Su Zhuo Tony, Segal Jodi Beth, Lanzkron Sophie, Ogunsile Foluso Joy
Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Center for Health Services and Outcomes Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pharmacoepidemiol Drug Saf. 2019 Sep;28(9):1246-1250. doi: 10.1002/pds.4860. Epub 2019 Jul 22.
To identify trends in physician drug prescribing practices for sickle cell disease (SCD).
We used data from the National Disease and Therapeutic Index to evaluate medications prescribed to children (definition: aged 19 years or younger) and adults (20 years or older) with SCD by office-based physicians in the United States during 1997 to 2017. Prescriptions were evaluated in 3-year intervals.
The proportion of SCD visits that included new/continued hydroxyurea prescriptions increased from less than or equal to 8% before 2009 to 33% in 2015 to 2017. The increase was significant in visits by children (2.5% in 1997-1999 to 47% in 2015-2017; P = .003 by Spearman's rank-order correlation) but not in adults (6.9% to 11%; P = .12). Opioids, started/continued in 13% (lowest 3-year average) to 35% (highest) of visits by children and 55% to 81% of visits by adults, remained the most frequently prescribed medications for SCD overall. There were no significant changes over time in opioid prescribing for adults (P = .64) or children (P = .38). Hematologists/oncologists accounted for a higher proportion of visits by children (67.2% over 1997-2017) than adults (25.2%), while emergency medicine visits were higher in adults (14.0%) than children (2.6%).
This study suggests a robust increase in hydroxyurea prescribing for children with SCD. The BABY HUG trial, which demonstrated safety and efficacy of starting hydroxyurea in infancy and informed current SCD guidelines recommending broader use in children, may have contributed to this increase. However, hydroxyurea prescribing for adults remains infrequent and considerably lower than opioids. Barriers in access to specialist care persist for adults with SCD.
确定镰状细胞病（SCD）患者的医生用药处方趋势。
我们使用了国家疾病与治疗指数的数据，以评估1997年至2017年期间美国门诊医生为患有SCD的儿童（定义为19岁及以下）和成人（20岁及以上）开具的药物。处方按3年间隔进行评估。
包含新的/持续使用羟基脲处方的SCD就诊比例从2009年前的小于或等于8%增加到2015年至2017年的33%。儿童就诊中的增加具有显著性（1997 - 1999年为2.5%，2015 - 2017年为47%；Spearman等级相关分析P = 0.003），而成人就诊中无显著性增加（6.9%至11%；P = 0.12）。总体而言，阿片类药物仍是SCD最常开具的药物，在儿童就诊中有13%（最低3年平均值）至35%（最高）开始使用/持续使用，在成人就诊中有55%至81%。成人（P = 0.64）和儿童（P = 0.38）使用阿片类药物的处方随时间无显著变化。血液科医生/肿瘤内科医生在儿童就诊中所占比例（1997 - 2017年期间为67.2%）高于成人（25.2%），而成人急诊科就诊比例（14.0%）高于儿童（2.6%）。
本研究表明SCD儿童使用羟基脲的处方量强劲增加。BABY HUG试验证明了婴儿期开始使用羟基脲的安全性和有效性，并为当前SCD指南推荐在儿童中更广泛使用提供了依据，这可能促成了这种增加。然而，成人使用羟基脲的处方仍然很少，且远低于阿片类药物。患有SCD的成人在获得专科护理方面仍然存在障碍。
