Polypharmacy and potentially inappropriate medication use in older adults with systemic lupus erythematosus.

Objective To assess the prevalence and potential risk factors for polypharmacy and prescribing of the potentially inappropriate medications (PIMs), opioids and benzodiazepines/Z-drugs, in older adults with systemic lupus erythematosus (SLE). Methods Population comprised of adults aged ≥50 years meeting ACR or SLICC SLE classification criteria followed at a tertiary care rheumatology clinic. Information on prescriptions filled in the 4 months preceding chart review was obtained from the Manitoba Drug Program Information Network (DPIN). Clinical data, including age, sex, Charlson Co-morbidity Index (CCI), SLE disease activity (SLEDAI-2K), prednisone use, SLE duration, and rural residence were abstracted from electronic medical records. Logistic regression analyses were performed to assess any association between polypharmacy (2 definitions: ≥5 and ≥10 medications), PIM use, and clinical features. Results 206 patients (mean age 62 years, 91% female, 36% rural) included: 148(72%) filled ≥5 medications, 71(35%) ≥10 medications, 63(31%) used benzodiazepines/Z-drugs, and 50(24%) used opioids. Among the 77 patients ≥65 years old, 57(74%) filled ≥5 medications and 26(34%), ≥10 medications compared to 30% and 4%, respectively, of Manitobans ≥65 years old (NPDUIS, 2016). The odds of polypharmacy were greater with prednisone use (adjusted OR 3.70, 95% CI 1.40-9.79 for ≥5 medications), CCI (1.62, 1.20-2.17), and rural residence (2.05, 1.01-4.18). Odds of benzodiazepine/Z-drug use were increased with polypharmacy (4.35, 1.69-11.22); opioid use, with polypharmacy (6.75, 1.93-23.69) and CCI (1.29, 1.08-1.54). Conclusion The prevalence of polypharmacy in this SLE cohort is higher than in the general Manitoban population. Polypharmacy is a strong marker for use of prescription benzodiazepines/Z-drugs and opioids.