{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:16:33Z","timestamp":1785392193021,"version":"3.55.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acetylcholinesterase inhibitors (AChEIs), are commonly prescribed for dementia and can cause adverse drug events that may lead to new prescriptions, known as prescription cascades. We aimed to identify potential AChEI-induced prescription cascades using high-throughput sequence symmetry analysis (SSA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients aged \u226518\u00a0years with 365\u00a0days of prior observation initiating AChEIs (donepezil, rivastigmine, or galantamine) were identified from the Clinical Practice Research Datalink GOLD (2002\u20132022). We screened 510 drug classes and 1213 individual ingredients initiated within \u00b1180\u00a0days of AChEI initiation (365\u00a0days in sensitivity analyses). Crude and adjusted sequence ratios (ASRs) were calculated, and positive signals were reviewed for clinical plausibility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 66 155 AChEI initiators (median age 81\u00a0years [IQR 76\u201385]; 62.8% female). Among ATC classes and individual ingredients, 51 and 46 signals were positive with 28 (55%) and 22 (48%) classified as potential prescription cascades after review. Gastrointestinal drugs showed positive signals including antipropulsives (ASR 1.50 [99% CI 1.28\u20131.75]), loperamide (ASR 1.52 [1.30\u20131.77]) and cyclizine (ASR 2.10 [1.72\u20132.59]). Positive signals were also observed nervous system drugs such as benzodiazepine derivatives (ASR 1.83 [1.55\u20132.16]) and respiratory drugs including corticosteroids (ASR 1.66 [1.33\u20132.08]) and glucocorticoids (ASR 1.54 [1.30\u20131.83]). Most positive signals remained in sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings suggest potential AChEI-related prescription cascades consistent with gastrointestinal, neuropsychiatric, dermatological and respiratory adverse effects. While findings require further validation, this study demonstrates the utility of high-throughput signal detection to support pharmacovigilance in high-risk populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag188","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:22:16Z","timestamp":1780917736000},"source":"Crossref","is-referenced-by-count":1,"title":["Prescription cascades associated with acetylcholinesterase inhibitors use: a high-throughput sequence symmetry analysis"],"prefix":"10.1093","volume":"55","author":[{"given":"Danielle","family":"Newby","sequence":"first","affiliation":[{"name":"Health Data Sciences (HDS), Translational Sciences, Botnar Research Centre, University of Oxford , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Sumedha","family":"Bobba","sequence":"additional","affiliation":[{"name":"Health System, University of Alabama at Birmingham \u00a0 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,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8274-0357","authenticated-orcid":false,"given":"Talita","family":"Duarte-Salles","sequence":"additional","affiliation":[{"name":"IDIAP Jordi Gol, Fundaci\u00f3 Institut Universitari per a la recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona ,","place":["Spain"]},{"name":"Department of Medical Informatics, Erasmus Medical Center , Rotterdam, Zuid-Holland ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0388-3403","authenticated-orcid":false,"given":"Antonella","family":"Delmestri","sequence":"additional","affiliation":[{"name":"Health Data Sciences (HDS), Translational Sciences, Botnar Research Centre, University of Oxford , Oxford ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wai 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