Domperidone is Commonly Prescribed With QT-Interacting Drugs: Review of a Community-based Practice and a Postmarketing Adverse Drug Event Reporting Database.

INTRODUCTION: Domperidone, a peripheral D2 dopamine receptor antagonist, has efficacy for treatment of nausea, dyspepsia, and gastroparesis. Domperidone prolongs the QT interval (QTc), and may cause life-threatening arrhythmias. METHODS: Electronic medical records for all patients receiving domperidone in the NorthShore University HealthSystem from January 1, 2008 to December 1, 2013 were reviewed. All concomitant medications were noted. The coadministration of QT-interacting medications was determined. Electrocardiogram (EKG) evaluation before and during domperidone therapy was noted. A query of the FDA Adverse Event Reporting System (FAERS) database was also performed. Individual reports from the FAERS Web site from January 2008 to June 2014 were downloaded and analyzed. The database was queried for all reports of adverse events with domperidone. Coadministration of QT-interacting medications was noted. Cardiac events that potentially were related to prolongation of the QTc were examined. RESULTS: In total, 108 of 155 patients (69.7%) were coprescribed QT-interacting drugs along with domperidone. Fifty-nine of 155 patients (38.1%) underwent a baseline EKG and 9 (15.3%) had prolongation of the QTc at initiation. Forty patients (25.8%) had a follow-up EKG and 13 (32.5%) had prolongation of the QTc. All 13 were coprescribed QT-interacting medications. On the FAERS, 221 nonfatal cardiac events were reported in domperidone patients; of these, 162 (73.3%) occurred in patients receiving QT-interacting medications. Coprescription occurred in 53 of 151 deaths (35.1%) and in 16 of 61 cardiac arrests (26.2%). CONCLUSIONS: Coprescribing of QT-prolonging medications and inconsistent EKG monitoring occur in patients receiving domperidone, placing these patients at risk for arrhythmias.

Effect of the Diagnosis of Inflammatory Bowel Disease on Risk-Adjusted Mortality in Hospitalized Patients with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia.

INTRODUCTION: Measurement of mortality in patients with acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN) is a high priority since these are common reasons for hospitalization. However, mortality in patients with inflammatory bowel disease (IBD) that are hospitalized for these common medical conditions is unknown. METHODS: A retrospective review of the 2005-2011 National Inpatient Sample (NIS), (approximately a 20% sample of discharges from community hospitals) was performed. A dataset for all patients with ICD-9-CM codes for primary diagnosis of acute myocardial infarction, pneumonia or congestive heart failure with a co-diagnosis of IBD, Crohn's disease (CD) or ulcerative colitis (UC). 1:3 propensity score matching between patients with co-diagnosed disease vs. controls was performed. Continuous variables were compared between IBD and controls. Categorical variables were reported as frequency (percentage) and analyzed by Chi-square tests or Fisher's exact test for co-diagnosed disease vs. control comparisons. Propensity scores were computed through multivariable logistic regression accounting for demographic and hospital factors. In-hospital mortality between the groups was compared. RESULTS: Patients with IBD, CD and UC had improved survival after AMI compared to controls. 94/2280 (4.1%) of patients with IBD and AMI died, compared to 251/5460 (5.5%) of controls, p = 0.01. This represents a 25% improved survival in IBD patients that were hospitalized with AMI. There was a 34% improved survival in patients with CD and AMI. There was a trend toward worsening survival in patients with IBD and CHF. Patients with CD and PN had improved survival compared to controls. 87/3362 (2.59%) patients with CD and PN died, compared to 428/10076 (4.25%) of controls, p < .0001. This represents a 39% improved survival in patients with CD that are hospitalized for PN. CONCLUSION: IBD confers a survival benefit for patients hospitalized with AMI. A diagnosis of CD benefits survival in patients that are hospitalized with PN.

Inpatient Costs for Patients with Inflammatory Bowel Disease and Acute Pancreatitis.

BACKGROUND: Inflammatory bowel disease (IBD) is associated with an increased risk of acute pancreatitis (AP). Our group examined differences in length of stay and costs for patients with IBD hospitalized for AP and the general population. METHODS: Using the National Inpatient Sample, we examined all admissions during 2005 to 2011 with a primary diagnosis of AP and codiagnosis of IBD. Continuous variables were reported as mean ± SD and compared between IBD and controls. To compare the outcomes of interest, we conducted a 1:3 propensity score matching using a greedy algorithm based on age, gender, race, number of comorbidities, procedures, insurance, income quartiles, hospital bed size, hospital location, and teaching status. Statistical analyses were performed on SAS 9.3 (Cary, NC). RESULTS: There were 4291 hospitalizations of patients with IBD and AP over the 7-year period and 379,627 hospitalizations of patients without IBD and with AP. More patients with Crohn's disease developed AP than patients with ulcerative colitis (2145 versus 1219). The length of stay and costs for patients with AP and IBD were significantly higher than controls (5.7 days versus 4.9 days, P < 0.0001 and $29,724.89 versus $27,916.76, P < 0.0001). The percentage of patients with alcohol abuse was lower in patients with IBD than that of controls (11.8% versus 21.7%, P < 0.0001). However, the percentage of patients with IBD who were drug abusers was higher than controls (5.8% versus 4.3%, P < 0.0005). CONCLUSIONS: Our study suggests that a codiagnosis of Crohn's disease or ulcerative colitis incurs a greater economic burden in patients with AP.