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Tran PT, Lapeyre-Mestre M, Berangere B, Lanteri-Minet M, Palmaro A, Donnet A, Micallef J. Triptan use in elderly over 65 years and the risk of hospitalization for serious vascular events. J Headache Pain 2024; 25:68. [PMID: 38671362 PMCID: PMC11055320 DOI: 10.1186/s10194-024-01770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Several studies have focused on the use of triptan and the risk of acute vascular events but the existence of such association is still debated and has never been quantified in patients over 65 years. To assess whether triptan use among older is associated with an increased risk of hospitalization for acute vascular events. METHODS A propensity score-matched cohort study was designed using the French national health insurance database linked to hospital stays. Patients aged ≥ 65 years, newly treated by triptans between 2011 and 2014, were included… The primary event was hospitalization for an acute ischemic vascular event within de 90 days following triptan initiation. Association with triptan exposure was investigated through cox regression model, considering exposure at inclusion, and with exposure as a time-varying variable A case-crossover (CCO) and a self-controlled case series (SCCS) analyses were also conducted to address potential residual confounding. RESULTS The cohort included 24, 774 triptan users and 99 096 propensity matched controls (mean (SD) age: 71 years (5.9), 74% of women). Within 90 days after cohort entry, 163 events were observed in the triptan group, and 523 in the control group (0.66% vs. 0.53%, adjusted hazard ratio (aHR) exposed/not exposed 1.25 95%CI [1.05-1.49]; aHR time-varying 8.74 [5.21-14.66]). The association was significant (CCO) for all events (adjusted odds ratio (aOR1.63 [1.22-2.19]) with a more consistent association with cerebral events (aOR 2.14 [1.26-3.63]). The relative incidence (RI) for all events was 2.13 [1.76-2.58] in the SCCS, for cardiac (RI: 1.67 [1.23-2.27]) and for cerebral events (RI: 3.20, [2.30-4.45]). CONCLUSION The incidence of acute vascular events was low among triptan users. We found that triptan use among older may be associated with a low increased risk for acute vascular events, which may be more marked for cerebral events such as stroke, than for cardiac events.
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Affiliation(s)
- Phuong Thao Tran
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Maryse Lapeyre-Mestre
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre d'Investigation Clinique Inserm (CIC 1436), Université de Toulouse, Toulouse, France
| | - Baricault Berangere
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
- PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre d'Investigation Clinique Inserm (CIC 1436), Université de Toulouse, Toulouse, France
| | - Michel Lanteri-Minet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
- Département d'évaluation et de traitement de la douleur, CHU de Nice, FHU InovPain Université Côte Azur, Nice, France
| | - Aurore Palmaro
- Service de Pharmacologie Médicale et Clinique, Université de Toulouse, CHU de Toulouse, Toulouse, France
| | - Anne Donnet
- Neuro-Dol Inserm U1107, Université Clermont Auvergne, Clermont-Ferrand, France
- Centre d'Evaluation et de Traitement de la douleur, FHU InovPain Pôle Neurosciences Cliniques, APHM, Marseille, France
| | - Joëlle Micallef
- service de pharmacologie clinique & pharmacosurveillance, centre régional de pharmacovigilance, Aix-Marseille université, Inserm, UMR 1106, Assistance publique-Hôpitaux de Marseille, Hopital Sainte Marguerite 270, boulevard sainte Marguerite, Marseille, 13009, France.
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Hyeraci G, Gini R, Bezin J, Iannone LF, Benemei S, Lupi C, De Cesaris F, Geppetti P, Roberto G. Utilization patterns, cardiovascular risk, and concomitant serotoninergic medications among triptan users between 2008 and 2018: A gender analysis in one Italian region, Tuscany. Headache 2023; 63:222-232. [PMID: 36705316 DOI: 10.1111/head.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the pattern of triptan use by gender in Tuscany, Italy, focusing on special user populations in which evidence on triptan safety is still not conclusive. BACKGROUND Growing evidence supports the role of gender differences in migraine pathophysiology and treatment. However, gender impact on triptan real-word utilization has been poorly investigated. METHODS A retrospective, descriptive, cohort study was performed using the population-based Administrative Healthcare Database of Tuscany region (Italy). Subjects registered in the database on the January 1 of each year between 2008 and 2018 were identified. New users (NU) of triptans (ATC:N02CC*) were patients with one or more triptan dispensation during the year of interest and none in the past. Age, cardiovascular comorbidities representing an absolute or a possible contraindication to triptan utilization, concomitant serotonergic medications, and pattern of triptan use during 1-year follow-up were described by gender. RESULTS A total of 86,109 patients who received one or more triptan dispensing were identified. Of 64,672 NU (men = 17,039; women = 47,633), 10.2% (6823/64,672) were aged >65 years, who were mostly women (n = 4613). Among NU, men and women with absolute cardiovascular contraindications were 4.3% (740/17,039) and 2.1% (1022/47,633), respectively, while those concomitantly taking serotonergic medications were 17.2% (267/1549) and 21.9% (949/4330), respectively (949/4330). Regular users (two or more dispensing with ≥3 months between first and last observed dispensing) accounted for 26.4% of women (12,597/47,633) and 19.11% of men (3250/17,039); frequent users (≥15 dosage units/month during ≥3 consecutive months) were overall 0.1% (94/64,672) and 62.0% (58/94) of them concomitantly received serotonergic medications. CONCLUSION Considering gender differences in triptan use highlighted here, large scale observational studies are warranted to better define what populations are safe to use triptans and whether it is appropriate to tighten or relax certain recommendations on triptan use. In the meantime, any suspected adverse drug reaction observed in the special user populations highlighted in this study should be promptly reported.
