Gruppe Wehling: UMM Universitätsmedizin Mannheim

FORTA, "Fit fOR The Aged", ist ein Medikamentenklassifizierungssystem, das als klinisches Hilfsmittel zur Überwachung und Optimierung der medikamentösen Therapie älterer Patienten dienen soll. In der FORTA-Liste 2024 wurden 253 Substanzen bzw. Substanzklassen für 27 Indikationsbereiche, die älteren Patienten besonders häufig verordnet werden, in die Kategorien A bis D eingeordnet. Dabei fand der aktuelle Forschungsstand zur Eignung für ältere Patienten ebenso Berücksichtigung wie Nutzen-Risiko-Gesichtspunkte.

Kategorie A – Besonders vorteilhaft

Für Arzneimittel der FORTA-Kategorie A ist der Nutzen bei bestehender Indikation gut belegt.

Kategorie B – Vorteilhaft

Für Arzneimittel der FORTA-Kategorie B ist die Wirksamkeit bei älteren Patienten nachgewiesen, aber es bestehen Einschränkungen bezüglich ihrer Sicherheit und Wirksamkeit.

Kategorie C – Fragwürdig

Arzneimittel der FORTA-Kategorie C verfügen über ein ungünstiges Nutzen-Risiko-Verhältnis. Bei diesen Medikamenten sollte der Arzt den Einsatz kritisch überdenken. Falls sie trotzdem eingesetzt werden, sollte der Patient bezüglich der zu erwartenden Wirkungen und eventuellen Nebenwirkungen genau beobachtet werden. Ferner sollten bessere Alternativen erwogen werden.

Kategorie D – Vermeiden

Arzneimittel der FORTA-Kategorie D sollten nicht eingesetzt werden. Hier sollte der Arzt immer Alternativpräparate finden.

Dieser innovative Ansatz zur Verbesserung der medikamentösen Therapie älterer Patienten wird derzeit im Bereich der Klinischen Pharmakologie an der Universität Heidelberg in Mannheim weiterentwickelt. Das FORTA-Projekt wurde von der Deutschen Forschungsgemeinschaft gefördert (WE 1184/15-1).

Publikationen

Stenmanns C, Moellmann HS, Wehling M, Frohnhofen H. Evaluation of drug prescriptions on hospital admission in older trauma patients using the Fit fOR The Aged (FORTA) rules. Z Gerontol Geriatr. 2024 Dec;57:609-615.

Wehling M, Weindrich J, Weiss C, Heser K, Pabst A, Luppa M, Bickel H, Weyerer S, Pentzek M, König HH, Lühmann D, van der Leeden C, Scherer M, Riedel-Heller SG, Wagner M, Pazan F. Validation of MyFORTA: An Automated Tool to Improve Medications in Older People Based on the FORTA List. Drugs Aging. 2024 Jun;41:555-564.

Pazan F, Wehling M. Die FORTA (Fit fOR The Aged) Liste [The FORTA (Fit fOR The Aged) List]. Inn Med (Heidelb). 2024 Jan;65:3-8. German.

Pazan F, Weiss C, Wehling M; FORTA Expert Panel Members. The EURO-FORTA (Fit fOR The Aged) List Version 2: Consensus Validation of a Clinical Tool for Improved Pharmacotherapy in Older Adults. Drugs Aging. 2023 May;40:417-426.

Pazan F, Wehling M, Weiss C, Frohnhofen H. Medication optimization according to the Fit fOR The Aged (FORTA) rules improves functional status in patients hospitalized for geriatric rehabilitation. Eur Geriatr Med. 2023 Jun;14:477-483.

Pazan F, Breunig H, Weiss C, Röhr S, Luppa M, Pentzek M, Bickel H, Weeg D, Weyerer S, Wiese B, König HH, Brettschneider C, Heser K, Maier W, Scherer M, Riedel-Heller S, Wagner M, Wehling M. Higher FORTA (Fit fOR The Aged) scores are associated with poor functional outcomes, dementia, and mortality in older people. Eur J Clin Pharmacol. 2022 Nov;78:1851-1859.

Schmitt AK, Weiss C, Burkhardt H, Frohnhofen H, Wehling M, Pazan F. The Sex- Specific Impact of the FORTA (Fit-fOR-The-Aged) List on Medication Quality and Clinical Endpoints in Older Hospitalized Patients: Secondary Analysis of a Randomized Controlled Trial. Drugs Real World Outcomes. 2022 Jun;9:287-297.

Pazan F, Weiss C, Wehling M; FORTA. The FORTA (Fit fOR The Aged) List 2021: Fourth Version of a Validated Clinical Aid for Improved Pharmacotherapy in Older Adults. Drugs Aging. 2022 Mar;39:245-247.

Pazan F, Gercke Y, Weiss C, Wehling M; FORTA Raters. The JAPAN-FORTA (Fit fOR The Aged) list: Consensus validation of a clinical tool to improve drug therapy in older adults. Arch Gerontol Geriatr. 2020 Nov/Dec;91:104217.

Rieg S, Wehling M. FORTA(Fit-fOR-The-Aged)-based medication optimization: retrospective analysis of experiences from an unconventional outpatient service. Eur Geriatr Med. 2020 Dec;11(6):1035-1041. doi: 10.1007/s41999-020-00378-z. Epub 2020 Aug 9. Erratum in: Eur Geriatr Med. 2021 Oct;12:1115.

