Jang Yunjeung, Song Inmyung, Oh In-Sun, Shin Ju-Young
School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
Eur J Clin Pharmacol. 2019 Jan;75(1):109-117. doi: 10.1007/s00228-018-2563-9. Epub 2018 Oct 2.
Abuse of zolpidem has sporadically been reported and little is known regarding nationwide patterns of zolpidem use in Korea. This study investigates the extent of zolpidem usage exceeding the recommended duration and the predictors.
We conducted a drug utilization study using the national sample cohort database of the Korea National Health Insurance Corporation between 2002 and 2013. The study subjects were patients treated with zolpidem in the outpatient setting. An episode was defined as a period of continuous zolpidem therapy. The provider-based episode allowed for a gap of up to 3 days between two consecutive prescriptions from the same institution. The person-based episode allowed for a gap of up to 3 days, regardless of institution. We calculated the proportion of zolpidem use for periods over 30 days and conducted logistic regression analyses to investigate the relevant predictors. An adjusted odds ratio (aOR) with a 95% confidence interval (CI) was estimated for each predictor.
The usage of zolpidem is dramatically increased by approximately 18 times since zolpidem was authorized in the market (1181 in 2002 vs. 21,399 in 2013). The treatment duration in 8.3% of episodes exceeded 30 days out of 75,087 zolpidem users. The odds of zolpidem prescription exceeding 30 days were highest in patients aged 65 years and older (aOR = 2.13, 95% CI 1.78-2.53) and at tertiary hospitals (aOR = 2.14, 95% CI 1.68-2.72). Women were more likely than men to be treated with zolpidem for over 30 days.
We found dramatic increase of zolpidem use from 2002 to 2013. In 8.3% of the prescribed episodes of zolpidem, the recommended duration was exceeded. Efforts are required to reduce prescriptions that are inconsistent with the recommended guidelines for older patients, women, and in tertiary hospitals.
已有唑吡坦滥用的零星报道，而韩国全国范围内唑吡坦的使用模式鲜为人知。本研究调查了唑吡坦使用时间超过推荐时长的情况及其预测因素。
我们利用韩国国民健康保险公团2002年至2013年的全国样本队列数据库进行了一项药物利用研究。研究对象为门诊接受唑吡坦治疗的患者。一个疗程定义为持续使用唑吡坦的时间段。基于医疗机构的疗程允许同一机构连续两次处方之间间隔最多3天。基于个人的疗程允许间隔最多3天，无论机构如何。我们计算了唑吡坦使用超过30天的比例，并进行逻辑回归分析以研究相关预测因素。为每个预测因素估计了调整后的优势比（aOR）及95%置信区间（CI）。
自唑吡坦上市以来，其使用量急剧增加了约18倍（2002年为1181例，2013年为21399例）。在75087名唑吡坦使用者中，8.3%的疗程持续时间超过30天。唑吡坦处方超过30天的几率在65岁及以上患者中最高（aOR = 2.13，95% CI 1.78 - 2.53），在三级医院中也最高（aOR = 2.14，95% CI 1.68 - 2.72）。女性接受唑吡坦治疗超过30天的可能性高于男性。
我们发现2002年至2013年唑吡坦的使用量急剧增加。在8.3%的唑吡坦处方疗程中，超过了推荐时长。需要做出努力，减少针对老年患者、女性以及三级医院中不符合推荐指南的处方。
