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Daveluy A, Bryan MC, Miremont-Salamé G, Lassalle R, Lacueille C, Grelaud A, Floccia M, Haramburu F, Lapeyre-Mestre M, Micallef J, Salvo F. Analgesic switching in chronic users of dextropropoxyphene in France. Fundam Clin Pharmacol 2024; 38:389-397. [PMID: 37864449 DOI: 10.1111/fcp.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/01/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The combination dextropropoxyphene/paracetamol (DXP/P) was the most prescribed opioid analgesic until its withdrawal in 2011. OBJECTIVES This study investigated dispensations of analgesics in chronic users of DXP/P during the 18 months following its withdrawal. METHODS A cross-sectional study repeated yearly was conducted by using the French reimbursement database from 2006 to 2015. Chronic DXP/P users were defined as patients who received at least 40 boxes of DXP/P in the year prior to withdrawal. Data on analgesic dispensing were analyzed at DXP/P withdrawal (T0) and then every 6 months for 18 months. RESULTS A total of 63 671 subjects had a DXP/P reimbursement in the year prior to its discontinuation, of whom 7.1% were identified as chronic users (mean age: 71.5 years, women: 68.7%). Among the patients taking DXP/P alone at T0 (74.6%), one fourth switched to a peripheral analgesic, one fourth to a combination of peripheral analgesic/opioid, one fourth to another opioid, and the others mainly discontinued their treatment (14.1%) or died. During the following 12 months, most of the subjects taking only peripheral analgesics continued this treatment, while half of the subjects with a combination of opioid/peripheral analgesic or taking only an analgesic remained on this type of treatment. CONCLUSION Eighteen months after DXP/P withdrawal, more than 10% of patients stopped taking an analgesic. Vigilance is required regarding any change in analgesics by regularly reassessing patients' pain and, in the case of opioid treatments, by monitoring the risk of use disorders.
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Affiliation(s)
- Amélie Daveluy
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | | | - Ghada Miremont-Salamé
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Clémentine Lacueille
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Angela Grelaud
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Université de Bordeaux, Bordeaux, France
| | - Marie Floccia
- Centre d'Etude et de Traitement de la Douleur, University Hospital of Bordeaux, Bordeaux, France
| | - Françoise Haramburu
- Centre d'addictovigilance de Bordeaux, Department of Medical Pharmacology, University Hospital of Bordeaux, Bordeaux, France
- INSERM, BPH, University of Bordeaux, Bordeaux, France
| | | | - Joëlle Micallef
- AP-HM, INSERM, Inst Neurosci Syst, Service de Pharmacologie Clinique et Pharmacovigilance, Aix-Marseille University, Marseille, France
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Stanway JA, Walker D. Inflammatory arthritis—the end of the golden age. Rheumatol Adv Pract 2022; 6:rkac015. [PMID: 35265790 PMCID: PMC8902173 DOI: 10.1093/rap/rkac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/16/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- James A Stanway
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - David Walker
- Rheumatology department, Northumbria Healthcare Trust, Northumbria, UK
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Combier A, Bon L, Van Ganse E, Aubrun F, Letrilliart L. Perceptions of French general practitioners and patients regarding dextropropoxyphene withdrawal: a qualitative study. BMJ Open 2018; 8:e021582. [PMID: 30244207 PMCID: PMC6157533 DOI: 10.1136/bmjopen-2018-021582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Dextropropoxyphene (DXP), a step 2 analgesic commonly prescribed in France, was withdrawn from the French market in 2011 following a European decision due to its poor risk-benefit ratio. The purpose of this study was to explore the perceptions of French general practitioners (GPs) and patients regarding DXP withdrawal. DESIGN Qualitative study based on 26 individual semi-structured interviews. SETTING Rhône-Alpes region of France. PARTICIPANTS Thirteen patients and 13 GPs. METHODS Interviews were conducted to collect data concerning the status of DXP, its efficacy and safety, the conditions of DXP's withdrawal and its potential impact. The transcripts were analysed using NVivo software. RESULTS DXP was a very popular drug among both patients and GPs. Its withdrawal was a bad experience for patients and many GPs; these misunderstood the reasons for its withdrawal and several contested them. They generally recognised more benefits than risks of DXP and considered alternative drugs unsatisfactory. In the same period, a French court case regarding another drug led to distrust towards the pharmaceutical industry and healthcare institutions, which contributed to the negative feelings reported. However, the experience was positive for the GPs who had been alerted to the poor DXP risk-benefit ratio well before its withdrawal. CONCLUSIONS Apart from physicians who were previously informed of its poor risk-benefit ratio, DXP withdrawal was not a good experience for patients and GPs. Better anticipation by the health authorities, in terms of pharmacoepidemiological surveillance and communication to healthcare professionals as well as the general public, should provide better acceptance of such a decision in the future.
