Carga anticolinérgica da farmacoterapia de pacientes com mieloma múltiplo e sua associação com a qualidade de vida relacionada à saúde.

Abstract

Multiple myeloma (MM) is an incurable disease characterized by the proliferation of plasma cells. The main goal of MM treatment is to increase life expectancyand improve health-related quality of life (HRQoL). Anticholinergic drugs (DAch) are associated with potential adverse effects such as a significant decline in physical function and quality of life. The study aims to analyze the use of DACh by individuals with MM and its association with HRQoL. Furthermore, verify the agreement between three measurement scales of anticholinergic activity. This is an observational, cross-sectional study. The data come from a cohort, carried out between April 2019 and February 2020, in onco-hematology outpatient clinics from the public and private services in Belo Horizonte, Minas Gerais. Data were collected through interviews and from medical records and exported to Microsoft Excel®. Statistical analysis was performed using the Statistical Package for the Social Sciences® (SPSS®), version 25.0. DAch were identified through the following scales: Brazilian Scale of Drugs with Anticholinergic Activity; Anticholinergic Cognitive BurdenScale (ACB) and Anticholinergic Risk Scale (ARS). HRQoL scores were obtained using the QLQ-C30 instruments and the specific module QLQ-MY20. Descriptive analysis was performed for categorical and numerical variables. Multiple logistic regression was performed to identify factors associated with DACh use. The agreement between the scales in the classification and categorization of anticholinergic burden was measured by Fleiss Kappa and Weighted Kappa, respectively. To assess HRQoL, univariate analyzes (Mann-Whitney) and multiple linear regression were performed. It was possible to conclude that the frequency of use of DACh was 70% in patients with MM, according to Brazilian Scale, and positively associated with polypharmacy. It was identified 56 DAch, the most frequent were: dexamethasone, tramadol, codeine and atenolol. There is low agreement between the three scales in the classification of MACh and moderate agreement in the categorization of anticholinergic burden. The use of DACh in patients with MM is associated with worse HRQoL, identified by the reduction of global status scores (QLQ-C30), functional scale (QLQ-C30), body image (QLQ-MY20) and future perspective (QLQ-MY20). At the same time, it increases the symptom scores of the QLQ-C30 and QLQ-MY20 scales. Polypharmacy is also associated with worse HRQoL, with reduction of functionality and symptoms scores on the QLQ-C30 scale.