1
|
Benevent J, Bensadallah I, Caillet A, Michelet M, Beau AB, Lacroix I, Damase-Michel C. Prescriptions of respiratory medications in children aged 0-10 years: A longitudinal drug utilization study in the POMME database. Respir Med 2024; 232:107741. [PMID: 39059725 DOI: 10.1016/j.rmed.2024.107741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/03/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Respiratory tract disorders are common in children. However, there is no available data on the prescription of respiratory medications for children in France. This study aimed to provide an overview of medications for obstructive airway diseases prescriptions for children during the initial ten years of their lives within POMME, a French population-based cohort of children. MATERIAL AND METHODS This longitudinal, population-based study used data from the French POMME birth cohort, comprising children born in Haute Garonne between July 2010 and June 2011. Anonymous medical information, including medication reimbursement data, was collected between ages 0 and 10 years. Exposure was defined as at least one prescription for respiratory medications (ATC code R03*), focusing on specific subclasses. Data were analyzed by age, season, and prescribing physicians' specialties. RESULTS Out of 5956 children, 4951 (83.1 %) received respiratory medication prescriptions. Inhaled corticosteroids (ICSs) were the most prescribed (95.3 %), followed by short-acting β2-agonists (68.8 %). The number of prescriptions increased with age, except for ICSs alone, which peaked between 6 months and 2 years. The average number of prescriptions per child was relatively low. DISCUSSION This study highlighted high prescription rates of respiratory medications in children under 10 years, with ICSs being the most prevalent. While these medications are primarily intended for asthma management, the findings suggested a significant proportion of off-label prescriptions, especially in young children. Further research and clinical guidance are warranted to ensure appropriate medication use in the pediatric population.
Collapse
Affiliation(s)
- Justine Benevent
- Department of Medical and Clinical Pharmacology, University Hospital Center, CERPOP INSERM UMR 1295 - SPHERE team, 37 allées Jules Guesde, 31000, Toulouse, France.
| | - Inès Bensadallah
- Department of Medical and Clinical Pharmacology, University Hospital Center, CERPOP INSERM UMR 1295 - SPHERE team, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Anthony Caillet
- Department of Medical and Clinical Pharmacology, University Hospital Center, CERPOP INSERM UMR 1295 - SPHERE team, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Marine Michelet
- Department of Pediatric Pulmonology and Allergology, University Hospital Center, INSERM U1043 (CPTP), 330 Avenue de Grande-Bretagne, 31300, Toulouse, France
| | | | - Isabelle Lacroix
- Department of Medical and Clinical Pharmacology, University Hospital Center, CERPOP INSERM UMR 1295 - SPHERE team, 37 allées Jules Guesde, 31000, Toulouse, France
| | - Christine Damase-Michel
- Department of Medical and Clinical Pharmacology, University Hospital Center, CERPOP INSERM UMR 1295 - SPHERE team, 37 allées Jules Guesde, 31000, Toulouse, France
| |
Collapse
|
2
|
de Alencar Morais Lima W, de Souza JG, García-Villén F, Loureiro JL, Raffin FN, Fernandes MAC, Souto EB, Severino P, Barbosa RDM. Next-generation pediatric care: nanotechnology-based and AI-driven solutions for cardiovascular, respiratory, and gastrointestinal disorders. World J Pediatr 2024:10.1007/s12519-024-00834-x. [PMID: 39192003 DOI: 10.1007/s12519-024-00834-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/21/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Global pediatric healthcare reveals significant morbidity and mortality rates linked to respiratory, cardiac, and gastrointestinal disorders in children and newborns, mostly due to the complexity of therapeutic management in pediatrics and neonatology, owing to the lack of suitable dosage forms for these patients, often rendering them "therapeutic orphans". The development and application of pediatric drug formulations encounter numerous challenges, including physiological heterogeneity within age groups, limited profitability for the pharmaceutical industry, and ethical and clinical constraints. Many drugs are used unlicensed or off-label, posing a high risk of toxicity and reduced efficacy. Despite these circumstances, some regulatory changes are being performed, thus thrusting research innovation in this field. DATA SOURCES Up-to-date peer-reviewed journal articles, books, government and institutional reports, data repositories and databases were used as main data sources. RESULTS Among the main strategies proposed to address the current pediatric care situation, nanotechnology is specially promising for pediatric respiratory diseases since they offer a non-invasive, versatile, tunable, site-specific drug release. Tissue engineering is in the spotlight as strategy to address pediatric cardiac diseases, together with theragnostic systems. The integration of nanotechnology and theragnostic stands poised to refine and propel nanomedicine approaches, ushering in an era of innovative and personalized drug delivery for pediatric patients. Finally, the intersection of drug repurposing and artificial intelligence tools in pediatric healthcare holds great potential. This promises not only to enhance efficiency in drug development in general, but also in the pediatric field, hopefully boosting clinical trials for this population. CONCLUSIONS Despite the long road ahead, the deepening of nanotechnology, the evolution of tissue engineering, and the combination of traditional techniques with artificial intelligence are the most recently reported strategies in the specific field of pediatric therapeutics.
