Reassess drugs affecting balance, perception in multiple myeloma patients, says study

Polypharmacy cannot be avoided in patients with multiple myeloma, but medications affecting balance and perception must be reconsidered in these individuals, suggests a study.

“Multiple myeloma is a chronic, uncurable haematological cancer with the involvement of multiple organ systems,” the authors said. “As a disease affecting older patients, the treatment of multiple myeloma should be based on individual patient characteristics.”

Sixty-five patients had polypharmacy with ≥4 drugs while 51 patients were on ≥5 drugs. In women, poor Eastern Cooperative Oncology Group (ECOG) performance status was associated with autonomous neuropathy, polypharmacy with ≥4 or ≥5 drugs, and use of multiple medications in the same category. Poor ECOG performance status in men was predicted by prolonged use of benzodiazepines and central nervous system affecting drugs and inappropriate polypharmacy.

In addition, inappropriate polypharmacy was observed in most patients aged 75–84 years and was significantly correlated with autonomous neuropathy and fall risk.

A 2016 study assessing the prevalence of potentially inappropriate prescriptions in comorbid older patients suggests that strategies should focus on the management of polypharmacy and that medication review at hospital discharge is advised for those taking ≥6 drugs. [J Eval Clin Pract 2016;22:189-193]

In the present study, the authors retrospectively enrolled 80 patients with multiple myeloma aged >65 years. They determined patient files, prescriptions and evaluations for polypharmacy according to Beers and START/STOPP criteria. Outcomes were recorded from files in terms of fractures, renal functions and autonomous neuropathy.

“Polypharmacy is an increasing problem in the care of older patients and in patients with multiple myeloma, polypharmacy is almost inevitable,” the authors said.