Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial,Drugs & Aging

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Benzodiazepine Receptor Agonists Use and Cessation Among Multimorbid Older Adults with Polypharmacy: Secondary Analysis from the OPERAM Trial
Drugs & Aging ( IF 3.4 ) Pub Date : 2023-05-23 , DOI: 10.1007/s40266-023-01029-1
François-Xavier Sibille _{1,

2,

3} , Marie de Saint-Hubert _{1,

2} , Séverine Henrard _{2,

3} , Carole Elodie Aubert _{4,

5} , Namiko Anna Goto ₆ , Emma Jennings ₇ , Olivia Dalleur _{3,

8} , Nicolas Rodondi _{4,

5} , Wilma Knol ₆ , Denis O'Mahony ₇ , Matthias Schwenkglenks ₉ , Anne Spinewine _{3,

10}

Affiliation

Department of Geriatric Medicine, CHU UCL Namur, Avenue Dr Gaston Therasse, 1, 5530, Yvoir, Belgium.
Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium.
Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Medicine, School of Medicine, University College Cork, Cork, Republic of Ireland.
Department of Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
Department of Pharmacy, CHU UCL Namur, Yvoir, Belgium.

Background

Benzodiazepine receptor agonists (BZRAs) are commonly prescribed in older adults despite an unfavorable risk–benefit ratio. Hospitalizations may provide a unique opportunity to initiate BZRA cessation, yet little is known about cessation during and after hospitalization. We aimed to measure the prevalence of BZRA use before hospitalization and the rate of cessation 6 months later, and to identify factors associated with these outcomes.

Methods

We conducted a secondary analysis of a cluster randomized controlled trial (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly [OPERAM]), comparing usual care and in-hospital pharmacotherapy optimization in adults aged 70 years or over with multimorbidity and polypharmacy in four European countries. BZRA cessation was defined as taking one or more BZRA before hospitalization and not taking any BZRA at the 6-month follow-up. Multivariable logistic regression was performed to identify factors associated with BZRA use before hospitalization and with cessation at 6 months.

Results

Among 1601 participants with complete 6-month follow-up data, 378 (23.6%) were BZRA users before hospitalization. Female sex (odds ratio [OR] 1.52 [95% confidence interval 1.18–1.96]), a higher reported level of depression/anxiety (OR up to 2.45 [1.54–3.89]), a higher number of daily drugs (OR 1.08 [1.05–1.12]), use of an antidepressant (OR 1.74 [1.31–2.31]) or an antiepileptic (OR 1.46 [1.02–2.07]), and trial site were associated with BZRA use. Diabetes mellitus (OR 0.60 [0.44–0.80]) was associated with a lower probability of BZRA use. BZRA cessation occurred in 86 BZRA users (22.8%). Antidepressant use (OR 1.74 [1.06–2.86]) and a history of falling in the previous 12 months (OR 1.75 [1.10–2.78]) were associated with higher BZRA cessation, and chronic obstructive pulmonary disease (COPD) (OR 0.45 [0.20–0.91]) with lower BZRA cessation.

Conclusion

BZRA prevalence was high among included multimorbid older adults, and BZRA cessation occurred in almost a quarter of them within 6 months after hospitalization. Targeted BZRA deprescribing programs could further enhance cessation. Specific attention is needed for females, central nervous system-acting co-medication, and COPD co-morbidity.

Registration

ClinicalTrials.gov identifier: NCT02986425. December 8, 2016.

中文翻译：

多病老年人多药治疗中苯二氮卓受体激动剂的使用和停用：OPERAM 试验的二次分析

背景

尽管风险效益比不利，但苯二氮卓受体激动剂（BZRA）仍常用于老年人。住院治疗可能提供了一个独特的机会来开始戒烟 BZRA，但对于住院期间和住院后的戒烟知之甚少。我们的目的是测量住院前 BZRA 使用率和 6 个月后的戒断率，并确定与这些结果相关的因素。

方法

我们对一项整群随机对照试验（优化治疗以防止多病老年人入院可避免的住院 [OPERAM]）进行了二次分析，比较了 70 岁或以上成年人的常规护理和住院药物治疗优化与四项多病和多药治疗的情况。欧洲国家。BZRA 戒断定义为住院前服用一种或多种 BZRA，并且在 6 个月随访时不服用任何 BZRA。进行多变量逻辑回归以确定与住院前使用 BZRA 以及 6 个月停止使用 BZRA 相关的因素。

结果

在拥有完整 6 个月随访数据的 1601 名参与者中，378 名（23.6%）在住院前是 BZRA 用户。女性（比值比 [OR] 1.52 [95% 置信区间 1.18–1.96]）、报告的抑郁/焦虑水平较高（OR 高达 2.45 [1.54–3.89]）、每日用药次数较多（OR 1.08 [ 1.05–1.12]）、抗抑郁药（OR 1.74 [1.31–2.31]）或抗癫痫药（OR 1.46 [1.02–2.07]）的使用以及试验地点与 BZRA 的使用相关。糖尿病（OR 0.60 [0.44–0.80]）与 BZRA 使用概率较低相关。86 名 BZRA 用户（22.8%）停止了 BZRA。抗抑郁药物的使用 (OR 1.74 [1.06–2.86]) 和过去 12 个月内的跌倒史 (OR 1.75 [1.10–2.78]) 与 BZRA 戒断率较高和慢性阻塞性肺疾病 (COPD) (OR 0.45 [0.20) 相关–0.91]），BZRA 停止率较低。