Older allogeneic HSCT recipients receive as many potentially inappropriate medications as younger counterparts

ORLANDO — Individuals aged 65 years or older received potentially inappropriate medications after allogeneic hematopoietic stem cell transplantation as frequently as their younger counterparts aged 40 to 64 years, according to results of a study presented at TCT | Transplantation & Cellular Therapy Meetings.

Use of these medications — particularly narcotics — by older transplant recipients appeared associated with increased nonrelapse mortality and greater risk for grade 3 to grade 4 adverse events.

“We took the [American Geriatrics Society] Beers Criteria for Potentially Inappropriate Medication Use in Older Adults and applied it to the bone marrow transplant population,” Divya Bhargava, medical student at St. Paul Academy and Summit School, told Healio. “We compared it with a group of younger patients and found that they receive the same amount of inappropriate medications, which is bad because older adults are usually in worse shape.”

American Geriatrics Society established Beers criteria to help reduce potentially inappropriate medication use among adults aged 65 years or older. However, use of such medications among recipients of allogeneic HSCT — and the effect this use has on outcomes — had not been established.

Bhargava and colleagues compared potentially inappropriate medication use between allogeneic HSCT recipients aged 65 years and older (n = 114) and recipients aged 40 to 64 years (n = 240) who received reduced-intensity conditioning.

Researchers looked at use of anticholinergics, benzodiazepines and narcotics, as well as medications that affect the central nervous system and the gastrointestinal and genitourinary tracts, during initial HSCT admission (14 days prior to and 28 days after transplantation).

They defined use of potentially inappropriate medications as the number of days a patient received one or more of the medications during that period.

Researchers retrieved medication data from medical records and categorized them using Beers criteria. They calculated log use of potentially inappropriate medications in each group through Poisson regression.

Results showed similar median days of receipt of all potentially inappropriate medications for older and younger patients (94 vs. 101 days; P = .048).

Patients with high Hematopoietic Cell Transplantation Comorbidity Index scores received potentially inappropriate medications for more days in general than patients with low scores (P = .02).

Older patients received fewer days of potentially inappropriate benzodiazepines (log decrease, –0.18, P = 0.04) and narcotics (log decrease, –0.21, P = .04) than younger patients, but they received more days of anticholinergics (log increase, 0.22, P = .03) and gastrointestinal medications (log increase, 0.16, P < .01).

Patients with high comorbidity index scores received more potentially inappropriate genitourinary (log increase, 0.23, P = .01) and CNS (log increase, 0.23, P < .01) medications than those with low scores. Women received more potentially inappropriate benzodiazepines (log increase, 0.19, P < .01) and gastrointestinal medications (log increase, 0.09, P = .04) than men, whereas recipients of umbilical cord blood received more anticholinergic (log increase, 0.26, P = .01) and gastrointestinal (log increase, 0.16, P < .01 potentially inappropriate medications.

Among those aged 65 years and older, adjusted regression analysis showed associations between increasing days of narcotics and a 1.6-fold (95% CI, 1.1-2.6) increased risk for nonrelapse mortality (P = .03), as well as 1.66 times (95% CI, 1.02-2.69) greater risk for grade 3 to grade 4 toxicities (P = .04).

More days of any potentially inappropriate medication use appeared associated with five times greater odds (95% CI, 1.43-10) of discharge to rehab or a nursing facility (P < .01).

“These results could potentially cut down overall costs because, if you are using medicines that have effects you don’t want them to have, you probably use more medication to counteract [those effects],” Bhargava said. “The goal here is to cut down use of all of the above.” – by John DeRosier

Reference: Bhargava D, et al. Abstract 188. Presented at: TCT | Transplantation & Cellular Therapy Meetings; Feb. 19-23, 2020; Orlando.

Disclosures: 

Bhargava reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.