The findings showed that 34% of patients (34.1%) had at least one interaction, while 25.1% had at least one drug–drug interaction. Also, 10.7% of patients who had a drug–drug interaction involved a nonprescription drug. Sixteen percent of patients had a potential drug–disease interaction, with at least 37% of those reactions involving a nonprescription drug.
Non-steroidal anti-inflammatory drugs (NSAIDs) and anti-hypertensive agents were the most common drug–drug interaction. Aspirin/NSAID use in patients with a history of peptic ulcer disease without the use of gastro-protection (4.3%) was the most common drug–disease interaction. Having a history of falls or fractures and taking one of five central nervous system medication classes (4%; e.g., anticonvulsants, antipsychotics, SSRIs, TCAs, benzodiazepine receptor agonists) was the second most common drug–disease interaction.
Two factors were associated with drug interactions: a history of hospitalization in the prior year and the number of medications used. The use of each prescription drug raised the likelihood of having at least one type of drug interaction by 35–40%. In patients with a prior hospitalization, hospitalization raised the odds of having at least one type of drug interaction by 49–84%.
The authors write that the ability to generalize this study to the older U.S. population may be limited because the study participants did not have mobility issues, heart failure or chronic kidney disease. Thus, the rate of drug interactions observed in this study may be low. More research is needed in this area, especially in patients with more comorbidities.
Older patients were more likely to be prescribed abatacept & tocilizumab compared with patients receiving a TNFi.
Piclidenoson Studied in Autoimmune Diseases
Piclidenoson is an oral, A3 adenosine receptor antagonist (A3AR) currently in clinical trials for autoimmune diseases, including psoriasis (Phase 2/3) and rheumatoid arthritis (RA).4 This agent was developed and is being investigated as a first-line therapy and replacement for methotrexate, the current standard of care for RA.
Phase 2 clinical trials for RA are completed. Piclidenoson is scheduled to enter Phase 3 trials this year for both RA and psoriasis. ACRobat, a Phase 3 randomized, double-blind, active and placebo-controlled clinical trial of piclidenoson, has begun patient enrollment for 500 patients in Europe, Canada and the U.S.
The Phase 3 study’s primary endpoint is a decrease in disease activity score (DAS) after Week 12 of treatment with 1 mg or 2 mg piclidenoson given twice daily compared with weekly doses of methotrexate and placebo. Secondary endpoints will include ACR20, ACR50 and ACR70 scores.5 The total study duration will be 24 weeks to provide additional data on long-term efficacy and safety.