Collapse
Affiliation(s)
| | - Jackson G de Souza
- InovAI Lab, nPITI/IMD, Federal University of Rio Grande Do Norte, Natal, RN, 59078-970, Brazil
| | - Fátima García-Villén
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Granada, Campus of Cartuja, 18071, Granada, Spain.
| | - Julia Lira Loureiro
- Laboratory of Galenic Pharmacy, Department of Pharmacy, Federal University of Rio Grande Do Norte, Natal, 59012-570, Brazil
| | - Fernanda Nervo Raffin
- Laboratory of Galenic Pharmacy, Department of Pharmacy, Federal University of Rio Grande Do Norte, Natal, 59012-570, Brazil
| | - Marcelo A C Fernandes
- InovAI Lab, nPITI/IMD, Federal University of Rio Grande Do Norte, Natal, RN, 59078-970, Brazil
- Department of Computer Engineering and Automation, Federal University of Rio Grande Do Norte, Natal, RN, 59078-970, Brazil
| | - Eliana B Souto
- Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Rua Jorge de Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Patricia Severino
- Industrial Biotechnology Program, University of Tiradentes (UNIT), Aracaju, Sergipe, 49032-490, Brazil
| | - Raquel de M Barbosa
- Department of Pharmacy and Pharmaceutical Technology, School of Pharmacy, University of Seville, C/Professor García González, 2, 41012, Seville, Spain.
| |
Collapse
|
3
|
Juntunen P, Salmela P, Pakkasela J, Karjalainen J, Lehtimäki L. Diagnoses and prescription patterns among users of medications for obstructive airway diseases in Finland. BMC Pulm Med 2024; 24:64. [PMID: 38297257 PMCID: PMC10829254 DOI: 10.1186/s12890-024-02870-9] [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: 04/25/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Asthma and chronic obstructive pulmonary disease (COPD) are common diseases mostly treated in primary care. However, the usage patterns of drugs for obstructive airway diseases (R03 drugs) at the national level are not known. OBJECTIVE The aims of this study were to describe (1) for which diagnoses each class of R03 drugs were used, (2) the usage pattern of different drug classes for asthma and COPD, and (3) how often these medications were used without a diagnosis of asthma or COPD in Finland. METHODS We sent questionnaires that included questions on physician-diagnosed asthma and COPD to a random sample of 2000 Finnish subjects who had been dispensed R03 medications in the previous year. Details of R03 medications dispensed were retrieved from national registries. RESULTS Altogether, 803 subjects (40.6%) responded. Of these, 61.6% had asthma, 5.7% had both asthma and COPD, 5.1% had COPD, and 27.5% had neither asthma nor COPD. Among subjects with asthma or asthma and COPD, inhaled corticosteroids (ICS) were the most frequently dispensed class of drugs (93.7% and 97.8%, respectively). Even among subjects with COPD, ICS were dispensed as frequently (68.3%) as long-acting bronchodilators (70.7%). Antileukotrienes were dispensed mainly to asthmatic individuals only (18.4%) but far less frequently than ICS. The use of theophylline and roflumilast was rare. CONCLUSIONS R03 medications are dispensed far more frequently for asthma than for COPD and often also for subjects without asthma or COPD. In line with guidelines, asthma is treated mainly with ICS, but there seems to be overuse of ICS for COPD.
