骨关节炎患者的药物使用情况：一项基于人群的研究。
Drug utilization in patients with OA: a population-based study.
作者信息
Wilson Nicholas, Sanchez-Riera Lidia, Morros Rosa, Diez-Perez Adolfo, Javaid M Kassim, Cooper Cyrus, Arden Nigel K, Prieto-Alhambra Daniel
机构信息
Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
出版信息
Rheumatology (Oxford). 2015 May;54(5):860-7. doi: 10.1093/rheumatology/keu403. Epub 2014 Oct 21.
OBJECTIVE
Patients with OA use different drugs in their search for relief. We aimed to study the prevalence of use and combinations of different medications for OA in a population-based cohort of OA patients in Catalonia, Spain, while characterizing users of each of the drugs available, with a particular focus on cardiovascular risk factors.
METHODS
Data were obtained from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database, which includes electronic medical records and pharmacy invoice data for >5 million people from Catalonia. Study participants were those with a clinical diagnosis of OA in 2006-10. Drugs studied included oral and topical NSAIDs, analgesics (paracetamol, metamizole), opioids (tramadol, fentanyl), cyclooxygenase 2 (COX-2) inhibitors and symptomatic slow-acting drugs in OA. Drug utilization was described using medication possession ratios (MPRs), equivalent to the proportion of days covered with the drug of interest. The annual incidence of new users in the first year after OA diagnosis from 2006 to 2010 was estimated for all studied drugs among newly diagnosed OA patients using Poisson regression.
RESULTS
We identified 238 536 study participants. The most common regimen of treatment consisted of at least three drugs (53.9% of patients). The drugs most frequently used regularly (MPR ≥50%) were chondroitin (21.2%), glucosamine (15.8%) and oral NSAIDs (14.4%). The incidence of the use of opioids, COX-2 inhibitors and chondroitin increased over the 5 year period, whereas all others decreased.
CONCLUSION
Drug combinations are common in the treatment of OA patients, who are thus exposed to potential drug interactions, with unknown impacts on their health. The increasing use of opioids and COX-2 inhibitors is noteworthy because of the potential impact on safety and costs.
目的
骨关节炎（OA）患者会使用不同药物来寻求缓解。我们旨在研究西班牙加泰罗尼亚地区以人群为基础的OA患者队列中不同OA药物的使用情况及联合用药情况，同时对每种可用药物的使用者进行特征描述，特别关注心血管危险因素。
方法
数据来自初级医疗保健研究发展信息系统（SIDIAP）数据库，该数据库包含加泰罗尼亚地区500多万人的电子病历和药房发票数据。研究参与者为2006年至2010年临床诊断为OA的患者。研究的药物包括口服和外用非甾体抗炎药、镇痛药（对乙酰氨基酚、安乃近）、阿片类药物（曲马多、芬太尼）、环氧化酶2（COX-2）抑制剂以及OA的症状性慢作用药物。使用药物持有率（MPR）来描述药物使用情况，MPR相当于使用目标药物覆盖的天数比例。使用泊松回归估计2006年至2010年新诊断OA患者中所有研究药物在OA诊断后第一年的新使用者年发病率。
结果
我们确定了238536名研究参与者。最常见的治疗方案包括至少三种药物（53.9%的患者）。经常使用（MPR≥50%）的最常见药物是软骨素（21.2%）、氨基葡萄糖（15.8%）和口服非甾体抗炎药（14.4%）。在这5年期间，阿片类药物、COX-2抑制剂和软骨素的使用发病率增加，而其他所有药物的发病率均下降。
结论
药物联合在OA患者治疗中很常见，因此患者面临潜在的药物相互作用，对其健康的影响尚不清楚。阿片类药物和COX-2抑制剂使用的增加值得关注，因为这可能对安全性和成本产生影响。
Zotero 插件