The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland

Przemysław Kardas; Filip Urbański; Aneta Lichwierowicz; Ewa Chudzyńska; Marcin Czech; Katarzyna Makowska; Grzegorz Kardas

doi:10.3389/fphar.2020.607852

The Prevalence of Selected Potential Drug-Drug Interactions of Analgesic Drugs and Possible Methods of Preventing Them: Lessons Learned From the Analysis of the Real-World National Database of 38 Million Citizens of Poland

Front Pharmacol. 2021 Jan 18:11:607852. doi: 10.3389/fphar.2020.607852. eCollection 2020.

Authors

Przemysław Kardas¹, Filip Urbański², Aneta Lichwierowicz², Ewa Chudzyńska², Marcin Czech³, Katarzyna Makowska¹, Grzegorz Kardas⁴

Affiliations

¹ Department of Family Medicine, Medical University of Lodz, Łódź, Poland.
² National Health Fund, Warsaw, Poland.
³ Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland.
⁴ Department of Internal Diseases, Asthma and Allergy, Medical University of Lodz, Łódź, Poland.

Abstract

Introduction: Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors. Aim of study: To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing). Methods: A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month. Results: Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by "NSAIDs + antihypertensives" (1,583,575 cases, i.e., 4.12% of the Polish population), followed by "NSAIDs + NSAIDs" (538,640, 1.40%) and "NSAIDs + glucocorticoids" (213,504, 0.56%). The most persistent pDDIs among those studied were caused by "Opioids + Gabapentinoids" (2.19, 95%CI: 2.16-2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers. Conclusion: Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.

Keywords: Poland; analgesic drugs; claim database; drug safety; drug – drug interactions; inapropriate prescribing; pharmacoepidaemiology; real-world data.