.9 ± 6.8 years, 486 (71.0 %) females]. According to the Laroche list, 46.8 % [95 % confidence interval (CI) 43.0–50.5 %] of the patients had at least one PIM. “Cerebral vasodilators” were the most widely used class of PIM, accounting for 24.0 % (95 % CI 20.9–27.3 %) of all prescriptions, followed by atropinic drugs (17.0 %, 95 % CI 14.1–19.8 %) and long half-life benzodiazepines (8.5 %, 95 % CI 6.4–10.6 %). Atropinic drugs were associated with cholinesterase inhibitors in 16 % of patients. In the multivariate analysis, only two factors, namely, female gender [odds ratio (OR) 1.5, 95 % CI 1.1–2.2] and polypharmacy (≥5 drugs; OR 3.6, 95 % CI 2.6–4.5) were associated with prescriptions for PIMs.

Conclusions

These results reveal that approximately one out of two community-dwelling patients with mild-to-moderate AD treated by AD specialists use PIMs. They also indicate that the characteristics of the disease and the pharmacodynamic/pharmacokinetic profile of the drugs prescribed are not sufficiently taken into account by physicians when prescribing for AD patients.

Keywords

Alzheimer’s disease Potentially inappropriate medications Atropinic drugs Benzodiazepines