Study examines solution to gauge adverse drug event risk

Most adults rely on prescription medications to manage various illnesses and conditions. A Lown Institute study finds more than 40% of older patients in the US take at least five prescriptions each day—an increase of approximately 200% over the past two decades.

A recent peer-reviewed study from the Precision Pharmacotherapy Research and Development Institute of Tabula Rasa Healthcare (TRHC) examined the ability of the MedWise Risk Score (a technology from TRHC) to determine the risk of adverse drug events (ADEs) from a patient’s medication regimen. According to the report, the tool could be used to predict an increased risk of death, suggesting pharmaceutical interventions for those with a higher score could improve patient safety.

TRHC conducted the study in partnership with the DARTNet Institute and Department of Clinical Pharmacy, and the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado. Outsourcing-Pharma recently spoke with two company leaders about the report, and how the information could lead toward increased patient safety:

• Calvin H. Knowlton, TRHC CEO and chairman
• Jacques Turgeon, CEO and chief scientific officer, TRHC’s Precision Pharmacotherapy Research and Development Institute

OSP: Could you please share the ‘elevator presentation’ description of TRHC—who you are, what you do, key capabilities and areas of expertise, and what sets you apart.​

CK: TRHC is a leader in advancing the safe use of medications by providing patient-specific, data-driven technology and solutions that empower healthcare professionals and consumers to optimize medication regimens, combatting medication overload, and reducing adverse drug events – the third leading cause of death in the US.

TRHC’s proprietary technology solutions, including MedWise, improve patient outcomes, reduce hospitalizations, and lower healthcare costs.  Our advanced solutions provide pharmacists with powerful tools to use for risk mitigation and clinical intervention to improve patients’ medication regimens at scale.  Its solutions are trusted by health plans and pharmacies to help drive value-based care.

OSP: As you cited, prescription drug use is increasing. What are some of the concerns or potential problems that might arise from that?​

CK: With the introduction of new medications, including the treatment of COVID-19, the risk of ADEs increases, which creates the need for more accessible and trained medication safety experts. Central to the patient healthcare continuum is the community pharmacist; they become the 'quarterback' for patient care. It is becoming increasingly important to have conversations with your pharmacist about your medication regimen.

Additionally, as the US healthcare market continues to evolve from fee-for-service to value-based models of care, healthcare organizations will require new and emerging technologies to optimize treatment and manage risk on a patient-specific, customized basis. The industry will need to adapt and evolve, moving on from old methods of analyzing prescription drug interactions to simultaneous multi-drug interactions, for example.

The simulation ability of MedWise, when applied in both clinical trials or clinical practice, can save lives by identifying risks before patients are exposed to inappropriate therapies based on their medication regimens or disease states.

OSP: Could you please share with us some of the prescription drugs (categories/conditions—no need to name specific drugs or brands) that are particularly likely to lead to ADEs?​

JT: The risk of ADEs caused by multi-drug interactions increases significantly as the proliferation of new medications continues to accelerate. This is the first major study that demonstrates that the risk of death increased with higher medication risk scores (MRS).

This peer-reviewed study indicates that pharmacists equipped with TRHC’s MedWise Risk Score can intervene on some actionable elements of a patient’s medication regimen to stave off premature death for those taking multiple medications. Drugs that can be particularly problematic for ADEs include opioids, anticoagulants, antipsychotics, cardiovascular agents, antidepressants, anticholinergic agents, several anti-neoplastic agents, and more.

OSP: Please share a little more detail about the MedWise Risk Score—how it was created, how it works, and how it could be put to use by healthcare providers, pharma firms, and other professionals in the life-sciences sphere to predict and avoid ADEs.​

JT: The MedWise Risk Score (MRS) is a quick and easy way to assess which patients are at the highest risk for ADEs and require the most immediate medication management attention. The MRS calculation uses active medication ingredients of a patient's complete medication list, including over-the-counter supplements and incorporates pharmacogenomics, pharmacokinetics, and pharmacodynamics to predict the risk of medication problems and ADEs.

A published study, involving nearly 2,000 patients, found that a lower MRS correlated with fewer ADEs, emergency department visits, hospitalizations, and lower medical costs and that each risk score unit reduction equated to about $1,000 in medical cost savings.

Pharmacists typically make recommendations to reduce the risk score by 4-5 units. Assessing the risk of medications in aggregate, the MRS guides pharmacists and prescribers toward individualized medication decision support. The MRS helps physicians make safer prescribing choices and take a more personalized approach to prescribing medications, including medication selection, dosage levels, time-of-day administration, and reduction of the total number of medications by eliminating unnecessary prescriptions.

OSP: How do you anticipate or hope the information revealed in the study you published will be put to use?​

JT: This study adds to the body of research that demonstrates how science-based THRC MedWise Risk Scores can help reduce ADEs, increasing patient safety and lowering medical costs. This is the first major study that demonstrates that the risk of death increased with higher medication risk scores. This peer-reviewed study suggests that pharmacists equipped with TRHC’s MedWise Risk Score can stave off premature death for those taking multiple medications.

We hope that payers, including state and federal government, begin to realize that there is a solution to the ongoing problem of morbid and costly adverse drug events and that they mandate the use of technologies like MedWise that can prevent ADEs and save lives.

OSP: Do you have anything to add we didn’t touch upon above?​

CK: THRC is the only company that can produce a medication risk score based solely upon the medication regimen, and then demonstrate as we reduce the patients’ risk scores, they avoid ADEs and premature death. Along with pharmacogenomics, this is one more step toward precision, personalized medication therapy.

Consumers are largely unaware of the risks that medications pose, let alone that solutions exist to identify preventable ADEs.  Consumers need to know about the problems that medications can cause along with the systems that can prevent them, which have a tremendous return on investment.