Associação de fatores clínicos epidemiológicos à polifarmácia em pacientes com esclerose múltipla: dados da vida real
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Introdução: O tratamento da esclerose múltipla deve ser concentrado na prevenção e tratamento de recaídas, bem como no controle da progressão dos sintomas e doenças, o que requer o uso de vários medicamentos. Objetivo: Avaliar a associação de polifarmácia a fatores epidemiológicos clínicos em uma coorte de pacientes com esclerose múltipla. Métodos: Foi realizado um estudo prospectivo de pacientes com esclerose múltipla que possuíam prescrição de medicamentos modificadores da doença entre janeiro e dezembro de 2017. Os medicamentos foram analisados e classificados como medicamentos de longo prazo ou conforme necessário para fins terapêuticos de objetivo e status de prescrição. Resultados: Durante 2017 foram atendidos 124 pacientes, destes 106 pacientes foram elegíveis para o estudo e 81 concordaram em participar. A idade média foi de 40,95±11,69 anos. A duração da doença variou entre 6 meses e 30 anos, com mediana de 7 anos. Mais da metade dos pacientes com esclerose múltipla apresentava comorbidades (54,32%) e 76,54% foram classificados com polifarmácia. A comparação da polifarmácia entre os grupos demonstrou diferenças significativas para comorbidades, e situação de trabalho, e em relação à idade entre pacientes com polifarmácia e pacientes sem polifarmácia com medicamentos de longa duração. Conclusão: A idade do paciente e a presença de comorbidades são fatores importantes relacionados à polifarmácia.
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Oliveira, V. M. de ., Rios, C. C. ., Gubert, V. T. ., Ferreira, C. M., Vasconcelos-Pereira, E. F. de ., Toffoli-Kadri, M. C., & Monreal, M. T. F. D. (2021). Associação de fatores clínicos epidemiológicos à polifarmácia em pacientes com esclerose múltipla: dados da vida real. ABCS Health Sciences, 46, e021212. https://doi.org/10.7322/abcshs.2020137.1899
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https://doi.org/10.1016/j.mayocp.2013.11.002
26. Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. N Engl J Med. 2018;378(2): 169-80. https://doi.org/10.1056/NEJMra1401483
27. Kimball S, Vieth R, Dosch HM, Bar-Or A, Cheung R, Gagne D, et al. Cholecalciferol plus calcium suppresses abnormal PBMC reactivity in patients with multiple sclerosis. J Clin Endocrinol Metab. 2011;96(9):2826-34. https://doi.org/10.1210/jc.2011-0325
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29. James E, Dobson R, Kuhle J, Baker D, Giovannoni G, Ramagopalan SV. The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis. Mult Scler. 2013;19(12):1571-9. https://doi.org/10.1177/1352458513489756
30. Lentjes MAH. The balance between food and dietary supplements in the general population. Proc Nutr Soc. 2019;78(1):97-109. https://doi.org/10.1017/S0029665118002525
31. Schmitz K, Barthelmes J, Stolz L, Beyer S, Diehl O, Tegeder I. “Disease modifying nutricals” for multiple sclerosis. Pharmacol Ther. 2015;148:85-113. https://doi.org/10.1016/j.pharmthera.2014.11.015
32. Mathur R, Hull SA, Badrick E, Robson J. Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management. Br J Gen Pract. 2011;61(586):262-70. https://doi.org/10.3399/bjgp11X572454
33. Delcher A, Hily S, Boureau AS, Chapelet G, Berrut G, Decker L. Multimorbidities and overprescription of proton pump inhibitors in older patients. PLoS One. 2015;10(11):e0141779. https://doi.org/10.1371/journal.pone.0141779
34. Wade BJ. Spatial analysis of global prevalence of multiple sclerosis suggests need for an updated prevalence scale. Mult Scler Int. 2014; 2014:124578. https://doi.org/10.1155/2014/124578
35. Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, et al. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler. 2011;17(4):468-77. https://doi.org/10.1177/1352458510391339
2. Belbasis L, Bellou L, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 2015;14(3):263-73. http://doi.org/10.1016/S1474-4422(14)70267-4
3. Ribeiro TAGJ, Duarte AL, Silva DJ, Borges FE, Costa VM, Papais-Alvarenga RM, et al. Prevalence of multiple sclerosis in Goiânia, Goiás, Brazil. Arq Neuro-Psiquiatr. 2019;77(5):352-6. https://doi.org/10.1590/0004-282x20190032
4. Pedro L, Pais-Ribeiro JL, Pinheiro JP. A importância de um programa de atividade física em doentes com esclerose múltipla na satisfação com a vida e bem-estar psicológico. Saúde Tecnol. 2013;(Supl.)e49-e51.