Collapse
Affiliation(s)
- Pekka Juntunen
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Petri Salmela
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Johanna Pakkasela
- Department of Respiratory Medicine, Tampere University Hospital, PO Box 2000, Tampere, N33521, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
4
|
Biset N, Lelubre M, Pochet S, De Vriese C. Asthma and COPD: Comparison with International Guidelines and Medication Adherence in Belgium. Pharmaceuticals (Basel) 2023; 16:1030. [PMID: 37513942 PMCID: PMC10386066 DOI: 10.3390/ph16071030] [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: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are major chronic conditions. It is possible to limit their impact by controlling symptoms, which limits exacerbations and worsening of the disease, by choosing the appropriate treatment and ensuring that the patient adheres to it. The main purpose of this study was to assess medication adherence and persistence with inhaled medications for chronic treatment of asthma and COPD, as well as to evaluate the factors influencing this adherence. Medication adherence was measured from January 2013 to December 2016 using continuous multiple-interval measures of medication availability (CMA). Persistence was evaluated by treatment episodes (TE). We analyzed the influence of different factors on CMA such as sex, age, type of device, and the realization of the "new medicines service" (NMS), introduced in Belgium in October 2013 to support patients in adhering to their treatment. We also analyzed the consumption of these inhaled medications within the Belgian population and compared them with the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Medication adherence varied greatly between the different pharmacological classes: inhaled corticosteroids (ICS) alone or in combination with long-acting beta agonists (LABA) had the lowest medication adherence and persistence, while adherence was highest for the long-acting muscarinic antagonists (LAMA) and LABA/LAMA associations. The NMS seemed to have a positive impact on medication adherence, although few patients completed the two guidance interviews offered by the service. In addition, only a minority of the targeted patients took advantage of this new service.
Collapse
Affiliation(s)
- Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Mélanie Lelubre
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Stéphanie Pochet
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculty of Pharmacy, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| |
Collapse
|
5
|
Bodum KS, Hjerrild BE, Dalsgaard S, Rubak SLM. Behavioural side effects of inhaled corticosteroids among children and adolescents with asthma. Respir Res 2022; 23:192. [PMID: 35902927 PMCID: PMC9330944 DOI: 10.1186/s12931-022-02112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background Inhalation corticosteroids (ICS) are prescribed for treatment of asthma in approximately 3% of all children in Denmark. Despite limited evidence, case reports suggest that ICS-related behavioural adverse drug events (ADEs) may be frequent. In general, underreporting of ADEs to official databases is common, and little is known about doctor’s clinical experiences with behavioural ADEs when prescribing ICS for children with asthma. The objective was to investigate the extent of behavioural ADEs in children with asthma treated with ICS by comparing database findings to experiences of specialist doctors. Methods First, databases of the European Medicines Agency (EMA) and the Danish Medicines Agency (DKMA) were searched for reports made by healthcare professionals about behavioural ADEs in children from 2009 to 2018. Second, questionnaire data on behavioural ADEs were collected from eight of the 11 specialist doctors responsible for treating children with asthma at the six paediatric departments in Central Denmark Region and North Denmark Region. Results EMA and DKMA had registered 104 and 3 reports, respectively, on behavioural ADEs during the 10-year study period. In contrast, five of the eight specialist doctors (45.5%) had experienced patients who had developed behavioural changes during ICS treatment. However, none of the five specialist doctors had filed reports on these events to DKMA. Conclusion Behaviour-related ADEs to ICS in children with asthma are likely to be highly underreported in official databases and doctors treating children with ICS should be aware of potential ADEs and consider submitting ADE reports whenever appropriate. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02112-8.
Collapse
Affiliation(s)
- Karoline S Bodum
- Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark.
| | - Britta E Hjerrild
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Søren Dalsgaard
- National Center for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Sune L M Rubak
- Danish Center for Pediatric Pulmonology and Allergology, Department of Paediatrics and Adolescents Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
6
|
Biset N, Kestens W, Detemmerman D, Lona M, Karakaya G, Ceuppens A, Pochet S, De Vriese C. Analysis of the Consumption of Drugs Prescribed for the Treatment of Asthma in Belgian Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:548. [PMID: 35010808 PMCID: PMC8744625 DOI: 10.3390/ijerph19010548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 02/04/2023]
Abstract
(1) Asthma is one of the most common chronic diseases in the world among children. The main purpose of this study was to analyze the consumption of asthma medications in order to investigate asthma in children (2-18 years) and the association with health care consumption; (2) a retrospective study using anonymized administrative data for 2013-2018 from the third largest Belgian health insurer was conducted; (3) in 2018, 12.9% of children received at least one asthma medication and 4.4% received at least two packages with a minimum of 30 days between purchases. Preschool children (2-6 years) were three times more likely to take asthma medication than older children (7-18 years). ICS, in combination or not with LABA, were the most dispensed drugs among children. Children with asthma medications were almost twice as likely to receive antibiotics, more likely to end up in the emergency room, and twice as likely to be hospitalized; (4) most children took ICS, according to the GINA guidelines. High rates of nebulization in young children were observed, despite the recommendation to use an inhaler with a spacing chamber as much as possible. Finally, children who took asthma medications were more likely to end up in the ER or be hospitalized.
