Potentially inappropriate medications in older adults living with HIV.

OBJECTIVES: We assessed the prevalence of potentially inappropriate medication (PIM) among older (≥ 65 years) people living with HIV (O-PLWH) in the region of Madrid. METHODS: We analysed the dispensation registry of community and hospital pharmacies from the Madrid Regional Health Service (SERMAS) for the period between 1 January and 30 June 2017, looking specifically at PIMs according to the 2019 Beers criteria. Co-medications were classified according to the Anatomical Therapeutic Chemical (ATC) classification system. RESULTS: A total of 6 636 451 individuals received medications. Of these individuals, 22 945 received antiretrovirals (ARVs), and of these 1292 were O-PLWH. Overall, 1135 (87.8%) O-PLWH were taking at least one co-medication, and polypharmacy (at least five co-medications) was observed in 852 individuals (65.9%). A PIM was identified in 482 (37.3%) O-PLWH. Factors independently associated with PIM were polypharmacy [adjusted odds ratio (aOR) 7.08; 95% confidence interval (CI) 5.16-9.72] and female sex (aOR 1.75; 95% CI 1.30-2.35). The distribution of PIMs according to ATC drug class were nervous system drugs (n = 369; 28.6%), musculoskeletal system drugs (n = 140; 10.8%), gastrointestinal and metabolism drugs (n = 72; 5.6%), cardiovascular drugs (n = 61; 4.7%), respiratory system drugs (n = 13; 1.0%), antineoplastic and immunomodulating drugs (n = 10; 0.8%), and systemic anti-infectives (n = 2; 0.2%). Five drugs accounted for 84.8% of the 482O PLWH with PIMs: lorazepam (38.2%), ibuprofen (18.0%), diazepam (10.2%), metoclopramide (9.9%), and zolpidem (8.5%). CONCLUSIONS: Prescription of PIMs is highly prevalent in O-PLWH. Consistent with data in uninfected elderly people, the most frequently observed PIMs were benzodiazepines and nonsteroidal anti-inflammatory drugs . Targeted interventions are warranted to reduce inappropriate prescribing and polypharmacy in this vulnerable population.

[Metformin for type-2 diabetes mellitus. Systematic review and meta-analysis]. / Metformina para la diabetes mellitus tipo 2. Revisión sistemática y metaanálisis.

OBJECTIVE: To evaluate the efficacy of metformin against placebo, diet, oral anti-diabetics, or insulin in type 2 diabetes mellitus. DESIGN: Systematic review. DATA SOURCES: MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003). SELECTION OF STUDIES: 29 randomized clinical trials of metformin in monotherapy, with results on mortality, morbidity, and biochemistry. EXTRACTION OF DATA: RevMan 4 computer program. Two reviewers extracted the data and evaluated the quality. MAIN VARIABLES: any clinical event related to diabetes (mortality, coronary disease, stroke, arterial disease, and retinopathy). Secondary variables: weight and biochemistry. RESULTS: 29 clinical studies with 37 comparisons of metformin were analyzed (13 with sulphonylureas, 12 with placebo, 3 with diet, 3 with thiazolidinediones, 2 with alpha-glucosidase inhibitors, 2 with insulin, and 2 with meglitinides). Metformin was more beneficial than the sulphonylureas or insulin for any clinical event associated with diabetes (relative risk [RR]=0.78; 95% confidence interval [CI], 0.65-0.94) and than diet (RR=0.74; 95% CI, 0.60-0.90). Metformin decreased glycosylated hemoglobin A1 (weighted mean difference, -1.21%; 95% CI, -1.48 to -0.94), low density lipoprotein cholesterol (weighted mean difference, -0.24; 95% CI, -0.40 to -0.09), and weight (standardized mean difference, -0.11; 95% CI, -0.18 to -0.04). Metformin was more beneficial than the placebo, diet or the thiazolidinediones on glycosylated hemoglobin A1, and than the sulphonylureas or insulin on weight. CONCLUSIONS: In the long term metformin reduces the risks of clinical events associated with diabetes. There are no long term clinical trials which compare alpha-glucosidase inhibitors, meglitinides, and thiazolidinediones with metformin, in primary results. The different treatments compared with metformin did not obtain more benefit for the secondary results evaluated.

Metformina para la diabetes mellitus tipo 2. Revisión sistemática y metaanálisis / Metformin for type 2 diabetes mellitus. Systematic review and meta-analysis

