Juurlink David N, Gomes Tara, Paterson J Michael, Hellings Chelsea, Mamdani Muhammad M
Institute for Clinical Evaluative Sciences (Juurlink, Gomes, Paterson, Hellings, Mamdani); Sunnybrook Research Institute (Juurlink); Li Ka-Shing Knowledge Institute (Gomes, Mamdani), St. Michael's Hospital; Institute of Health Policy, Management, and Evaluation (Gomes), University of Toronto; Leslie Dan Faculty of Pharmacy, the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.
CMAJ Open. 2015 Nov 26;3(4):E428-31. doi: 10.9778/cmajo.20140078. eCollection 2015 Oct-Dec.
In early 2009, 2 observational studies and a US Food and Drug Administration (FDA) advisory addressed the drug interaction between proton pump inhibitors (PPIs) and clopidogrel. One study suggested that pantoprazole could be used safely in this setting, whereas the other study and the FDA advisory did not distinguish among PPIs. We examined trends in PPI prescribing among clopidogrel recipients in the period following these events.
We conducted a population-based time series analysis of Ontario residents aged 66 years or older for whom clopidogrel was prescribed between Apr. 1, 1999, and Sept. 30, 2013. We determined the proportion of clopidogrel recipients dispensed a PPI during each quarter and the proportions who received pantoprazole or other PPIs. The outcome of interest was change in the use of pantoprazole.
In the final quarter of 2008, pantoprazole represented 23.7% of all PPI prescriptions dispensed to patients receiving clopidogrel. Following the publications and FDA advisory in early 2009, pantoprazole use increased substantially. By the end of 2009, this medication accounted for 52.5% of all PPI prescriptions issued to patients receiving clopidogrel; by the end of the study period, it accounted for 71.0% of all PPI prescriptions dispensed to such patients (p < 0. 001). We also observed a modest drop in overall PPI use among clopidogrel recipients beginning in early 2009.
In 2009, the prescribing of PPIs with clopidogrel changed substantially in Ontario, with pantoprazole rapidly becoming the most commonly prescribed agent in its class. However, a modest decline in overall PPI use also occurred that may reflect suboptimal translation of emerging drug safety information to clinical practice.
2009年初，两项观察性研究以及美国食品药品监督管理局（FDA）的一份咨询报告探讨了质子泵抑制剂（PPI）与氯吡格雷之间的药物相互作用。一项研究表明泮托拉唑在此情况下可安全使用，而另一项研究及FDA的咨询报告并未对不同的PPI进行区分。我们研究了这些事件发生后氯吡格雷使用者中PPI处方的变化趋势。
我们对1999年4月1日至2013年9月30日期间为66岁及以上安大略省居民开具氯吡格雷处方的情况进行了基于人群的时间序列分析。我们确定了每个季度接受氯吡格雷治疗且同时配用PPI的患者比例，以及接受泮托拉唑或其他PPI的患者比例。感兴趣的结果是泮托拉唑使用情况的变化。
在2008年最后一个季度，泮托拉唑占所有开具给接受氯吡格雷治疗患者的PPI处方的23.7%。在2009年初相关研究发表及FDA发布咨询报告后，泮托拉唑的使用大幅增加。到2009年底，这种药物占所有开具给接受氯吡格雷治疗患者的PPI处方的52.5%；到研究期结束时，它占所有配发给此类患者的PPI处方的71.0%（p<0.001）。我们还观察到从2009年初开始，氯吡格雷使用者中PPI的总体使用量略有下降。
2009年，安大略省氯吡格雷与PPI的联合处方情况发生了很大变化，泮托拉唑迅速成为该类药物中最常用的药物。然而，PPI的总体使用量也略有下降，这可能反映出新兴药物安全信息在临床实践中的转化不够理想。