Collapse
Affiliation(s)
- Natacha Biset
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
| | - Wies Kestens
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Dominique Detemmerman
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Murielle Lona
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Güngör Karakaya
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Ann Ceuppens
- Department of Studies & Innovation, Mutualités Libres—Onafhankelijke Ziekenfondsen, 1070 Brussels, Belgium; (W.K.); (D.D.); (M.L.); (G.K.); (A.C.)
| | - Stéphanie Pochet
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
| | - Carine De Vriese
- Department of Pharmacotherapy and Pharmaceutics, Faculté de Pharmacie, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium; (N.B.); (S.P.)
| |
Collapse
|
7
|
Levin JC, Beam AL, Fox KP, Mandl KD. Medication utilization in children born preterm in the first two years of life. J Perinatol 2021; 41:1732-1738. [PMID: 33547407 PMCID: PMC8277664 DOI: 10.1038/s41372-021-00930-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/12/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare medications dispensed during the first 2 years in children born preterm and full-term. STUDY DESIGN Retrospective analysis of claims data from a commercial national managed care plan 2008-2019. 329,855 beneficiaries were enrolled from birth through 2 years, of which 25,408 (7.7%) were preterm (<37 weeks). Filled prescription claims and paid amount over 2 years were identified. RESULTS In preterm children, the number of filled prescriptions was 1.4 times and cost was 3.8 times that of full-term children. Number and cost of medications were inversely related to gestational age. Differences peak at 4-9 months and resolve by 19 months after discharge. Palivizumab, ranitidine, albuterol, lansoprazole, budesonide, and prednisolone had the greatest differences in utilization. CONCLUSION Prescription medication utilization among preterm children under 2 years is driven by palivizumab, anti-reflux, and respiratory medications, despite little evidence regarding efficacy for many medications and concern for harm with certain classes.
Collapse
Affiliation(s)
- Jonathan C Levin
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Andrew L Beam
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kathe P Fox
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Brauer R, Wong ICK, Man KK, Pratt NL, Park RW, Cho SY, Li YCJ, Iqbal U, Nguyen PAA, Schuemie M. Application of a Common Data Model (CDM) to rank the paediatric user and prescription prevalence of 15 different drug classes in South Korea, Hong Kong, Taiwan, Japan and Australia: an observational, descriptive study. BMJ Open 2020; 10:e032426. [PMID: 31937652 PMCID: PMC7044847 DOI: 10.1136/bmjopen-2019-032426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To measure the paediatric user and prescription prevalence in inpatient and ambulatory settings in South Korea, Hong Kong, Taiwan, Japan and Australia by age and gender. A further objective was to list the most commonly used drugs per drug class, per country. DESIGN AND SETTING Hospital inpatient and insurance paediatric healthcare data from the following databases were used to conduct this descriptive drug utilisation study: (i) the South Korean Ajou University School of Medicine database; (ii) the Hong Kong Clinical Data Analysis and Reporting System; (iii) the Japan Medical Data Center; (iv) Taiwan's National Health Insurance Research Database and (v) the Australian Pharmaceutical Benefits Scheme. Country-specific data were transformed into the Observational Medical Outcomes Partnership Common Data Model. PATIENTS Children (≤18 years) with at least 1 day of observation in any of the respective databases from January 2009 until December 2013 were included. MAIN OUTCOME MEASURES For each drug class, we assessed the per-protocol overall user and prescription prevalence rates (per 1000 persons) per country and setting. RESULTS Our study population comprised 1 574 524 children (52.9% male). The highest proportion of dispensings was recorded in the youngest age category (<2 years) for inpatients (45.1%) with a relatively high user prevalence of analgesics and antibiotics. Adrenergics, antihistamines, mucolytics and corticosteroids were used in 10%-15% of patients. For ambulatory patients, the highest proportion of dispensings was recorded in the middle age category (2-11 years, 67.1%) with antibiotics the most dispensed drug overall. CONCLUSIONS Country-specific paediatric drug utilisation patterns were described, ranked and compared between four East Asian countries and Australia. The widespread use of mucolytics in East Asia warrants further investigation.