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Affiliation(s)
- Aurélie Combier
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Lucile Bon
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Eric Van Ganse
- Faculté d’odontologie, Université Claude-Bernard-Lyon 1, UMR CNRS 5558, Lyon, France
- Groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, Hospices Civils de Lyon, CHU de Lyon, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
| | - Frédéric Aubrun
- Groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, Hospices Civils de Lyon, CHU de Lyon, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
- Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Lyon, France
| | - Laurent Letrilliart
- Collège universitaire de médecine générale, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
- HESPER EA 7425, Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, Lyon, France
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Van Ganse E, Belhassen M, Ginoux M, Chrétien E, Cornu C, Ecoffey C, Aubrun F. Use of analgesics in France, following dextropropoxyphene withdrawal. BMC Health Serv Res 2018; 18:231. [PMID: 29609613 PMCID: PMC5880096 DOI: 10.1186/s12913-018-3058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
Background In 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France. Up until that time the combination dextropropoxyphene-paracetamol (DXP/PC) was widely used for analgesia. At withdrawal, French regulators recommended that DXP/PC be replaced by other step 2 analgesics, i.e. tramadol, codeine, or opium-containing drugs, or by PC for a weak level of pain. To investigate prescribing behaviours after DXP/PC withdrawal, dispensations of analgesics before and after withdrawal were analysed. Methods Aggregated dispensation data of analgesics prescribed between January 2009 and December 2012 in the Rhône-Alpes region were obtained from the general health insurance claims data; changes in analgesic dispensation over time were analysed with the ATC/DDD methodology. Pre (Jan-June 2009) and post-withdrawal (Jan-June 2012) changes of DDDs where computed for each analgesic step. Results The dispensations of DXP/PC experienced a two-step decrease until 2011. Over the withdrawal period 2009-2012, there was a 14% decrease in the overall use of analgesic (from 109 to 94 DDDs), while the use of step 2 analgesics declined by 46% (− 22 DDDs, from 47 to 25 DDDs). This latter decline included a cessation of use of DXP/PC (29 DDDs in 2009) that were only in part (+ 7 DDDs, from 18 to 25 DDDs) compensated by increased use of codeine, tramadol and opium, in monotherapy or combined with PC. For step 1 analgesics, use increased with 9%, mostly PC (+ 8 DDDs, from 31 to 39 DDDs). Step 3 analgesics dispensations remained largely unchanged over this period (around 3 DDDs). Conclusions In the Rhône-Alpes region, DXP/PC withdrawal was accompanied in part by an increased use of same level analgesics, and in part by an increased use of PC in monotherapy. The extent of DXP/PC use before withdrawal, and the increased use of PC after DXP withdrawal, underline the complexity of pain management.
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Affiliation(s)
- E Van Ganse
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France. .,PELyon, PharmacoEpidemiologie Lyon, Lyon, France. .,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
| | - M Belhassen
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - M Ginoux
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - C Cornu
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University, CNRS, Lyon, France.,Louis Pradel Hospital, Lyon University, Lyon, France INSERM Clinical Investigation Centre (CIC1407), Lyon, France
| | - C Ecoffey
- Department of Anaesthesiology and Critical Care, Ponchaillou University Hospital, CIC Inserm, Rennes, France
| | - F Aubrun
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Affiliation(s)
- Savita Butola
- Border Security Force, Composite Hospital, Border Security Force Campus, Jalandhar Cantonmentt, Punjab, India
| | - Mr Rajagopal
- WHO Collaborating Centre for Policy and Training on Access to Pain Relief, Chairman, Pallium India, Trivandrum, Kerala, India
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Bismuth S, Leng EL, Oustric S, Montastruc JL, Lapeyre-Mestre M. Quel(s) antalgique(s) après le retrait du dextropropoxyphène ? Enquête auprès de médecins généralistes de la région Midi-Pyrénées. Therapie 2011; 66:25-8. [DOI: 10.2515/therapie/2011004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 12/13/2010] [Indexed: 11/20/2022]
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Bannwarth B, Richez C. The dextropropoxyphene controversy. Joint Bone Spine 2009; 76:449-51. [DOI: 10.1016/j.jbspin.2009.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2009] [Indexed: 11/28/2022]
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