Using a Precision-Medicine Platform to Address Polypharmacy in Cognitive Impairment

John Q. Walker II, PhD, CTO, umethod

John Q. Walker II, PhD

At the 2019 Alzheimer’s Association International Conference, July 14-18, in Los Angeles, California, uMETHOD Health shared results from an analysis that evaluated the implementation of a precision-medicine platform to create personalized, multidomain care plans for the treatment of dementia and mild Alzheimer disease.

The algorithms analyze medication interactions and adverse drug reactions, such as drug-drug interactions, opioid usage, anticholinergic cognitive burden, and depression-inducing drugs, rate them using input from an open-source database, and then attend to each in a generated treatment plan.

“Polypharmacy, the concurrent use of multiple medications, increases the likelihood that an individual will experience potential drug interactions and adverse drug reactions. Those with dementia or Alzheimer disease are at greater risk due to age, comorbidities, and an increased likelihood of being on more neuroactive medications,” the authors, including, John Q. Walker II, PhD, chief technology officer, uMETHOD Health, wrote. “With the growing elderly and AD populations, medication management (MM) for polypharmacy is a need that grows direr every year. The complexity of MM increases when dealing with an older population who are not only on more medications, but also have existing comorbidities and alternate pharmacokinetics.”

Of the 448 individuals included the analysis, 98.2% were on at least 1 medication (mean 11.6 medications/person), 84.6% on 5 or more, and 48% on 10 or more. Notably, 10.7% of subjects were on at least 1 opioid, and 70.5% were on 1 or more anticholinergic drugs.

Investigators reported a total of 5469 clinically-significant drug-drug interactions and 1 high-priority drug-drug interaction. Drug-drug interactions significantly increased as medications per person increased (P <.0001).

Anticholinergic cognitive burden scores were significantly higher for those with cognitive decline than those without, and 70.1% of this population were on depression-inducing drugs (mean 2.1 depression-inducing drug/person).

The investigators explained that precision medicine can better enable medication management when considering a full list of medications and comorbidities, manage high-risk medical recommendations, reduce redundancies, reduce drug-drug interactions and adverse drug reactions, and recommend alternatives.

“Such a platform can generate effective and highly-usable guidelines for each recommended change (deprescribing methodologies, changing dosages or formulations, recommending alternatives), and give guidance on the total picture: what needs to happen, how, and when,” the investigators concluded. “uMETHOD Health’s platform addresses a multitude of polypharmacy problems that individuals may face.”

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REFERENCE

Walker J, Zelek M, Sabbagh M. Addressing Polypharmacy Issues in an Elderly Population with Cognitive Impairment, Using a Precision-Medicine Platform. Presented at: 2019 Alzheimer’s Association International Conference. July 14—18, 2019; Los Angeles, CA.