Braunstein David, Donnet Anne, Pradel Vincent, Sciortino Vincent, Allaria-Lapierre Véronique, Lantéri-Minet Michel, Micallef Joëlle
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.
Centre d'évaluation et de traitement de la douleur, hôpital Timone, Pôle Neurosciences Cliniques, Hôpital de la Timone, France INSERM/UdA, France.
Cephalalgia. 2015 Nov;35(13):1172-80. doi: 10.1177/0333102415570497. Epub 2015 Feb 9.
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.
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.
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).
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.
本研究的目的是利用药物报销数据库来估计并描述法国曲坦类药物的实际使用和过度使用模式。
我们纳入了来自普罗旺斯-阿尔卑斯-蓝色海岸（PACA）和科西嘉行政区、被法国全民健康保险系统（GHIS）覆盖、在2010年5月至2011年12月期间至少有一剂曲坦类药物配药记录的所有人。所有曲坦类药物、偏头痛预防性治疗药物和精神药物的配药记录均从GHIS数据库中提取。曲坦类药物过度使用被定义为连续三个月以上每月常规使用曲坦类药物超过20限定日剂量（DDD）。使用经性别和年龄调整的逻辑回归评估过度使用风险。
在研究的20个月中，我们纳入了99540名至少有一次曲坦类药物处方的患者。其中，2243名患者（2.3%）被确定为过度使用者，他们接受了所开总DDD的20.2%。12%的过度使用者和6.9%的非过度使用者年龄超过65岁（比值比：1.81）。与非过度使用者相比，过度使用者的开处方医生和药剂师数量并不更多。他们更频繁地被开具偏头痛预防性治疗药物（分别为56.8%和35.9%，比值比：2.36）、苯二氮䓬类药物（分别为69.9%和54.7%，比值比：1.93）以及抗抑郁药（分别为49.4%和30.2%，比值比：2.33）。
这项研究表明，曲坦类药物的过度使用可能是由于开处方医生对合理用药的认识不足。老年人中曲坦类药物的超说明书用药需要对该亚组人群的心血管风险状况进行调查。
