Ehrhardt Carole, Boucherie Quentin, Pauly Vanessa, Braunstein David, Ronflé Eléonore, Thirion Xavier, Frauger Elisabeth, Micallef Joelle
Service de pharmacologie clinique et pharmacovigilance, CEIP-addictovigilance, hôpital de la Timone, AP-HM, Aix Marseille université, institut des neurosciences Timone, CNRS, 13005 Marseille, France.
EA 3279 laboratoire de santé publique, Aix Marseille université, AP-HM, CEIP-addictovigilance associé PACA-Corse, 13005 Marseille, France.
Therapie. 2017 Dec;72(6):635-641. doi: 10.1016/j.therap.2017.05.005. Epub 2017 Jul 21.
Methylphenidate (MPH) is a prescription-stimulant medication which is authorized in France for two indications: attention-deficit hyperactivity disorder in children (aged≥6years) and narcolepsy in cases where modafinil is ineffective (for children and adults). MPH use has increased worldwide in the past 2 decades in children and adults. Different pharmacoepidemiological Europeans studies have described MPH patterns of use. To our knowledge, few pharmacoepidemiological studies have described MPH patterns of use in France.
In this context, we have performed a study on regional reimbursement database (PACA-Corse area, covering approximately 4 millions inhabitants). The first part of the study analyzed the evolution of MPH users characteristic's yearly (grouped by age and gender) over a 7year period (2005-2011). In order to better characterize patterns of MPH use in adults, a specific analyze has been performed in the second part on MPH adult users in 2011 with a gender descriptive approach.
During the 7year period, MPH dispensing grew from 0.28 to 0.68 patient per 1000. The proportion of adult patients rose from 14.8 to 25.7% (P<0.0001), with patients mainly aged 35-49years old. Gender differences in MPH users were noted between adults and children: the proportion of girls was less important in children than in adult (in 2011, 20.7% of girls among children vs 44.9% among adults). Moreover, the proportion of girls among children increased between 2005 to 2011 (15.1% of girls in 2005 versus 20.7% in 2011). Among adults, women were prescribed more antidepressants (41.5% versus 28.2%, P=0.003) and less opiate maintenance treatments (22.4% versus 31.9%, P=0.03) than men. Finally, 11% of men and 16.4% of women were over 50years old.
MPH prescription greatly increased over7years, especially in adults. Moreover, in this population, patterns of MPH use differed with gender specificities. Such findings may increase clinical attention on monitoring MPH use in adults.
哌甲酯（MPH）是一种处方兴奋剂药物，在法国被批准用于两种适应症：6岁及以上儿童的注意力缺陷多动障碍，以及莫达非尼无效时（儿童和成人）的发作性睡病。在过去20年里，MPH在全球范围内儿童和成人中的使用量都有所增加。欧洲不同的药物流行病学研究描述了MPH的使用模式。据我们所知，很少有药物流行病学研究描述法国MPH的使用模式。
在此背景下，我们对地区报销数据库（普罗旺斯-阿尔卑斯-蓝色海岸大区-科西嘉地区，覆盖约400万居民）进行了一项研究。研究的第一部分分析了7年期间（2005 - 2011年）MPH使用者特征（按年龄和性别分组）的年度变化。为了更好地描述成人MPH的使用模式，第二部分对2011年的MPH成年使用者采用性别描述方法进行了具体分析。
在这7年期间，MPH的配药量从每1000人0.28例增加到0.68例。成年患者的比例从14.8%上升到25.7%（P<0.0001），患者主要为35 - 49岁。在MPH使用者中，成人和儿童存在性别差异：儿童中女孩的比例低于成人（2011年，儿童中女孩占20.7%，而成人中占44.9%）。此外，2005年至2011年期间儿童中女孩的比例有所增加（2005年女孩占15.1%，2011年占20.7%）。在成人中，女性比男性被开更多的抗抑郁药（41.5%对28.2%，P = 0.003），而阿片类维持治疗较少（22.4%对31.9%，P = 0.03）。最后，11%的男性和16.4%的女性年龄超过50岁。
7年间MPH的处方量大幅增加，尤其是在成人中。此外，在这一人群中，MPH的使用模式存在性别特异性差异。这些发现可能会增加临床对监测成人MPH使用情况的关注。
