1 Introduction
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Class A (A-bsolutely) = indispensable drug, clear-cut benefit in terms of efficacy/safety ratio proven in elderly patients for a given indication
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Class B (B-eneficial) = drugs with proven or obvious efficacy in the elderly, but limited extent of effect or safety concerns
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Class C (C-areful) = drugs with questionable efficacy/safety profiles in the elderly, to be avoided or omitted in the presence of too many drugs, lack of benefits or emerging side effects; review/find alternatives
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Class D (D-on’t) = avoid in the elderly, omit first, review/find alternatives
2 Methods
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Range 0: unanimity among all experts giving a FORTA rating (no deviation);
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Range 1: greatest range only from A to B, B to C or C to D (neighbouring classes), half weight;
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Range 2: greatest distance from A to C or B to D, two-thirds weight;
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Range 3: greatest distance from A to D, full weight.
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If 1 ≤ m < 1.5 → FORTA Class A
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If 1.5 ≤ m < 2.5 → FORTA Class B
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If 2.5 ≤ m < 3.5 → FORTA Class C
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If m ≥ 3.5 → FORTA Class AD
Range | Frequency (n = 190) | Percent |
---|---|---|
0 | 54 | 28.42 |
1 | 86 | 45.26 |
2 | 43 | 22.63 |
3 | 7 | 3.68 |
3 Results
Re-evaluated substance/group (original FORTA rating) | FORTA indication area | No. of raters (n = 20) | Consensus coefficient | Expert rating on a numerical scalea
| Proposed FORTA rating, based on mean value from Round 2 |
---|---|---|---|---|---|
Round 1 | Round 1 (cutoff 0.800) | Round 1 | |||
Round 2 | Round 2 mean; mode | ||||
Drugs to prevent or treat dementia or dementia-related syndromes | |||||
Nimodipine (C) | Dementia | 20 | 0.750 | 3.5; 3 | D |
19 | 3.7; 4 | ||||
Antioxidants (C) | Dementia | 19 | 0.710 | 3.6; 4 | D |
20 | 3.9; 4 | ||||
Phytotherapeutic agents, e.g. Ginseng (C) | Dementia | 20 | 0.725 | 3.6; 4 | D |
20 | 3.8; 4 | ||||
Hormone preparations, e.g. DHEA (C) | Dementia | 20 | 0.700 | 3.6; 4 | D |
20 | 3.9; 4 | ||||
Gingko biloba (C) | Dementia | 20 | 0.775 | 3.5; 3 | D |
20 | 3.6; 4 | ||||
Ergoline derivatives (C) | Dementia | 19 | 0.763 | 3.5; 3 | D |
20 | 3.8; 4 | ||||
Piracetam (C) | Dementia | 20 | 0.800 | 3.4; 3 | D |
20 | 3.6; 4 | ||||
Pyritinol (C) | Dementia | 18 | 0.778 | 3.4; 3 | D |
19 | 3.7; 4 | ||||
Selegiline (C) | Dementia | 19 | 0.763 | 3.5; 3 | D |
20 | 3.7; 4 | ||||
Haloperidol (D) | BPSD paranoia, hallucinations | 19 | 0.632 | 3.3; 4 | C |
20 | 3.0; 3 | ||||
Risperidone (D) | BPSD paranoia, hallucinations | 20 | 0.500 | 3.0; 2 | C |
20 | 2.7; 2 | ||||
Quetiapine (D) | BPSD paranoia, hallucinations | 20 | 0.575 | 3.2; 4 | C |
20 | 2.9; 3 | ||||
Aripiprazole (D) [2–15 mg/day] | BPSD paranoia, hallucinations | 19 | 0.789 | 3.6; 4 | C |
17 | 3.4; 4 | ||||
Clozapine (D) [10–50 mg/day] | BPSD paranoia, hallucinations | 20 | 0.800 | 3.6; 4 | D |
19 | 3.7; 4 | ||||
Risperidone (D) | BPSD restlessness | 20 | 0.625 | 3.3; 4 | C |
20 | 2.7; 2 | ||||
Melperone (D) | BPSD restlessness | 20 | 0.675 | 3.4; 4 | C |
20 | 3.4; 4 | ||||
Quetiapine (D) [25–200 mg/day] | BPSD restlessness | 19 | 0.763 | 3.5; 4 | C |
19 | 3.3; 3 | ||||
Pipamperone (D) [20–150 mg/day] | BPSD restlessness | 19 | 0.790 | 3.6; 4 | D |
17 | 3.6; 4 | ||||
Mirtazapine (C) [15–30 mg] | BPSD sleep disorders | 20 | 0.775 | 3.0; 3 | C |
20 | 3.0; 3 | ||||
Mirtazapine (D) | Insomnia | 20 | 0.700 | 3.4; 4 | C |
20 | 3.45; 4 | ||||
Other drugs | |||||
Digitoxin (D) | Atrial fibrillation | 20 | 0.525 | 3.1; 4 | C |
19 | 2.5; 2 | ||||
Digoxin (B) | Atrial fibrillation | 20 | 0.800 | 2.4; 2 | B |
19 | 2.4; 2 | ||||
Dronedarone (B) | Atrial fibrillation | 18 | 0.556 | 2.9; 3 | C |
18 | 3.0; 3 | ||||
Strontium ranelate (B) | Osteoporosis | 17 | 0.794 | 2.1; 2 | B |
18 | 2.1; 2 |