Pregabalin is increasingly prescribed for neuropathic pain, generalised anxiety disorder and epilepsy but many patients discontinue treatment

AIM

To assess prescribing patterns, sociodemographic characteristics and previous disease history in patients receiving pregabalin.

METHODS

An observational study using register data on dispensed drugs and recorded diagnoses for all patients in Stockholm, Sweden, who filled at least one prescription of pregabalin between July 2005 and December 2009. Analyses focused on prevalence, incidence, diagnosis patterns, prior dispensing of other analgesics/psychotropics and persistence to treatment over time.

RESULT

A total of 18,626 patients (mean age 55 years, 63% women) were initiated on treatment between July 2006 and December 2009. Approved indications were recorded in hospital and/or primary care within 1 year prior to the first dispensing for 40% of the patients (epilepsy 1.3%, neuropathic pain 35.5% and generalised anxiety disorder (GAD) 3.6%). Antidepressants were used by 55%, opioids by 49% and sedatives by 48% prior to initiation of pregabalin. One-third (34%) only purchased one prescription and the proportion purchasing pregabalin 1 year after initiation was 42.1% for epilepsy, 36.3% for GAD, 21.5% for neuropathic pain and 25.6% for those without any of the included diagnoses.

CONCLUSION

Pregabalin was mainly used as a second-line drug for the treatment of GAD or neuropathic pain and to a lesser extent as add-on therapy in epilepsy. However, a large proportion of all patients only purchased one prescription and the persistence declined rapidly over time. The issue of potential off-label prescribing or poor registration of diagnoses should also be noted as a high proportion had been prescribed the drug without a record of any of the approved indications.

FC13-04 - Suicide risk in relation to age and psychiatric hospitalization

Introduction

Suicide risk is increased in patients with a history of psychiatric hospitalization.

Aim

To explore how suicide risk varies by age during psychiatric hospitalization and in the year post-discharge.

Methods

This is a population-based case-control study of all suicides (n = 20,675; 70% male) in Sweden aged ≥18 years during 1991–2003. Each suicide was individually matched to 10 population controls by age, sex, and county of residence. Discharge diagnoses of a mental disorder (except dementia and other organic disorders) in the year prior to suicide were identified by register linkage. Odds ratios (OR) were calculated by conditional logistic regression to estimate the relative risk of suicide in those with psychiatric diagnoses compared to the general population. ORs were estimated by age group (18–34 years, 35–49 years, 50–64 years, and ≥ 65 years) and timing of the suicide in relation to discharge.

Results

During hospitalization, the youngest age group had the greatest suicide risk elevation [OR 64 (95% CI 44-92)]. In the first month post-discharge, the oldest age group had the highest suicide risk elevation [OR 162 (95% 66–399) in the first week and OR 127 (95% 67–242) in the second to fourth weeks]. In the remaining eleven months, suicide risk elevation was lower and relatively similar in different age groups.

Conclusions

During the year following psychiatric hospitalization, an especially high attention should be paid to the suicide risk of the elderly patients in the first month post-discharge.

Relief of pruritus as an early sign of spinal cord compression in Hodgkin's disease

In a patient with advanced Hodgkin's disease (HD) associated with generalized pruritus, an unexpected relief of itching was found to be an early sign of spinal cord compression. Following irradiation of an extradural mass at the Th II level, itching recurred. Although the mechanisms bringing about itching in HD are unknown, the relief and recurrence of the symptom in our patient are in line with a peripheral origin of pruritus in the disease. Spontaneous relief of pruritus in HD despite other signs of active disease should prompt a neurological examination, since early recognition and treatment of spinal cord compression in lymphoma are important to avoid residual neurological disability.