Abstract Background Evidence from randomized controlled trials (RCTs) testing medication reviews in geriatric oncology is sparse. Methods We conducted a single‐blinded RCT in ten rehabilitation clinics across Germany. Patients with common cancers, aged ≥ 65 years, and polypharmacy (regularly ≥ five drugs) were randomly allocated in equal proportions to usual care or a comprehensive pharmacist‐led medication review conducted with the validated Fit fOR The Aged (FORTA) list. The FORTA score is the sum of drugs classified as potentially inappropriate medication (PIM) (each two points), drug underuse (each one point), and drug overuse (each one point). Changes in the FORTA score and its subcomponents from rehabilitation admission to discharge were tested using the chi‐square test or the Wilcoxon's rank‐sum test. Findings At admission, 66.1%, 94.6%, and 58.9% of 443 trial participants included in the intention‐to‐treat analysis were exposed to PIM, medication underuse, or overuse, respectively, and the median FORTA score was six. At discharge, participants of the intervention group ( n = 234) had a statistically significant greater reduction in the mean FORTA score than the control group ( n = 209): mean difference [95% confidence interval]: −3.7 [−4.2; −3.3] score points. Furthermore, the proportions of subjects with PIM, underuse, and overuse were statistically significantly reduced by the intervention by 41.3, 35.5, and 30.7 percentage points (all p < 0.001). Interpretation The pharmacist‐led intervention with the FORTA list substantially improved the medication quality of older cancer patients with polypharmacy in clinical practice. A reduction of four FORTA score points (rounded) translates, for example, to the withdrawal of two PIMs or four drugs labeled overuse.
Abstract Background Familial Mediterranean fever (FMF) and periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome share innate‐immune features, but population‐level data on oropharyngeal morbidity before FMF recognition are lacking. Objectives To examine the magnitude, timing, specificity, and treatment burden of a PFAPA‐like oropharyngeal phenotype in patients later diagnosed with FMF. Methods Population‐based matched case–control study in Leumit Health Services, Israel. FMF patients with colchicine dispensing ( n = 3324) were matched 1:4 by birth year and sex to 13,296 controls. Oropharyngeal diagnoses, tonsil/adenoid surgery, antibiotic dispensing, and ear, nose, and throat (ENT) visits were compared across windows up to 20 and 10 years before diagnosis (30‐day blackout), using streptococcal, hypertrophy, and non‐ENT negative controls with false discovery rate (FDR) adjustment. Results A PFAPA diagnostic code was recorded in 2.6% of FMF patients versus 0.1% of controls (odds ratio [OR] 25.4, 95% confidence interval 14.3–48.5). Up to 20 years before diagnosis, future FMF patients had more acute tonsillitis (35.6% vs. 27.2%; OR 1.48, 1.37–1.61), viral‐labeled tonsillitis (OR 2.65), oral aphthae (OR 1.72), and cervical lymphadenitis (OR 1.62; all q < 0.05); associations persisted after diagnosis. Streptococcal sore‐throat coding was not increased (lifelong OR 1.03, 0.94–1.14). Antibiotic dispensing and ENT visits were increased; tonsillectomy alone was more frequent (OR 2.51), although surgical comparisons did not survive FDR correction. Conclusions FMF is associated with a non‐streptococcal, PFAPA‐like oropharyngeal phenotype detectable years before diagnosis. Recurrent pharyngotonsillitis with aphthae or cervical adenitis, without demonstrated streptococcal disease, may be a clinical cue to consider FMF in at‐risk populations.