Pazan F, Collins R, Gil VM, Hanon O, Hardt R, Hoffmeister M, Monteiro P, Quinn TJ, Ropers D, Sergi G, Verheugt FWA, Wehling M. A Structured Literature Review and International Consensus Validation of FORTA Labels of Oral Anticoagulants for Long-Term Treatment of Atrial Fibrillation in Older Patients (OAC-FORTA 2019). Drugs Aging. 2020 Jul;37:539-548.

Meyer L, Wehling M. Knowledge on and use of the FORTA ("Fit fOR The Aged")-list and the FORTA App by general practitioners in Baden-Württemberg, Germany. Eur Geriatr Med. 2020 Jun;11:499-503.

Pazan F, Wehling M. The Fit fOR The Aged (FORTA) project and its clinical implications. Expert Opin Drug Metab Toxicol. 2020 Apr;16:275-277.

Pazan F, Gercke Y, Weiss C, Wehling M; FORTA Raters. The U.S.-FORTA (Fit fOR The Aged) List: Consensus Validation of a Clinical Tool to Improve Drug Therapy in Older Adults. J Am Med Dir Assoc. 2020 Mar;21:439.e9-439.e13.

Rabenberg A, Schulte T, Hildebrandt H, Wehling M. The FORTA (Fit fOR The Aged)-EPI (Epidemiological) Algorithm: Application of an Information Technology Tool for the Epidemiological Assessment of Drug Treatment in Older People. Drugs Aging. 2019 Oct;36:969-978.

Pazan F, Weiss C, Wehling M. The FORTA (Fit fOR The Aged) List 2018: Third Version of a Validated Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging. 2019 Apr 2.

Pazan F, Kather J, Wehling M. A systematic review and novel classification of listing tools to improve medication in older people. Eur J Clin Pharmacol. 2019 Jan 26.

Pazan F, Burkhardt H, Frohnhofen H, et al. Higher Fit-fOR-The-Aged (FORTA) Scores Comprising Medication Errors are Associated with Impaired Cognitive and Physical Function Tests in the VALFORTA Trial. Drugs Aging. 2019;36:269-277.

Pazan F, Burkhardt H, Frohnhofen H, et al. Changes in prescription patterns in older hospitalized patients: the impact of FORTA on disease-related over- and under-treatments. Eur J Clin Pharmacol. 2018 Mar;74:339-347.

Pazan F, Weiss C, Wehling M. The EURO-FORTA (Fit fOR The Aged) list: international consensus validation of a clinical tool for improved drug treatment in older people. Drugs Aging. 2018;35:61-71.

Pazan F, Wehling M. The FORTA (Fit fOR The Aged) App as a Clinical Tool to Optimize Complex Medications in Older People. J Am Med Dir Assoc. 2017 Oct 1;18:893.

Wehling M, Collins R, Gil VM, et al. Appropriateness of oral anticoagulants for the long-term treatment of atrial fibrillation in older people: results of an evidence-based review and international consensus validation process (OAC-FORTA 2016). Drugs Aging 2017; 34, 499-507.

Pazan F, Weiss C, Wehling M. The FORTA (Fit fOR The Aged) List 2015: Update of a Validated Clinical Tool for Improved Pharmacotherapy in the Elderly. Drugs Aging. 2016;33:447–449.

Wehling M. How to Use the FORTA ("Fit fOR The Aged") List to Improve Pharmacotherapy in the Elderly. Drug Res (Stuttg). 2016;66:57-62.

Wehling M, Burkhardt H, Kuhn-Thiel A, Pazan F, et al. VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Age Ageing. 2016;45:262-267.

Wehling M, Burkhardt H. Arzneitherapie für Ältere. Springer-Verlag, Heidelberg, 4. Auflage 2016.

Oelke M, Becher K, Castro-Diaz D, et al. Appropriateness of oral drugs for long-term treatment of lower urinary tract symptoms in older persons: results of a systematic literature review and international consensus validation process (LUTS-FORTA 2014). Age Ageing. 2015;44:745–755.

Michalek C, Wehling M, Schlitzer J, et al. Effects of "Fit fOR The Aged" (FORTA) on pharmacotherapy and clinical endpoints--a pilot randomized controlled study. Eur J Clin Pharmacol. 2014;70:1261-7.

Kuhn-Thiel AM, Weiß C, Wehling M. Consensus validation of the FORTA (Fit fOR The Aged) List: a clinical tool for increasing the appropriateness of pharmacotherapy in the elderly. Drugs Aging. 2014;31:131-40.

Wehling M, Ed., Drug Therapy for the Elderly. Springer, Wien 2013.

Wehling M. Multimorbidity and polypharmacy: how to reduce the harmful drug load and yet add needed drugs in the elderly? Proposal of a new drug classification: fit for the aged. J Am Geriatr Soc 2009;57:560-561.

Wehling M. Drug therapy in the elderly: too much or too little, what to do? A new assessment system: fit for the aged FORTA. Dtsch Med Wochenschr 2008;133:2289-91.

Pazan F, Weiss C, Wehling M. The FORTA (Fit fOR The Aged) List 2018: Third Version of a Validated Clinical Tool for Improved Drug Treatment in Older People. Drugs Aging. 2019 Apr 2. [Epub ahead of print]

Pazan F, Kather J, Wehling M. A systematic review and novel classification of listing tools to improve medication in older people. Eur J Clin Pharmacol. 2019 Jan 26. [Epub ahead of print]