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Affiliation(s)
- Giulia Hyeraci
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
| | - Julien Bezin
- Clinical Pharmacology Unit, Univ. Bordeaux, INSERM, BPH, Team Pharmacoepidemiology, U1219, CHU de Bordeaux, Bordeaux, France
| | - Luigi Francesco Iannone
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Silvia Benemei
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Chiara Lupi
- Area Vasta Centro Ethics Committee Secretariat - Clinical Trial Unit for Phase 1 Trials, Careggi University Hospital, Florence, Italy
| | - Francesco De Cesaris
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pierangelo Geppetti
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana (ARS), Florence, Italy
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Zebenholzer K, Gall W, Gleiss A, Pavelic AR, Wöber C. Triptans and vascular comorbidity in persons over fifty: Findings from a nationwide insurance database – A cohort study. Headache 2022; 62:604-612. [PMID: 35593784 PMCID: PMC9321590 DOI: 10.1111/head.14304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022]
Abstract
Objective To gather information about prescription of triptans and to evaluate whether vascular comorbidity differs in users and nonusers of triptans over the age of 50 years. Background Beyond the age of 50 years, migraine is still common—yet the incidence of vascular disorders increases. Triptans, medications for treating migraine attacks, are vasoconstrictive drugs and contraindicated in persons with vascular disorders. Methods Based on a nationwide insurance database from 2011, we compared the prescription of vascular drugs (identified by Anatomical Therapeutic Chemical codes), vascular diagnoses and hospitalizations, between triptan users greater than 50 years and a matched control group. Results Of the 3,116,000 persons over 50 years, 13,833 (0.44%) had at least one triptan prescription; 11,202 (81%) were women. Thirty percent of the triptan users (13,833/47,336 persons) were over 50 years. Of those over 50 years, 6832 (49.4%) had at least one vascular drug and 870 (6.3%) had at least one inpatient vascular diagnosis; 15.7% (2166 of 13,833 users) overused triptans. We compared triptan‐users to 41,400 nonusers, using a 1:3 match. In triptan‐users, prescriptions of cardiac therapies and beta blockers were significantly more common (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.24–1.47 and OR = 1.19, 95% CI = 1.14–1.25, respectively); whereas prescriptions of calcium channel blockers and renin/angiotensin inhibitors were significantly less common (OR = 0.82, 95% CI = 0.76–0.88 and OR = 0.75, 95% CI = 0.72–0.79, respectively). The prescriptions of antihypertensive, diuretic, and antilipidemic drugs as well as platelet inhibitors and direct thrombin inhibitors did not differ in users and nonusers. Triptan users had significantly more hospital stays (OR = 1.39, 95% CI = 1.33–1.45); however, the number of days spent in the hospital and more importantly the frequency of inpatient vascular diagnoses did not differ statistically significantly between the two groups. Conclusion In persons over 50 years of age, a prescription of triptans is common. Vascular comorbidity is comparable in users and nonusers of triptans showing that triptans are prescribed despite vascular comorbidity and suggesting that triptan use does not increase vascular risk in patients with migraine over the age of 50 years. Nevertheless, regular evaluation for contraindications against triptans and for vascular risk factors is recommended in this age group.
