Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials

Pazan, Farhad; Petrovic, Mirko; Cherubini, Antonio; Onder, Graziano; Cruz-Jentoft, Alfonso J.; Denkinger, Michael; van der Cammen, Tischa J. M.; Stevenson, Jennifer M.; Ibrahim, Kinda; Rajkumar, Chakravarthi; Bakken, Marit Stordal; Baeyens, Jean-Pierre; Crome, Peter; Fr�hwald, Thomas; Gallaghar, Paul; Gu�mundsson, Adalsteinn; Knol, Wilma; O�Mahony, Denis; Pilotto, Alberto; R�nnemaa, Elina; Serra-Rexach, Jos� Antonio; Soulis, George; van Marum, Rob J.; Ziere, Gijsbertus; Mair, Alpana; Burkhardt, Heinrich; Neumann-Podczaska, Agnieszka; Wieczorowska-Tobis, Katarzyna; Fernandes, Marilia Andreia; Gruner, Heidi; Dallmeier, Dhayana; Beuscart, Jean-Baptiste; van der Velde, Nathalie; Wehling, Martin

Abstract

Background
Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.

Methods
A literature search was performed in Medline to detect prospective randomized controlled trials (RCTs) testing the effects of pharmacological interventions or medication optimization in older frail adults on comprehensive frailty scores or partial aspects of frailty that were published from January 1998 to October 2019.

Results
Twenty-five studies were identified, 4 on comprehensive frailty scores and 21 on aspects of frailty. Two trials on comprehensive frailty scores showed positive results on frailty although the contribution of medication review in a multidimensional approach was unclear. In the studies on aspects related to frailty, ten individual drug interventions showed improvement in physical performance, muscle strength or body composition utilizing alfacalcidol, teriparatide, piroxicam, testosterone, recombinant human chorionic gonadotropin, or capromorelin. There were no studies examining negative effects of drugs on frailty.

Conclusion
So far, data on a causal relationship between drugs and frailty are inconclusive or related to single-drug interventions on partial aspects of frailty. There is a clear need for RCTs on this topic that should be based on a comprehensive, internationally consistent and thus reproducible concept of frailty assessment.

Citation

Pazan, F., Petrovic, M., Cherubini, A., Onder, G., Cruz-Jentoft, A. J., Denkinger, M., van der Cammen, T. J. M., Stevenson, J. M., Ibrahim, K., Rajkumar, C., Bakken, M. S., Baeyens, J.-P., Crome, P., Frühwald, T., Gallaghar, P., Guðmundsson, A., Knol, W., O’Mahony, D., Pilotto, A., Rönnemaa, E., …Wehling, M. (2021). Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. European Journal of Clinical Pharmacology, 77(1), 1-12. https://doi.org/10.1007/s00228-020-02951-8

• Journal Article Type: Article
• Acceptance Date: Jun 30, 2020
• Online Publication Date: Aug 7, 2020
• Publication Date: 2021-01
• Deposit Date: Apr 28, 2021
• Journal: European Journal of Clinical Pharmacology
• Print ISSN: 0031-6970
• Electronic ISSN: 1432-1041
• Publisher: Springer
• Peer Reviewed: Peer Reviewed
• Volume: 77
• Issue: 1
• Pages: 1-12
• DOI: https://doi.org/10.1007/s00228-020-02951-8
• Keywords: Frailty, Prefrailty, Polypharmacy, Medication optimization, Inappropriate drug treatment, Older people
• Public URL: http://researchrepository.napier.ac.uk/Output/2765819