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Measurement of Cumulative Drug Exposure from Clinical Data Warehouse

Authors: Bories, Mathilde; Bannay, Aurélie; Pierre-Jean, Morgane; Bouzillé, Guillaume; Le Corre, Pascal;

Measurement of Cumulative Drug Exposure from Clinical Data Warehouse

Abstract

Polypharmacy (PP) and hyperpolypharmacy (HPP), are prevalent among cancer patients and are associated with an increased risk of drug-drug interactions (DDI) and potentially inappropriate medications (PIM). This study aimed to characterize PP, HPP, DDI, and PIM in patients with hematological malignancies hospitalized for hematopoietic stem cell transplantation (HSCT) by introducing a novel metric: cumulative drug exposure. Clinical data warehouse (CDW) records were employed to develop algorithms that quantified patients’ cumulative exposure to these prescribing determinants during hospitalization. This entailed determining the number of days during the hospital stay when the patient was exposed to PP, HPP, PIM and/or DDI. For PIM and DDI, the number of PIMs or DDIs administered per day was taken into account in this calculation. Among 339 HSCT patients, PP and HPP were highly prevalent (over 67% of HSCT patients), almost all patients experienced DDI (over 98% of HSCT patients) and almost all elderly patients were exposed to PIM (over 98% of HSCT patients). Cumulative drug exposure differed between allogeneic and autologous HSCT patients, with allogeneic patients being more exposed to HPP (28.5 days vs 4.7 days for autologous HSCT patients) and DDI (255.6 days vs 58.4 for autologous HSCT patients). This study proposes a novel approach to assessing the impact of prescribing determinants on patient outcomes and provides insights for future research into the association between drug exposure and adverse events. Indeed, the use of cumulative drug exposure as a metric provides a comprehensive view of patient exposure throughout hospitalization, thereby enhancing understanding of the impact of prescribing practices on clinical outcomes.

Keywords

Male, Adult, drug-drug interactions, Hematopoietic Stem Cell Transplantation, Inappropriate Prescribing, Middle Aged, hyper polypharmacy, Clinical data warehouse, [SDV] Life Sciences [q-bio], Hospitalization, Data Warehousing, Hematologic Neoplasms, hematopoietic stem cell transplantation, Polypharmacy, Humans, Drug Interactions, Female, polypharmacy, potentially inappropriate medications, Potentially Inappropriate Medication List, Aged

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
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Cancer Research