Objetivo. Evaluar la eficacia de la metformina frente a placebo, dieta, antidiabéticos orales o insulina en la diabetes mellitus tipo 2. Diseño. Revisión sistemática. Fuentes de datos. MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986- 2003), Cochrane library (Issue 3, 2003). Selección de estudios. Se seleccionaron 29 ensayos clínicos aleatorizados de metformina en monoterapia, con resultados sobre mortalidad, morbilidad y bioquímica. Extracción de datos. Programa informático RevMan 4. Dos revisores extrajeron los datos y evaluaron la calidad. Variables principales: cualquier acontecimiento clínico relacionado con la diabetes (mortalidad, coronariopatía, ictus, nefropatía, arteriopatía y retinopatía). Variables secundarias: peso y bioquímica. Resultados. Se analizaron 29 ensayos clínicos con 37 comparaciones de metformina (13 con sulfonilureas, 12 con placebo, 3 con dieta, 3 con tiazolidindionas, 2 con inhibidores de la alfa-glucosidasa, 2 con insulina y 2 con meglitinidas). La metformina mostró mayor beneficio que las sulfonilureas o la insulina para cualquier acontecimiento clínico relacionado con la diabetes (riesgo relativo = 0,78; intervalo de confianza [IC] del 95%, 0,65 a 0,94) y que la dieta (riesgo relativo = 0,74; IC del 95%, 0,60 a 0,90). La metformina disminuyó la hemoglobina A1 glucosilada (diferencia media ponderada: ­1,21%; IC del 95%, ­1,48 a ­0,94), colesterol unido a lipoproteínas de baja densidad (diferencia media ponderada: ­0,24; IC del 95%, ­0,40 a ­0,09) y peso (diferencia media estandarizada: ­0,11; IC del 95%, ­0,18 a ­0,04). La metformina presentó mayor beneficio que el placebo, la dieta o las tiazolidindionas en la hemoglobina A1 glucosilada, y que las sulfonilureas o la insulina en el peso. Conclusiones. A largo plazo la metformina disminuye el riesgo de acontecimientos clínicos relacionados con la diabetes. No existen ensayos clínicos a largo plazo que comparen con metformina los inhibidores de la alfa-glucosidasa, meglitinidas y tiazolidindionas, en resultados primarios. Las diferentes intervenciones comparadas con metformina no obtuvieron más beneficio para los resultados secundarios evaluados

Objective. To evaluate the efficacy of metformin against placebo, diet, oral anti-diabetics, or insulin in type 2 diabetes mellitus. Design. Systematic review. Data sources. MEDLINE (1966-2003), EMBASE (1974-2003), LILACS (1986-2003), Cochrane library (Issue 3, 2003). Selection of studies. 29 randomized clinical trials of metformin in monotherapy, with results on mortality, morbility, and biochemistry. Extraction of data. RevMan 4 computer program. Two reviewers extracted the data and evaluated the quality. Main variables: any clinical event related to diabetes (mortality, coronary disease, stroke, arterial disease, and retinopathy). Secondary variables: weight and biochemistry. Results. 29 clinical studies with 37 comparisons of metformin were analyzed (13 with sulphonylureas, 12 with placebo, 3 with diet, 3 with thiazolidinediones, 2 with alpha-glucosidase inhibitors, 2 with insulin, and 2 with meglitinides). Metformin was more beneficial than the sulphonylureas or insulin for any clinical event associated with diabetes (relative risk [RR]=0.78; 95% confidence interval [CI], 0.65-0.94) and than diet (RR=0.74; 95% CI, 0.60-0,90). Metformin decreased glycosylated hemoglobin A1 (weighted mean difference, ­1.21%; 95% CI, ­1.48 to ­0.94), low density lipoprotein cholesterol (weighted mean difference, ­0.24; 95% CI, ­0.40 to ­0.09), and weight (standardized mean difference, ­0.11; 95% CI, ­0.18 to ­0.04). Metformin was more beneficial than the placebo, diet or the thiazolidinediones on glycosylated hemoglobin A1, and than the sulphonylureas or insulin on weight. Conclusions. In the long term metformin reduces the risks of clinical events associated with diabetes. There are no long term clinical trials which compare alpha-glucosidase inhibitors, meglitinides, and thiazolidinediones with metformin, in primary results. The different treatments compared with metformin did not obtain more benefit for the secondary results evaluated

¿Qué variables deberían tenerse en cuenta al asignarnos el presupuesto de farmacia?

Uno de los aspectos fundamentales de la autogestión de los equipos de atención primaria es el ajuste al presupuesto asignado en capítulo IV (prescripción de medicamentos a través de receta médica).Hasta la fecha, el único parámetro empleado para la asignación del presupuesto ha sido la población asignada a cada centro de salud. Sin embargo, empleando sólo esta variable se observan resultados muy dispares entre los centros.El objetivo del presente trabajo es identificar aquellas variables relacionadas con la calidad de la prescripción de medicamentos, la actividad asistencial realizada o la pirámide de población atendida que puedan tener incidencia en la desviación sobre el presupuesto asignado. Concretamente, se seleccionaron 5 equipos de atención primaria, con un total de 38 médicos y 59.319 habitantes, sobre los que se buscó la existencia de correlación entre el ajuste presupuestario y las siguientes variables: población de 65 a 74 años, población mayor de 75 años, presión arterial, envases de medicamentos de utilidad terapéutica baja (UTB) por cada 100 habitantes y prescripción de medicamentos de alta utilidad terapéutica.En el análisis se observó la existencia de relación entre ajuste presupuestario y tres de las variables estudiadas: población entre 65 y 74 años, envases de medicamentos UTB por cada 100 habitantes y porcentaje de medicamentos de alta utilidad, con las que se explica el 72 por ciento de la variabilidad de la desviación sobre el presupuesto, sin encontrar relación con las demás variables estudiadas (AU)