Drug-drug interactions in patients treated for cancer: a prospective study on clinical interventions
R W F van Leeuwen1, F G A Jansman2, P M L A van den Bemt3
1Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
Background:
Drug-drug interactions (DDIs) are of major concern in oncology, since cancer patients typically take many concomitant medications. Retrospective studies have been conducted to determine the prevalence of DDIs. However, prospective studies on DDIs needing interventions in cancer patients have not yet been carried out. Therefore, a prospective study was designed to identify DDIs leading to interventions among ambulatory cancer patients receiving anticancer treatment.
Patients And Methods:
Patients starting with a new treatment regimen with i.v. or oral anticancer medication were asked to participate. The patients' medication was checked for DDIs by using drug interaction software. An expert team of clinical pharmacologists evaluated the relevance of these identified DDIs. If a DDI was qualified as potentially clinically relevant, an intervention was proposed to the treating (hemato)oncologist. Several variables were studied as determinants for performing an intervention. Descriptive statistics and uni- and multivariate logistic regression analyses were carried out.
Results:
In this study, 302 patients were included. A total of 603 DDIs were identified by the drug interaction software and judged by the expert team. Of all 603 DDIs, 120 DDIs were considered potentially clinically relevant. These 120 DDIs, present in a total of 81 patients, resulted in a clinical intervention already executed by the (hemato)oncologist in 39 patients (13%), while an additional intervention was proposed by a clinical pharmacologist in 42 patients (14%). The number of comorbidities and the number of 'over-the-counter' drugs were identified as determinants.
Conclusions:
Clinical interventions on DDIs are frequently required among patients starting with anticancer therapy. Structured screening for these potentially clinically relevant DDIs, by (hemato)oncologists in close collaborations with clinical pharmacologists, should take place before the start and during anticancer treatment.
Clinical Trials Number:
This study was registered at the Dutch Trial Registry under number NTR3760.
Insights
Drug-drug interactions (DDIs) requiring clinical intervention are common in cancer patients. Proactive screening by oncologists and pharmacologists is crucial before and during cancer treatment to ensure patient safety.
Area of Science:
- Oncology
- Clinical Pharmacology
- Drug Safety
Background:
- Cancer patients often require multiple medications, increasing the risk of drug-drug interactions (DDIs).
- Previous studies primarily focused on the prevalence of DDIs, with limited prospective data on interventions in oncology.
- This study addresses the need for prospective identification of DDIs requiring clinical action in ambulatory cancer patients.
Purpose of the Study:
- To prospectively identify drug-drug interactions (DDIs) that necessitate clinical interventions in ambulatory cancer patients undergoing anticancer treatment.
- To evaluate the frequency and clinical relevance of DDIs in this patient population.
Main Methods:
- A prospective study involving 302 ambulatory cancer patients initiating new anticancer therapy.
- Medication regimens were screened for DDIs using specialized software.
- An expert panel of clinical pharmacologists assessed the clinical relevance of identified DDIs and proposed interventions to oncologists.
Main Results:
- A total of 603 DDIs were identified, with 120 deemed potentially clinically relevant.
- These relevant DDIs occurred in 81 patients, leading to executed interventions in 39 patients (13%) and proposed interventions in 42 patients (14%).
- Comorbidities and the use of over-the-counter medications were significant determinants for interventions.
Conclusions:
- Clinical interventions for drug-drug interactions (DDIs) are frequently necessary for patients starting anticancer therapy.
- Structured, proactive screening for potentially clinically relevant DDIs is essential.
- Collaboration between (hemato)oncologists and clinical pharmacologists is vital for effective DDI management before and during treatment.
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