在心血管风险警告发布后立即使用罗格列酮和吡格列酮。
Use of rosiglitazone and pioglitazone immediately after the cardiovascular risk warnings.
机构信息
Department of Clinical and Administrative Pharmacy, College of Pharmacy, University of Georgia, 250 Green Street, Athens, GA 30602, USA.
出版信息
Res Social Adm Pharm. 2012 Jan-Feb;8(1):47-59. doi: 10.1016/j.sapharm.2010.12.003. Epub 2011 Jul 6.
BACKGROUND
Meta-analyses of oral hypoglycemic agents (OHAs) revealed that rosiglitazone increased the risk of myocardial infarction (MI) and heart failure (HF) and that pioglitazone increased the risk of HF and decreased the risk of MI.
OBJECTIVE
To characterize the change in the pattern of use of OHAs immediately after the publication of these meta-analyses on May 21, 2007.
METHODS
Pharmacy and medical claims data for a managed care organization were analyzed for patients continuously enrolled from January 1, 2005, to November 30, 2007, with at least 1 pharmacy claim for OHA in the 13-month period between November 1, 2006, and November 30, 2007. A 5-month pre-publication period (November 1, 2006, through March 31, 2007) was compared with a 5-month post-publication period (July 1, 2007, through November 30, 2007) using a differences-in-differences multinomial logistic regression. This regression explored discontinuation; continuation with monotherapy or adding another drug; and switching to a drug different from the index monotherapy drug after adjusting for gender, age, type of insurance, past 1-year history of MI or HF, and risk factors for MI and HF in the past 1 year.
RESULTS
The relative rate of switching to nonindex drug in the postpublication relative to prepublication was 2.64 (P=.046) for monotherapy rosiglitazone users and 0.72 (P=.583) for monotherapy pioglitazone users. The differences-in-differences estimate of the rate of switching to nonindex drugs for monotherapy rosiglitazone users was 3.64 (P=.090) times higher relative to the estimate for monotherapy pioglitazone users.
CONCLUSION
The pattern of use differed fundamentally between monotherapy rosiglitazone users and users of all other monotherapy OHAs in the postperiod. Not only were monotherapy rosiglitazone patients switching to non-rosiglitazone drugs at a higher rate, but the rate also was more than 3 times higher than similar switches among monotherapy pioglitazone users in the postperiod relative to the preperiod. This shows that the market response as observed by patient/prescriber decisions to the adverse news was interpreted narrowly to monotherapy rosiglitazone, and there is little or no spillover to the other drugs. Therefore, this study found that there was a differential effect of meta-analyses on the use of the 2 drugs.
背景
对口服降糖药（OHAs）的荟萃分析显示，罗格列酮增加了心肌梗死（MI）和心力衰竭（HF）的风险，吡格列酮增加了 HF 的风险，降低了 MI 的风险。
目的
描述 2007 年 5 月 21 日发表这些荟萃分析后，OHAs 使用模式的变化。
方法
对一家管理式医疗组织的药房和医疗索赔数据进行分析，纳入 2005 年 1 月 1 日至 2007 年 11 月 30 日连续入组的患者，在 2006 年 11 月 1 日至 2007 年 11 月 30 日的 13 个月内至少有 1 次 OHA 药房用药。使用差异中的差异多项逻辑回归比较 5 个月的发表前时期（2006 年 11 月 1 日至 2007 年 3 月 31 日）和 5 个月的发表后时期（2007 年 7 月 1 日至 2007 年 11 月 30 日）。在调整性别、年龄、保险类型、过去 1 年 MI 或 HF 病史以及过去 1 年 MI 和 HF 的危险因素后，这种回归探讨了停药、继续单药治疗或添加另一种药物、以及在索引单药治疗后改用与索引单药不同的药物。
结果
与发表前相比，发表后单药罗格列酮使用者改用非索引药物的相对比率为 2.64（P=.046），单药吡格列酮使用者为 0.72（P=.583）。单药罗格列酮使用者改用非索引药物的差异差异估计值比单药吡格列酮使用者高 3.64（P=.090）倍。
结论
在发表后时期，单药罗格列酮使用者和所有其他单药 OHA 使用者的用药模式发生了根本变化。不仅单药罗格列酮患者改用非罗格列酮药物的比率更高，而且与发表前相比，该比率在发表后时期也比单药吡格列酮患者高出 3 倍以上。这表明，从患者/处方者对不良消息的决策来看，市场反应被狭隘地解释为单药罗格列酮，而对其他药物的影响则很小或没有。因此，本研究发现，荟萃分析对这两种药物的使用产生了不同的影响。
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