Collapse
Affiliation(s)
- Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Ian Chi Kei Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
| | - Kenneth Kc Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong, Hong Kong
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soo-Yeon Cho
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taiwan Medical University, Taipei, Taiwan
- The International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
- International Medical Informatics Association (IMIA), Geneva, Switzerland
| | - Usman Iqbal
- The International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Masters & PhD Program in Global Health Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Phung-Anh Alex Nguyen
- The International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Martijn Schuemie
- Epidemiology Analytics, Janssen Research and Development, Titusville, New Jersey, USA
- Department of Biostatistics, University of California, Los Angeles, California, USA
| |
Collapse
|
9
|
Oshikoya KA, Oreagba IA, Godman B, Fadare J, Orubu S, Massele A, Senbanjo IO. Off-label prescribing for children with chronic diseases in Nigeria; findings and implications. Expert Opin Drug Saf 2017. [PMID: 28627939 DOI: 10.1080/14740338.2017.1344639] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Prescribing medicines in an off-label manner for children with chronic conditions is sparsely documented, even more so among developing countries. This needs addressing. The objective of this research was to investigate the extent of off-label prescribing among children with epilepsy, asthma, and sickle cell anaemia in Nigeria. METHODS Prescriptions for children ≤16 years documented in their case files that attended paediatric clinics in Lagos, Nigeria, for these three conditions between January and October 2015, were reviewed retrospectively to extract data on the medicines prescribed. British National Formulary for children and American Hospital Formulary Service Drug information were used as references. RESULTS 477 patients received 1746 prescriptions. Off-label prescriptions were seen in 7.7% of prescriptions, related to dose (93; 68.9%), indication (22; 16.3%), and age (20; 14.8%). Nervous system (525; 30.1%) and anti-infective (441; 25.2%) medicines were the most prescribed but only 9.5% and 8.2% of the respective prescriptions were off-label. Children with epilepsy received the most number (94; 69.6%) of off-label prescriptions. The three chronic conditions did not associate significantly with the category of off-label medicine prescribed (p = 0.925). CONCLUSION Off-label prescribing for children with epilepsy, asthma and sickle cell anaemia occurs. Encouragingly, the overall rate appears low in Nigeria.
Collapse
Affiliation(s)
- Kazeem Adeola Oshikoya
- a Pharmacology Department , Lagos State University College of Medicine , Lagos , Nigeria
| | - Ibrahim Adekunle Oreagba
- b Pharmacology, Therapeutic and Toxicology Department , College of Medicine, University of Lagos , Lagos , Nigeria
| | - Brian Godman
- c Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.,d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,e Health Economics Centre , Liverpool University Management School, Liverpool University , Liverpool , UK
| | - Joseph Fadare
- f Department of Pharmacology , Ekiti State University , Ado-Ekiti , Nigeria
| | - Samuel Orubu
- g Faculty of Pharmacy , Niger Delta University , Amassoma , Nigeria
| | - Amos Massele
- h Department of Clinical Pharmacology , School of Medicine, University of Botswana , Gaborone , Botswana
| | | |
Collapse
|
10
|
Reynolds RF, Kurz X, de Groot MCH, Schlienger RG, Grimaldi-Bensouda L, Tcherny-Lessenot S, Klungel OH. The IMI PROTECT project: purpose, organizational structure, and procedures. Pharmacoepidemiol Drug Saf 2017; 25 Suppl 1:5-10. [PMID: 27038353 DOI: 10.1002/pds.3933] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 12/13/2022]
Abstract
The Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) initiative was a collaborative European project that sought to address limitations of current methods in the field of pharmacoepidemiology and pharmacovigilance. Initiated in 2009 and ending in 2015, PROTECT was part of the Innovative Medicines Initiative, a joint undertaking by the European Union and pharmaceutical industry. Thirty-five partners including academics, regulators, small and medium enterprises, and European Federation of Pharmaceuticals Industries and Associations companies contributed to PROTECT. Two work packages within PROTECT implemented research examining the extent to which differences in the study design, methodology, and choice of data source can contribute to producing discrepant results from observational studies on drug safety. To evaluate the effect of these differences, the project applied different designs and analytic methodology for six drug-adverse event pairs across several electronic healthcare databases and registries. This papers introduces the organizational structure and procedures of PROTECT, including how drug-adverse event and data sources were selected, study design and analyses documents were developed, and results managed centrally.
