Detection of DRPs in geriatric patients with rare diseases: a systematic review and retrospective analysis

Introduction : The development of medicine and the introduction of new therapeutic options are leading to increasing scientific attention to rare diseases (RDs) affecting older adults. This requires the application of a systematic approach to drug therapy, with a focus on the identification and management of drug-related problems (DRPs). Objectives : To systematically review the evidence on DRPs in older adults with rare diseases and to evaluate DRPs in a real-world cohort of older patients with acromegaly. Methods : A three-step approach was applied: (1) a systematic review of the literature on DRPs in geriatric patients with RDs; (2) a retrospective study of patients with acromegaly hospitalized at the Expert Center of Rare Endocrine Diseases, University Hospital for Active Treatment in Endocrinology (USHATE) “Acad. Ivan Penchev,” Sofia, Bulgaria, in 2021, with application of the STOPP/START criteria for the assessment of DRPs; and (3) an exploratory analysis of the odds of experiencing a DRP according to the presence of polypharmacy and multimorbidity. Results : A total of six studies met the inclusion criteria in the systematic review. The most common DRPs were associated with therapeutic failure and adverse drug reactions (ADRs), which were inherently serious because they led to hospitalization or death. Based on the retrospective study, a total of 16 DRPs were identified among 42 geriatric patients with acromegaly. Ten potentially inappropriate medications and four cases of prescribing omissions were identified, and a review of the Summary of Product Characteristics revealed two additional DRPs. The variables polypharmacy (OR = 1.3043, p = 0.7701) and multimorbidity (OR = 3.9804, p = 0.3720) were not statistically significant factors for the development of DRPs in the study group. Conclusion : The study identified clinically relevant DRPs and demonstrated the potential value of tools such as the STOPP/START criteria in evaluating therapy in geriatric patients. The results highlight that, despite the severity of DRPs, some of them can be identified and prevented through comprehensive pharmacotherapeutic analysis. This emphasizes the need for more in-depth research on risk factors and long-term follow-up by a clinical pharmacist to optimize pharmacotherapy.