Tackling the dangers of polypharmacy through big data analytics and pharmacoepidemiology

While adults over 65 years old account for less than one-fifth of the United States population, they make up over half the population that takes more than three medications. This group is seven times more likely to be hospitalized and two-to-three times more likely to visit the emergency department because of a serious adverse drug event (ADE). Gastrointestinal bleeding, hypoglycemia and opioid-induced ADEs (e.g. opioid overdose) account for 60% of all ADE emergency room visits and are a target priority for prevention and observation by the US Health and Human Services.

Taking more than one medication, also known as polypharmacy, can increase the risk for consequential drug interaction and serious ADEs that result in emergency department visits and hospitalizations.

It is crucial to know the drug combinations that can cause ADEs, as well as those drug combinations that can be used together safely. However, this knowledge is currently limited.

Macarius Donneyong, PhD, MPH, assistant professor of outcomes and translational sciences at The Ohio State University College of Pharmacy, leads a team of researchers as the principal investigator (PI) in a $2.5 million National Institute of Aging (NIA)/National Institute of Health (NIH) funded study to generate knowledge that can improve polypharmacy outcomes among older adults. Pengyue Zhang, PhD, assistant research professor of biostatistics, Indiana University School of Medicine, is the co-PI.

Their study, titled “Significant high order drug interactions in the emergency department setting among older patient population,” will span five years.

This study is designed to address major knowledge gaps in polypharmacy involving three major high-risk drugs: anticoagulants (drugs that prevent blood clots), antidiabetic agents (diabetes medication) and opioids. These three classes of drugs can increase patients’ risk of ADEs, specifically, gastrointestinal bleeding (anticoagulants), hypoglycemia (antidiabetic agents) and opioid-induced ADEs (opioids).

A multidisciplinary approach of big data mining techniques, pharmacoepidemiology and clinical pharmacology will be used to identify three or more drug combinations that are associated with the highest risks of gastrointestinal bleeding, hypoglycemia and opioid-induced ADEs. This approach will also enable Dr. Donneyong and his colleagues to identify those three or more drug combinations that do not increase the risk of these serious ADEs.

The identification of high- and low-risk multiple drug combinations could guide the development of new polypharmacy prescribing recommendations to help address the significant public health challenge created by ADEs, especially among older adults.

“With a rapidly aging population who are burdened with multiple chronic conditions, polypharmacy is bound to rise,” said Dr. Donneyong. “Polypharmacy is not dangerous perse, however, patients could be harmed if the right drug combinations are not used. We hope that the findings from our study will help clinicians select safer drug combinations when polypharmacy is necessary. Our results could also guide clinicians to reduce or stop patients from using drug combinations that could harm patients.”

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Other researchers on this project include,

From the Ohio State Wexner Medical Center - Jeffrey M Caterino, MD, emergency room physician

From the Ohio State College of Medicine - Katherine Hunold, MD, assistant professor of emergency medicine, and Lang Li, PhD, professor and chair of the department of biomedical informatics

From the Indiana University School of Medicine - Kathleen Unroe, MD, associate professor of medicine, and Pengyue Zhang, PhD, assistant research professor of biostatistics