Real-World Claims Data on Prescribed Drugs and the Associated Drug-Drug Interaction Risk in Sickle Cell Disease in the United States.

Sickle cell disease (SCD) is a debilitating hereditary hematologic disorder characterized by severe physical complications, including painful vaso-occlusive crises, chronic pain, multi-organ damage, and reduced life expectancy. Diverse medications are prescribed to treat SCD or manage its associated complications. However, no comprehensive resource for concomitant medication and drug-drug interaction (DDI) risk exists for people living with SCD. Here, we utilized real-world claims data from the Merative Commercial MarketScan Research Database to identify the 100 most prescribed drugs for adolescents and adults living with SCD in the United States with commercial health insurance. DDI risks were assessed by leveraging the CERTARA Drug Interaction Database. In total, 43/100 drugs on the list were associated with DDI risks. Inhibitors were more frequently represented than inducers, suggesting that interaction risk in this population may be driven primarily by inhibition-mediated mechanisms. CYP3A4 accounted for the largest proportion of identified interactions. The high prescription rates of the CYP3A4 substrates oxycodone (40%) and fentanyl (18.5%), associated with potentially serious clinical consequences due to DDIs, highlight the importance of considering CYP3A4 interaction risk during development of novel therapies for SCD. Overall, this analysis provides a population-level insight into prescription patterns and subsequent DDI risks for people living with SCD. We expect these findings to (1) create clinical DDI risk awareness for this population and (2) inform strategic planning of DDI assessments during development of novel therapies indicated for SCD.