Melbourne, Australia—Polypharmacy and complexity of a regimen can affect how well patients do with certain conditions, such as interstitial lung disease (ILD), according to a new study.

The report in Respirology points out that ILD patients often are prescribed disease-targeted and symptomatic therapies, both of which can cause significant treatment burden due to polypharmacy and drug–disease interactions.

University of Melbourne researchers evaluated medication regimen complexity before and after introduction of ILD-specific therapies. They also focused on potential drug–disease interactions for patients who were prescribed prednisolone.

The study team assessed 214 patients with ILD for demographic information, comorbidities and medication use. Medication lists were reviewed prior to and after the introduction of ILD-specific therapies, while complexity of treatment regimen was examined using the validated Medication Regimen Complexity Index (MRCI).

Of the 214 patients, 75 had idiopathic pulmonary fibrosis (IPF) while the rest had inflammatory ILD, including chronic hypersensitivity pneumonitis and connective-tissue disease-related ILD.

Results indicate that polypharmacy was common at baseline (IPF: 51%, inflammatory ILD: 63%). Researchers point out that, following introduction of ILD-specific therapies, median total MRCI scores significantly rose from 8 (interquartile range (IQR) = 8-15) to 22.5 (17.5-27.5) and 14.5 (8.5-21) to 21.5 (16-30) for IPF and inflammatory ILD groups, respectively (P <.0001 for both). In addition, they found that complex dosing instructions contributed the most to total MRCI scores for ILD-specific therapies.

At the same time, they found that 88% of the patients receiving prednisolone had at least one comorbidity that could be adversely affected. Common comorbidities included gastrointestinal diseases (56%), obesity (37%), osteoporosis (24%), and diabetes mellitus (18%).

“Polypharmacy and complex medication regimen are common in patients with ILD of different etiologies,” study authors conclude. “There is a high frequency of potential drug–disease interactions among patients who are prescribed systemic corticosteroids. These findings highlight the need for careful evaluation of the impact of therapeutic complexity and burden in patients with ILD.”

“It’s exciting that we now have treatments with better evidence for managing patients with interstitial lung disease; however, a holistic approach with careful evaluation prior to treatment initiation is important to minimize treatment complexity and complications,” added lead author Yet Khor, MD, of Austin Health, in Australia.

 « Click here to return to Weekly News Update.