Collapse
Affiliation(s)
| | | | - Mark C H de Groot
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Chemistry and Haematology, Division of Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | - Olaf H Klungel
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| |
Collapse
|
11
|
Schmiedl S, Fischer R, Ibanez L, Fortuny J, Thürmann P, Ballarin E, Ferrer P, Sabaté M, Rottenkolber D, Gerlach R, Tauscher M, Reynolds R, Hasford J, Rottenkolber M. Tiotropium Respimat(®) vs. HandiHaler(®): real-life usage and TIOSPIR trial generalizability. Br J Clin Pharmacol 2015; 81:379-88. [PMID: 26506314 DOI: 10.1111/bcp.12808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 01/25/2023] Open
Abstract
AIM Two inhaler devices (Respimat® and HandiHaler®) are available for tiotropium, a long acting anticholinergic agent. We aimed to analyze drug utilization, off-label usage and generalizability of the TIOSPIR trial results for both devices. METHODS Patients aged ≥18 years exhibiting at least one documented prescription of tiotropium in the database of the Association of Statutory Health Insurance Physicians, Bavaria, Germany, were included (years 2004-2008). Annual period prevalence rates (PPRs) were calculated stratified by age, gender and inhaler devices. Off-label usage (patients lacking a chronic obstructive pulmonary disease (COPD) diagnosis) and the proportion of patients meeting the inclusion and exclusion criteria of the TIOSPIR trial were analyzed. RESULTS Between 2004 and 2008, PPRs increased and varied between 49.2 and 74.5 per 10 000 persons for HandiHaler® and between 1.5 and 9.3 per 10 000 persons for Respimat®. Small differences regarding patient characteristics existed between the two inhaler devices. Only about 30% (HandiHaler® 32.1%, Respimat® 30.0%) of the database patients receiving tiotropium could be theoretically included in the TIOSPIR trial. CONCLUSIONS Comparing the two tiotropium devices, no clinically relevant differences regarding patient and prescribing characteristics were revealed. Results of the TIOSPIR trial were generalizable only to a minority of our study patients, underlining the need for real-life data.
Collapse
Affiliation(s)
- Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | | | - Luisa Ibanez
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Petra Thürmann
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | - Elena Ballarin
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Pili Ferrer
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Monica Sabaté
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Dominik Rottenkolber
- Institute of Health Economics and Management, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany.,Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Member of the German Center for Lung Research, Neuherberg, Germany
| | - Roman Gerlach
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | - Martin Tauscher
- National Association of Statutory Health Insurance Physicians of Bavaria, Munich, Germany
| | | | - Joerg Hasford
- Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry, and Epidemiology, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| |
Collapse
|
12
|
Time trends of period prevalence rates of patients with inhaled long-acting beta-2-agonists-containing prescriptions: a European comparative database study. PLoS One 2015; 10:e0117628. [PMID: 25706152 PMCID: PMC4338187 DOI: 10.1371/journal.pone.0117628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Inhaled, long-acting beta-2-adrenoceptor agonists (LABA) have well-established roles in asthma and/or COPD treatment. Drug utilisation patterns for LABA have been described, but few studies have directly compared LABA use in different countries. We aimed to compare the prevalence of LABA-containing prescriptions in five European countries using a standardised methodology. METHODS A common study protocol was applied to seven European healthcare record databases (Denmark, Germany, Spain, the Netherlands (2), and the UK (2)) to calculate crude and age- and sex-standardised annual period prevalence rates (PPRs) of LABA-containing prescriptions from 2002-2009. Annual PPRs were stratified by sex, age, and indication (asthma, COPD, asthma and COPD). RESULTS From 2002-2009, age- and sex-standardised PPRs of patients with LABA-containing medications increased in all databases (58.2%-185.1%). Highest PPRs were found in men ≥ 80 years old and women 70-79 years old. Regarding the three indications, the highest age- and sex-standardised PPRs in all databases were found in patients with "asthma and COPD" but with large inter-country variation. In those with asthma or COPD, lower PPRs and smaller inter-country variations were found. For all three indications, PPRs for LABA-containing prescriptions increased with age. CONCLUSIONS Using a standardised protocol that allowed direct inter-country comparisons, we found highest rates of LABA-containing prescriptions in elderly patients and distinct differences in the increased utilisation of LABA-containing prescriptions within the study period throughout the five European countries.
Collapse
|