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Affiliation(s)
- Karin Zebenholzer
- Department of Neurology Medical University of Vienna Vienna Austria
| | - Walter Gall
- Institute of Medical Information Management Center for Medical Statistics, Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Andreas Gleiss
- Institute of Clinical Biometrics Center for Medical Statistics, Informatics and Intelligent Systems Medical University of Vienna Vienna Austria
| | - Antun R. Pavelic
- Department of Neurology Medical University of Vienna Vienna Austria
| | - Christian Wöber
- Department of Neurology Medical University of Vienna Vienna Austria
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Zebenholzer K, Gall W, Wöber C. Use and overuse of triptans in Austria - a survey based on nationwide healthcare claims data. J Headache Pain 2018; 19:34. [PMID: 29777424 PMCID: PMC5959824 DOI: 10.1186/s10194-018-0864-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/06/2018] [Indexed: 01/03/2023] Open
Abstract
Background To evaluate triptan use and overuse as well as prescription patterns in Austria based on a nationwide healthcare database because data on triptan use and overuse in Austria is missing. Methods We included all persons insured with one of 19 Austrian social security institutions in 2007. Inclusion criteria comprised an age of 18–99 years, known sex, and receipt of insurance benefits. We defined triptan use as ≥1 package of a triptan dispensed in 2007 and triptan overuse as ≥30 defined daily doses dispensed in at least one quarter. Results Out of 8.295 million inhabitants in Austria, 7,426,412 persons (89.5%) were insured with a social insurance carrier and 5,918,487 persons of those insured (79.7%) fulfilled the inclusion criteria. Among the latter 33,062 persons (0,56%) were triptan users and 1970 (0.033%) were triptan overusers. The estimated proportion of persons with migraine using a triptan was less than 6%. Among users 5.9% were overusers of whom 55% overused triptans in ≥2 quarters of 2007. The median number of days of sick-leave was higher in triptan users than in non-users: due to any reason of sick-leave 12 vs. 10, p < 0.001, due to migraine 3 vs. 2, p < 0.001. The proportion of hospital admissions did not differ between triptan users and non-users. Conclusion The rate of triptan use is low in Austria but triptan users are at risk for triptan overuse. In triptan users more days of sick-leave and the same proportion of hospital admissions as in the older non-users suggest poorer health.
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Affiliation(s)
- Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Walter Gall
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Information Management, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Reggio E, Chisari CG, Ferrigno G, Patti F, Donzuso G, Sciacca G, Avitabile T, Faro S, Zappia M. Migraine causes retinal and choroidal structural changes: evaluation with ocular coherence tomography. J Neurol 2016; 264:494-502. [DOI: 10.1007/s00415-016-8364-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 01/03/2023]
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Braunstein D, Donnet A, Pradel V, Sciortino V, Allaria-Lapierre V, Lantéri-Minet M, Micallef J. Triptans use and overuse: A pharmacoepidemiology study from the French health insurance system database covering 4.1 million people. Cephalalgia 2015; 35:1172-80. [DOI: 10.1177/0333102415570497] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/10/2015] [Indexed: 01/03/2023]
Abstract
Introduction The objective of this study was to estimate and to characterize the actual patterns of triptan use and overuse in France using a drug reimbursement database. Methods We included all people covered by the French General Health Insurance System (GHIS) from the Provence-Alpes-Côte-d’Azur (PACA) and Corsica administrative areas who had at least one dispensed dose of triptans between May 2010 and December 2011. All dispensed doses of triptans, migraine prophylactic treatment and psychotropic medications were extracted from the GHIS database. Triptan overuse was defined as triptan use >20 defined daily doses (DDD) per month on a regular basis for more than three consecutive months. Risk of overuse was assessed using logistic regression adjusted for gender and age. Results We included 99,540 patients who had at least one prescription of a triptan over the 20 months of the study. Among them, 2243 patients (2.3%) were identified as overusers and received 20.2% of the total DDD prescribed. Twelve percent of overusers and 6.9% of non-overusers were aged more than 65 years (OR: 1.81). Overusers did not have a greater number of prescribers and pharmacists than non-overusers. They were more frequently prescribed a prophylactic medication for migraine treatment (56.8% vs 35.9%, OR: 2.36), benzodiazepines (69.9% vs 54.7%, OR: 1.93) and antidepressants (49.4% vs 30.2%, OR: 2.33). Conclusions This work suggests that triptan overuse may be due to insufficient prescriber awareness of appropriate prescribing. The off-label prescription of triptans among the elderly necessitates investigating their cardiovascular risk profile in this sub-group.