5. Halpern R, Agarwal S, Dembek C, Borton L, Lopez-Bresnahan M. Comparison of adherence and persistence among multiple sclerosis patients treated with disease-modifying therapies: a retrospective administrative claims analysis. Patient Prefer Adherence. 2011;20(5):73-84. https://doi.org/10.2147/PPA.S15702
6. Frahm N, Hecker M, Zettl UK. Multi-drug use among patients with multiple sclerosis: A cross-sectional study of associations to clinicodemographic factors. Sci Rep. 2019;9:3743. https://doi.org/10.1038/s41598-019-40283-5
7. Kochs L, Wegener S, Sühnel A, Voigt K, Zettl UK. The use of complementary and alternative medicine in patients with multiple sclerosis: A longitudinal study. Complement Ther Med. 2014;22(1):166-72. https://doi.org/10.1016/j.ctim.2013.11.006
8. Richardson K, Ananou A, Lafortune L, Brayne C, Matthews FE. Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging. 2011;28(7):547-60. https://doi.org/10.2165/11592000-000000000-00000
9. Guthrie B, Makubate B, Hernandez-Santiago V, Dreischulte T. The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010. BMC Med. 2015;13:74. https://doi.org/10.1186/s12916-015-0322-7
10. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660
11. Beiske GAG, Holmøy T, Beiske AG, Johannessen SI, Johannessen Landmark C. Antiepileptic and Antidepressive Polypharmacy in Patients with Multiple Sclerosis. Mult Scler Int. 2015;2015:317859. https://doi.org/10.1155/2015/317859
12. Evans C, Marrie RA, Zhu F, Leung S, Lu X, Kingwell E, et al. Adherence to disease-modifying therapies for multiple sclerosis and subsequent hospitalizations. Pharmacoepidemiol Drug Saf. 2017;26(6):702-11. https://doi.org/10.1002/pds.4207
13. Jelinek GA, Weiland TJ, Hadgkiss EJ, Marck CH, Pereira N, Medication use in a large international sample of people with multiple sclerosis: associations with quality of life, relapse rate and disability. Neurol Res. 2015;37(8):662-73. https://doi.org/10.1179/1743132815Y.0000000036
14. Thelen JM, Lynch SG, Bruce AS, Hancock LM, Bruce JM. Polypharmacy in multiple sclerosis: relationship with fatigue, perceived cognition, and objective cognitive performance. J Psychosom Res. 2014;76(5):400-4. https://doi.org/10.1016/j.jpsychores.2014.02.013
15. Laroni A, Signori A, Maniscalco GT, Lanzillo R, Russo CV, Binello E, et al. Assessing association of comorbidities with treatment choice and persistence in MS: A real-life multicenter study. Neurology. 2017;89(22):2222-9. https://doi.org/10.1212/WNL.0000000000004686
16. Marrie RA, Miller A, Sormani MP, Thompson A, Waubant E, Trojano M, et al. Recommendations for observational studies of comorbidity in multiple sclerosis. Neurology. 2016;86(15):1446-53. https://doi.org/10.1212/WNL.0000000000002474
17. Frahm N, Hecker M, Zettl UK. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. PLoS One. 2019;24;14(1):e0211120. https://doi.org/10.1371/journal.pone.0211120
18. Patejdl R, Penner IK, Noack TK, Zettl UK. Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration. Autoimmun Rev. 2016;15(3):210-20. https://doi.org/10.1016/j.autrev.2015.11.005
19. Alves CA, Alvarenga MP, Vasconcelos CCF, Batista E, Campanella L, Camargo S, et al. Percalços de um estudo da prevalência de esclerose múltipla no estado do Rio de Janeiro. Rev Bras Neurol Psiquiat. 2013;7(3):103-11.
