Dtsch Med Wochenschr 2020; 145(20): 1504-1508
DOI: 10.1055/a-1234-9684
Aus Fachgremien

Entwicklung von Empfehlungen zum Management von Arzneimitteltherapie bei Multimorbidität

Recommendations for Drug Treatment in Patients with Multimorbidity
Daniel Grandt
Kommission Arzneimitteltherapie-Management und Arzneimitteltherapiesicherheit, Deutsche Gesellschaft für Innere Medizin e. V. (DGIM)
Thomas Gamstätter
Kommission Arzneimitteltherapie-Management und Arzneimitteltherapiesicherheit, Deutsche Gesellschaft für Innere Medizin e. V. (DGIM)
Ulrich R. Fölsch
Kommission Arzneimitteltherapie-Management und Arzneimitteltherapiesicherheit, Deutsche Gesellschaft für Innere Medizin e. V. (DGIM)
› Author Affiliations


Die Anwendung aller Leitlinien für jede Erkrankung eines Patienten mit Multimorbidität kann zu ungeeigneten Arzneimittelkombinationen und vermeidbaren Risiken führen. In einer Fachgesellschaften-übergreifenden, repräsentativen Arbeitsgruppe werden derartige therapeutische Konflikte identifiziert und Empfehlungen zum Management entwickelt, konsentiert und als S2k-Leitlinie formal Konsensus-basiert publiziert. Die Rationale für die Entwicklung der Empfehlungen, ihre Zielsetzung und die angewandte Methodik werden nachfolgend dargestellt. Die Struktur der Empfehlungen sowie ihre Erprobung, Fortschreibung und Aktualisierung werden erläutert.


Applying guidelines in patients with multimorbidity can result in dangerous or contraindicated drug-drug and drug-disease-interactions. A representative working group of medical scientific associations identifies such therapeutic conflicts and develops management strategies that will be published as a formally consensus based (S2K) guideline. Rational, aims and methods used are described, as well as evaluation and updating of recommendations.

