STOPP/START-criteria and a modified index of the rationality of drug use in the treatment of spinal osteochondrosis in older patients

BACKGROUND. On an outpatient basis, a common problem in older patients is osteochondrosis of the spine. His treatment in geriatric patients often forces him to prescribe drugs with multiple undesirable side effects. Possible tools for their prevention are the STOP/START criteria and the modified index of rationality of drug use (Medicine Appropriateness Index ― MAI, 2012), which make it possible to assess the effectiveness and safety of the therapy.

OBJECTIVE. Assessment of the safety of drug therapy for spinal osteochondrosis in patients over 60 years of age using STOPP/START criteria and MAI.

MATERIALS AND METHODS.

A retrospective analysis of medication prescriptions in 315 case histories of elderly patients of day care centers in Kursk with spinal osteochondrosis (2015-2024) was performed. The age of the studied patients was (70.94 ± 0.86) years. To solve the research tasks, STOPP/START criteria and a modified index of the rationality of drug use (MAI, 2012) were used. Statistical analysis of the results ― Microsoft Excel 2010.

RESULTS. All the examined corresponded to the elderly age ― (70.94 ± 0.86) year. The subjects received multicomponent drug therapy. So they could use up to 10 medications at a time (the average number of medications per patient was 6.13 ± 0.19).

Traditional therapy for spinal osteochondrosis in day hospitals consisted of anti–inflammatory and analgesic components (corticosteroids (GCS) and nonsteroidal anti-inflammatory drugs (NSAIDs)) and muscle relaxants, more often of central action.

The greatest number of limitations in the treatment of osteochondrosis of the spine were found in non-selective NSAIDs. However, there was no adequate prevention of adverse side effects.

Thus, 23.83 % had chronic heart failure (CHF), however, measures and recommendations for the prevention of it and its exacerbations are not recorded in the medical documentation. The proportion of patients with hypertension was 47.99 %. At the same time, the appointment of anti-inflammatory therapy was carried out without proper monitoring of blood pressure levels, which, in turn, provoked episodes of blood pressure destabilization.

Despite the large number of undesirable side effects of anti-inflammatory therapy on the part of the kidneys, the glomerular filtration rate was not calculated in 81.54 %, which indicates an almost complete lack of prevention of kidney dysfunction.

MAI GCS reached the highest values ― 14.59 ± 0.21. The indices of non–selective NSAIDs MAI were also high ― 14.09 ± 0.12. In selective NSAIDs, this indicator is significantly lower ― 9.15 ± 0.16. The intermediate MAI values for centrally acting muscle relaxants are 11.18 ± 0.14.

CONCLUSION. The prescribed anti-inflammatory therapy for osteochondrosis of the spine was carried out without taking into account the pathology of the cardiovascular system and the functional state of the kidneys, creating all the prerequisites for exacerbating the course of concomitant pathology. Extremely high MAI values indicate defects in the safety assessment and underestimation of possible side effects and insufficient control of inter-drug effects and somatic pathology of aging patients. The identified shortcomings require wider implementation of restrictive lists in clinical practice.