Optimizing drug selection from a prescription trajectory of one patient

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It is unknown how sequential drug patterns convey information on a patient’s health status and treatment guidelines rarely account for this. Drug-agnostic longitudinal analyses of prescription trajectories in a population-wide setting are needed. In this cohort study, we used 24 years of data (1.1 billion prescriptions) from the Danish prescription registry to model the risk of sequentially redeeming a drug after another. Drug pairs were used to build multistep longitudinal prescription trajectories. These were subsequently used to stratify patients and calculate survival hazard ratios between the stratified groups. The similarity between prescription histories was used to determine individuals’ best treatment option. Over the course of 122 million person-years of observation, we identified 9 million common prescription trajectories and demonstrated their predictive power using hypertension as a case. Among patients treated with agents acting on the renin-angiotensin system we identified four groups: patients prescribed angiotensin converting enzyme (ACE) inhibitor without change, angiotensin receptor blockers (ARBs) without change, ACE with posterior change to ARB, and ARB posteriorly changed to ACE. In an adjusted time-to-event analysis, individuals treated with ACE compared to those treated with ARB had lower survival probability (hazard ratio, 0.73 [95% CI, 0.64–0.82]; P < 1 × 10−16). Replication in UK Biobank data showed the same trends. Prescription trajectories can provide novel insights into how individuals’ drug use change over time, identify suboptimal or futile prescriptions and suggest initial treatments different from first line therapies. Observations of this kind may also be important when updating treatment guidelines.

OriginalsprogEngelsk
Artikelnummer150
Tidsskriftnpj Digital Medicine
Vol/bind4
Udgave nummer1
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
We would like to acknowledge funding from the Novo Nordisk Foundation (grant agreements NNF14CC0001, NNF17OC0027594, and NNF18SA0034956). This study has been approved by the Danish Data Protection Agency (ref: SUND-2016-83) and the Danish Health Authority (refs: FSEID-00001627, FSEID-00003092, and FSEID-00003096).

Publisher Copyright:
© 2021, The Author(s).

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