Publication History

Article published online:
06 October 2020

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  • Literatur

  • 1 Meinck M, Lubke N. Geriatric multimorbidity in claims data: part 3: prevalence and predictive power of geriatric conditions in an age-specific systematic sample. Z Gerontol Geriatr 2013; 46: 645-657
  • 2 van den Bussche H, Koller D, Kolonko T. et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 2011; 11: 101
  • 3 Grandt D. Arzneimittelreport 2018. Berlin: BARMER; 2018
  • 4 Payne RA, Abel GA, Avery AJ. et al. Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 2014; 77 (06) 1073-1082
  • 5 Wauters M, Elseviers M, Vaes B. et al. Too many, too few, or too unsafe? Impact of inappropriate prescribing on mortality, and hospitalization in a cohort of community-dwelling oldest old. Br J Clin Pharmacol 2016; 82 (05) 1382-1392
  • 6 Kua CH, Mak VSL, Huey Lee SS. Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis. J Am Med Dir Assoc 2019; 20 (03) 362-372 e11
  • 7 Dumbreck S, Flynn A, Nairn M. et al. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ 2015; 350: h949
  • 8 Hughes LD, McMurdo ME, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age Ageing 2013; 42 (01) 62-69
  • 9 DEGAM. Hausärztliche Leitlinie: Multimedikation. [cited 2020 18.04.]; Registernummer 053-043. Available from: https://www.awmf.org/leitlinien/detail/ll/053-043.html
  • 10 Pasina L, Djade CD, Nobili A. et al. Drug-drug interactions in a cohort of hospitalized elderly patients. Pharmacoepidemiol Drug Saf 2013; 22 (10) 1054-1060
  • 11 Heidelbaugh JJ, Goldberg KL, Inadomi JM. Magnitude and economic effect of overuse of antisecretory therapy in the ambulatory care setting. Am J Manag Care 2010; 16 (09) e228-e234
  • 12 Koop H. Prescription and risks of proton pump inhibitor: fiction and facts. Z Gastroenterol 2018; 56 (03) 264-274
  • 13 Carnovale C, Venegoni M, Clementi E. Allopurinol overuse in asymptomatic hyperuricemia: a teachable moment. JAMA Intern Med 2014; 174 (07) 1031-1032
  • 14 Scholle O, Kollhorst B, Haug U. Are prescribers not aware of cardiovascular contraindications for diclofenac? A claims data analysis. J Intern Med 2019; DOI: 10.1111/joim.12990.
  • 15 Endres HG, Kaufmann-Kolle P, Steeb V. et al. Association between Potentially Inappropriate Medication (PIM) Use and Risk of Hospitalization in Older Adults: An Observational Study Based on Routine Data Comparing PIM Use with Use of PIM Alternatives. PLoS One 2016; 11 (02) e0146811
  • 16 (EMA). E.M.A. Guideline on good pharmacovigilance practices (GVP) – Module IX – Signal management (Rev 1). 2017 [cited 2019 26.09.2019]. Available from: https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance/good-pharmacovigilance-practices
  • 17 Romagnoli KM, Nelson SD, Hines L. et al. Information needs for making clinical recommendations about potential drug-drug interactions: a synthesis of literature review and interviews. BMC Med Inform Decis Mak 2017; 17 (01) 21
  • 18 Golder S, Peryer G, Loke YK. Overview: comprehensive and carefully constructed strategies are required when conducting searches for adverse effects data. J Clin Epidemiol 2019; 113: 36-43
  • 19 Grizzle AJ, Horn J, Collins C. et al. Identifying Common Methods Used by Drug Interaction Experts for Finding Evidence About Potential Drug-Drug Interactions: Web-Based Survey. J Med Internet Res 2019; 21 (01) e11182
  • 20 Behera SK, Das S, Xavier AS. et al. Comparison of different methods for causality assessment of adverse drug reactions. Int J Clin Pharm 2018; 40 (04) 903-910
  • 21 Uppsala Monitoring Center. The use of the WHO-UMC system to standardize case causality assessment. Im Internet (Stand: 7.9.2020): https://www.who.int/medicines/areas/quality_safety/safety_efficacy/WHOcausality_assessment.pdf
  • 22 Meyboom RH, Hekster YA, Egberts AC. et al. Causal or casual? The role of causality assessment in pharmacovigilance. Drug Saf 1997; 17 (06) 374-389
  • 23 Agbabiaka TB, Savovic J, Ernst E. Methods for causality assessment of adverse drug reactions: a systematic review. Drug Saf 2008; 31 (01) 21-37
  • 24 Thaker SJ, Sinha RS, Gogtay NJ. et al. Evaluation of inter-rater agreement between three causality assessment methods used in pharmacovigilance. J Pharmacol Pharmacother 2016; 7 (01) 31-33
  • 25 Horn JR, Hansten PD, Chan LN. Proposal for a new tool to evaluate drug interaction cases. Ann Pharmacother 2007; 41 (04) 674-680
  • 26 Guyatt G, Oxman AD, Akl EA. et al. GRADE guidelines: 1. Introduction – GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011; 64 (04) 383-394
  • 27 Guyatt GH, Alonso-Coello P, Schünemann HJ. et al. Guideline panels should seldom make good practice statements: guidance from the GRADE Working Group. Journal of Clinical Epidemiology 2016; 80: 3-7
  • 28 Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995; 311: 376-380
  • 29 Fitch K, Bernstein SJ, Aquilar MD, Burnand B, LaCalle JR, Lazaro P, van het Loo M, McDonnell J, Vader JKahan JP. The RAND/UCLA Appropriateness Method User's Manual. 2000 [cited 2019 26.09.2019]. Available from: https://www.rand.org/pubs/monograph_reports/MR1269.html
  • 30 McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm 2016; 38 (03) 655-662
  • 31 Seidling HM, Phansalkar S, Seger DL. et al. Factors influencing alert acceptance: a novel approach for predicting the success of clinical decision support. J Am Med Inform Assoc 2011; 18 (04) 479-484
  • 32 Heringa M, van der Heide A, Floor-Schreudering A. et al. Better specification of triggers to reduce the number of drug interaction alerts in primary care. Int J Med Inform 2018; 109: 96-102
  • 33 Floor-Schreudering A, Geerts AF, Aronson JK. et al. Checklist for standardized reporting of drug-drug interaction management guidelines. Eur J Clin Pharmacol 2014; 70 (03) 313-318
  • 34 Antoniou T, Gomes T, Juurlink DN. et al Trimethoprim-sulfamethoxazole-induced hyperkalemia in patients receiving inhibitors of the renin-angiotensin system: a population-based study. Arch Intern Med 2010; 170: 1045-1049 . doi:10.1001/archinternmed.2010.142
  • 35 Fralick M, Macdonald EM, Gomes T. et al Co-trimoxazole and sudden death in patients recei-ving inhibitors of renin-angiotensin system: population based study. BMJ 2014; 349: g6196 . doi:10.1136/bmj.g6196
  • 36 Antoniou T, Hollands S, Macdonald EM. et al Trimethoprim-sulfamethoxazole and risk of sud-den death among patients taking spironolactone. CMAJ 2015; 187 (04) E138-E143 . doi:10.1503/cmaj.140816