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Affiliation(s)
- David Braunstein
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
| | - Anne Donnet
- Centre d’évaluation et de traitement de la douleur, hôpital Timone, Pôle Neurosciences Cliniques, Hôpital de la Timone, France
- INSERM/UdA, France
| | - Vincent Pradel
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
| | - Vincent Sciortino
- Direction Régionale du Service Médical de l’Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France
| | - Véronique Allaria-Lapierre
- Direction Régionale du Service Médical de l’Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France
| | - Michel Lantéri-Minet
- INSERM/UdA, France
- Département d’Evaluation et traitement de la Douleur, Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez, France
| | - Joëlle Micallef
- Aix Marseille Université, CNRS 7289 – Institut de Neurosciences Timone, Centre d’Evaluation et d’Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France
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Da Cas R, Nigro A, Terrazzino S, Sances G, Viana M, Tassorelli C, Nappi G, Cargnin S, Pisterna A, Traversa G, Genazzani AA. Triptan use in Italy: Insights from administrative databases. Cephalalgia 2014; 35:619-26. [DOI: 10.1177/0333102414550419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/17/2014] [Indexed: 01/03/2023]
Abstract
Introduction In this drug utilization study, we aimed at assessing the pattern of triptan use in Italy by means of the drug prescription databases of two local health authorities, accounting for approximately 1 million citizens. Methods The study population included all residents aged 18 to 84 years in the Vercelli province (about 175,000 inhabitants) and in the Umbria region (about 885,000 inhabitants), who had at least one dispensation for triptans in 2012. A frequent user, who might be at risk of medication-overuse headache (MOH), was defined as a patient being dispensed at least 10 defined daily doses (DDD) of triptans every month for at least three consecutive months. Results Triptans were used by 0.7%–1% of the population. While most patients were dispensed fewer than 60 DDDs per year, about 10% of all triptan users were classified as frequent users. In both areas, patients below the age of 29 were less likely to be frequent users while the 40- to 49-year-old population was the most affected, with no sex difference. About two-thirds of frequent users persisted in this behavior for an additional three-month period in the following six months. Conclusions Our data indicate that approximately 10% of all triptan users in the Italian population are potentially at risk for MOH. An approach based on drug prescription databases could be useful to identify patients at risk for MOH.
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Affiliation(s)
- Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Italy
| | | | | | - Grazia Sances
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | - Michele Viana
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | | | - Giuseppe Nappi
- Headache Science Center – C. Mondino National Neurological Institute, Italy
| | - Sarah Cargnin
- Department of Pharmaceutical Sciences, ‘‘A. Avogadro’’ University, Italy
| | | | - Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Italy
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Roberto G, Piccinni C, D'Alessandro R, Poluzzi E. Triptans and serious adverse vascular events: data mining of the FDA Adverse Event Reporting System database. Cephalalgia 2013; 34:5-13. [PMID: 23921799 DOI: 10.1177/0333102413499649] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM The aim of this article is to investigate the vascular safety profile of triptans through an analysis of the United States Food and Drug Administration Adverse Event Reporting System (FDA_AERS) database with a special focus on serious and unexpected adverse events. METHODS A CASE/NON-CASE analysis was performed on the reports entered in the FDA_AERS from 2004 to 2010: CASES were reports with at least one event included in the MedDRA system organ classes 'Cardiac disorder' or 'Vascular disorders', whereas NON-CASES were all the remaining reports. Co-reported cardiovascular drugs were used as a proxy of cardiovascular risk and the adjusted reporting odds ratio (adj.ROR) with 95% confidence intervals (95% CI) was calculated. Disproportionality signals were defined as adj.ROR value >1. Adverse events were considered unexpected if not mentioned on the relevant label. RESULTS Among 2,131,688 reports, 7808 concerned triptans. CASES were 2593 among triptans and 665,940 for all other drugs. Unexpected disproportionality signals were found in the following high-level terms of the MedDRA hierarchy: 'Cerebrovascular and spinal necrosis and vascular insufficiency' (103 triptan cases), 'Aneurysms and dissections non-site specific' (15), 'Pregnancy-associated hypertension' (10), 'Reproductive system necrosis and vascular insufficiency' (3). DISCUSSION Our analysis revealed three main groups of unexpected associations between triptans and serious vascular events: ischaemic cerebrovascular events, aneurysms and artery dissections, and pregnancy-related vascular events. A case-by-case assessment is needed to confirm or disprove their plausibility and large-scale analytical studies should be planned for risk rate estimation. In the meantime, clinicians should pay special attention to migraine diagnosis and vascular risk assessment before prescribing a triptan, also promptly reporting any unexpected event to pharmacovigilance systems.
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Affiliation(s)
- Giuseppe Roberto
- Department of Medical and Surgical Sciences - Pharmacology Unit, University of Bologna, Italy
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Panconesi A. A very high prevalence of migraine in adult general population. Cephalalgia 2012; 32:1084-5; author reply 1086. [DOI: 10.1177/0333102412458187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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