Personalising drug safety—results from the multi-centre prospective observational study on Adverse Drug Reactions in Emergency Departments (ADRED)

• Published in: European journal of clinical pharmacology 2020-03, Vol.76 (3), p.439-448
• Main Authors: Just, Katja S., Dormann, Harald, Böhme, Miriam, Schurig, Marlen, Schneider, Katharina L., Steffens, Michael, Dunow, Sandra, Plank-Kiegele, Bettina, Ettrich, Kristin, Seufferlein, Thomas, Gräff, Ingo, Igel, Svitlana, Schricker, Severin, Jaeger, Simon U., Schwab, Matthias, Stingl, Julia C.
• Format: Article
• Language: English
• Subjects: Analgesics; Antibiotics; Antidepressants; Antineoplastic drugs; Antipsychotics; Biomedical and Life Sciences; Biomedicine; Central nervous system; Demography; Emergency medical care; Glucocorticoids; Narcotics; Observational studies; Opioids; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology; Pharmacovigilance
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-019-02797-9

Purpose Adverse drug reactions (ADR) account for 5 to 7% of emergency department (ED) consultations. We aimed to assess medication risk profiles for ADRs leading to ED visits. Methods We analysed medication intake and patient demographics in a prospective multi-centre observational study collecting ADR cases in four large EDs in Germany. Odds ratios (OR) were calculated to relate drug classes taken to those suspicious for an ADR after a causality assessment. Results A total of 2215 cases of ED visits due to ADRs were collected. The median age of the cohort was 73 years; in median, six co-morbidities and an intake of seven drugs were documented. Antineoplastic/immunomodulating agents had the highest OR for being suspected for an ADR (OR 20.45, 95% CI 14.54–28.77), followed by antithrombotics (OR 2.94, 95% CI 2.49–3.47), antibiotics (OR 2.65, 95% CI 1.78–3.95), systemic glucocorticoids (OR 2.43, 95% CI 1.54–3.82) and drugs affecting the central nervous system (CNS), such as antipsychotics (OR 2.36, 95% CI 1.46–3.81), antidepressants (OR 2.10, 95% CI 1.57–2.83), antiparkinsonian medication (OR 2.11, 95% CI 1.15–3.84), opioids (OR 1.79, 95% CI 1.26–2.54) and non-opioid analgesics (OR 1.32, 95% CI 1.01–1.72). Conclusions Patients experiencing ADRs leading to ED visits are commonly old, multi-morbid and multi-medicated. CNS drugs may be more relevant than prior expected. With calculating ORs, we could replicate involvement of antineoplastic agents, antithrombotics, antibiotics, systemic glucocorticoids and non-opioid analgesics as frequently suspected for ADRs in EDs. Trial registration DRKS-ID: DRKS00008979.