4.5 Article

Modifiable statin characteristics associated with potential statin-related prescribing cascades

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PHARMACOTHERAPY
卷 -, 期 -, 页码 -

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WILEY
DOI: 10.1002/phar.2883

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drug prescriptions; drug-related side effects and adverse reactions; hydroxymethylglutaryl-CoA reductase inhibitors

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This study aims to identify modifiable statin characteristics associated with lower risk of prescribing cascades. The results show that compared to low-intensity statins, moderate- or high-intensity statins and the choice of individual statin agents are associated with increased risk of prescribing cascades.
Study Objective: Clinicians may prescribe new medications (marker drug) to treat statin-related (index drug) adverse events, constituting a prescribing cascade. We aimed to identify modifiable statin characteristics (intensity and individual statin agents) associated with lower risk of prescribing cascades to inform clinical decisions in the presence of statin-related adverse events.Design: A secondary analysis based on our previous work, a high-throughput sequence symmetry analysis screening for potential statin-related prescribing cascades.Data Source: MarketScan Commercial and Medicare Supplemental Insurance claims databases between 2005 and 2019.Patients: Adults who initiated a statin between 2007 and 2018, and who were continuously enrolled in the same healthcare plan for at least 720 days before and 360 days after statin initiation.Intervention: Among the previously identified 57 potential prescribing cascades, 42 statin-marker class dyad with a sample size of >= 500 were assessed in this study.Measurements: We measured patients' baseline characteristics within -360 days of statin initiation and reported by modifiable statin characteristics. We also performed logistic regression and reported the adjusted odds ratios (aOR) with 95% confidence intervals (CI) of modifiable statin characteristics after adjusting for baseline characteristics.Main Results: We identified 1,307,867 statin initiators who met the study criteria (21% elderly, 52% female). Compared with patients initiating low-intensity statins, those initiating moderate- or high-intensity statins had significantly greater odds to develop 29 (69%) prescribing cascades, including antidiabetic drugs such as dipeptidyl peptidase 4 (DPP-4) inhibitors (aOR 1.22; 95% CI, 1.11-1.35) and glucagon-like peptide-1 (GLP-1) analogs (aOR 1.31; 95% CI, 1.16-1.47), and opioids (aOR 1.18; 95% CI, 1.13-1.23). Individual statin agent selection also had a differential effect on 34 (81%) of the prescribing cascades. For example, compared with simvastatin initiators, the probability of initiating osmotically acting laxatives was significantly higher for lovastatin initiators (aOR 1.09; 95% CI, 1.03-1.15) and significantly lower in atorvastatin initiators (aOR 0.92; 95% CI, 0.89-0.94).Conclusion: Compared with low-intensity statins, high-intensity statins are associated with increased risk in many potential prescribing cascades, while the choice of individual statin agents affects the risk of prescribing cascades bidirectionally.

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