Polypharmacy in chronic liver disease patients: Implications for disease severity, drug-drug interaction, and quality of life

Cirrhotic patients with bone and joint infections: A 10-year cohort study from a reference center

INTRODUCTION

Bone and joint infections (BJI) require long-term and frequently high-dose antimicrobial treatment, often with heightened risk of drug-drug or drug-disease interactions. However, in some cases, notably regarding cirrhotic patients, these infections have yet to be adequately described. Cirrhosis is a major cause of end-stage chronic liver disease, entailing massive disorders in hepatic metabolism and a high rate of infections and comorbidities. We aimed to characterize the cirrhosis - BJI population treated over the last 10 years in our reference centre.

MATERIAL AND METHODS

A descriptive monocentric retrospective study analysed routine care data extracted from our computer files. Patients labelled with a chronic hepatic disease were included. Biological, clinical and survival rate were researched. Drug-drug and drug-disease interactions were compiled and analysed using the exposure ratio, according to the Child-Pugh scale.

RESULTS

Eighteen patients were included, for 28 presentations. Twelve were Child-Pugh B or C. Only two out of the 18 patients had their antimicrobial dosage adjusted. No patient who had not received the recommended dose adjustment was admitted to the emergency department or for consultation for an antibiotic-related adverse event. During the 1st year, two patients (11.1 %) required hospitalization for revision surgery. Neither relapsed a second time. Six patients (33.3 %) died during follow-up, but none of the deaths were related to infection (four cancers, two ischemic events).

CONCLUSION

We have shown that cirrhotic patients with BJI are infected with the same pathogens as the general population. Dose adjustments remain unclear, and further studies are required. BJI infections are particularly complex, and require enhanced multidisciplinary management.

Assessment of Drug-related Problems among Patients of Chronic liver Disease in a Tertiary Care Hospital

Background

Chronic Liver Disease (CLD) is a long-term condition marked by a gradual decline in liver function. Patients with CLD often experience multimorbidity and polypharmacy, which can adversely affect their health outcomes. The objective of the current study is to identify and resolve the drug-related problems associated with chronic liver disease.

Methods

This prospective observational study involved 150 patients with CLD over a six-month period. Eligible participants included individuals over 18 years old, diagnosed with CLD based on the Child-Pugh score, and currently receiving treatment. Drug-related problems (DRPs) were identified using the Pharmaceutical Care Network Europe (PCNE) classification version 9.1. Data analysis was conducted using Chi-square and Fisher's exact tests with SPSS software version 29.

Results

A total of 212 DRPs were identified and resolved. The most frequent type of DRP was related to treatment efficacy, with 96 instances (45.29%). Within this category, the subcategory 'effect of drug treatment not optimal' was the most common, accounting for 45 patients (21.23%). Drug interactions were identified as the leading cause of DRPs, comprising 65 cases (30.66%). Most issues were addressed at the prescriber level, with 48.11% of interventions accepted by physicians.

Conclusion

This study provides valuable insights into identifying and managing DRPs that can negatively impact treatment outcomes in CLD patients. The findings can assist healthcare professionals in prioritizing strategies to enhance clinical results.

Effect of changes in metabolic enzymes and transporters on drug metabolism in the context of liver disease: Impact on pharmacokinetics and drug-drug interactions

Changes in the pharmacokinetic and resulting pharmacodynamic properties of drugs are common in many chronic liver diseases, leading to adverse effects, drug interactions and increased risk of over- or underdosing of medications. Structural and functional hepatic impairment can have major effects on drug metabolism and transport. This review summarizes research on the functional changes in phase I and II metabolic enzymes and in transport proteins in patients with metabolic diseases such as type 2 diabetes, metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis and cirrhosis, providing a clinical perspective on how these changes affect drug uptake and metabolism. Generally, a decrease in expression and/or activity of many enzymes of the cytochrome P450 family (e.g. CYP2E1 and CYP3A4), and of influx and efflux transporters (e.g. organic anion-transporting polypeptide [OATP]1B1, OATP2B1, OAT2 and bile salt export pump), has been recently documented in patients with liver disease. Decreased enzyme levels often correlate with increased severity of chronic liver disease. In subjects with hepatic impairment, there is potential for strong alterations of drug pharmacokinetics due to reduced absorption, increased volume of distribution, metabolism and extraction. Due to the altered pharmacokinetics, specific drug-drug interactions are also a potential issue to consider in patients with liver disease. Given the huge burden of liver disease in western societies, there is a need to improve awareness among all healthcare professionals and patients with liver disease to ensure appropriate drug prescriptions.