20. Frahm N, Hecker M, Zettl UK. Polypharmacy in patients with multiple sclerosis: a gender-specific analysis. Biol Sex Differ. 2019;27;10(1):27. https://doi.org/10.1186/s13293-019-0243-9
21. World Health Organization (WHO). Global age-friendly cities project. Available from: https://www.who.int/ageing/projects/age-friendly_cities.pdf?ua=1
22. Marrie R, Reider N, Cohen J, Stuve O, Sorensen PS, Vutter G, et al. A systematic review of the incidence and prevalence of autoimmune disease in multiple sclerosis. Mult Scler. 2015;21(3):282-93. https://doi.org/10.1177/1352458514564490
23. Kaplan TB, Berkowitz AL, Samuels MA. Cardiovascular Dysfunction in Multiple Sclerosis. Neurologist. 2015;20(6):108-14. https://doi.org/10.1097/NRL.0000000000000064
24. Rommer PS, Zettl UK. Managing the side effects of multiple sclerosis therapy: Pharmacotherapy options for patients. Expert Opin Pharmacother. 2018;19(5):483-98. https://doi.org/10.1080/14656566.2018.1446944
25. Wingerchuk DM, Carter JL. Multiple sclerosis: Current and emerging disease-modifying therapies and treatment strategies. Mayo Clin Proc. 2014;89(2):225-40.
https://doi.org/10.1016/j.mayocp.2013.11.002
26. Reich DS, Lucchinetti CF, Calabresi PA. Multiple Sclerosis. N Engl J Med. 2018;378(2): 169-80. https://doi.org/10.1056/NEJMra1401483
27. Kimball S, Vieth R, Dosch HM, Bar-Or A, Cheung R, Gagne D, et al. Cholecalciferol plus calcium suppresses abnormal PBMC reactivity in patients with multiple sclerosis. J Clin Endocrinol Metab. 2011;96(9):2826-34. https://doi.org/10.1210/jc.2011-0325
28. Brum DG, Comini-Frota ER, Vasconcelos CCF, Dias-Tosta E. Supplementation and therapeutic use of vitamin D in patients with multiple sclerosis: Consensus of the Scientific Department of Neuroimmunology of the Brazilian Academy of Neurology. Arq Neuro-Psiquiatr. 2014;72(2):152-6. https://doi.org/10.1590/0004-282X20130252
29. James E, Dobson R, Kuhle J, Baker D, Giovannoni G, Ramagopalan SV. The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis. Mult Scler. 2013;19(12):1571-9. https://doi.org/10.1177/1352458513489756
30. Lentjes MAH. The balance between food and dietary supplements in the general population. Proc Nutr Soc. 2019;78(1):97-109. https://doi.org/10.1017/S0029665118002525
31. Schmitz K, Barthelmes J, Stolz L, Beyer S, Diehl O, Tegeder I. “Disease modifying nutricals” for multiple sclerosis. Pharmacol Ther. 2015;148:85-113. https://doi.org/10.1016/j.pharmthera.2014.11.015
32. Mathur R, Hull SA, Badrick E, Robson J. Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management. Br J Gen Pract. 2011;61(586):262-70. https://doi.org/10.3399/bjgp11X572454
33. Delcher A, Hily S, Boureau AS, Chapelet G, Berrut G, Decker L. Multimorbidities and overprescription of proton pump inhibitors in older patients. PLoS One. 2015;10(11):e0141779. https://doi.org/10.1371/journal.pone.0141779
34. Wade BJ. Spatial analysis of global prevalence of multiple sclerosis suggests need for an updated prevalence scale. Mult Scler Int. 2014; 2014:124578. https://doi.org/10.1155/2014/124578
35. Broekmans T, Roelants M, Feys P, Alders G, Gijbels D, Hanssen I, et al. Effects of long-term resistance training and simultaneous electro-stimulation on muscle strength and functional mobility in multiple sclerosis. Mult Scler. 2011;17(4):468-77. https://doi.org/10.1177/1352458510391339