Kardas Przemysław, Urbański Filip, Lichwierowicz Aneta, Chudzyńska Ewa, Czech Marcin, Makowska Katarzyna, Kardas Grzegorz
Department of Family Medicine, Medical University of Lodz, Łódź, Poland.
National Health Fund, Warsaw, Poland.
Front Pharmacol. 2021 Jan 18;11:607852. doi: 10.3389/fphar.2020.607852. eCollection 2020.
Drug-drug interactions may lead to poor health outcomes, as well as increased costs and utilization of healthcare services. Unfortunately, real-world data continuously prove high prevalence of potential drug-drug interactions (pDDIs) worldwide. Among identified drivers, ageing, multimorbidity and polypharmacy play a very important role. With these factors being widespread, the need for implementation of strategies minimizing the burden of pDDIs becomes an urgency. This, however, requires a better understanding of the prevalence of pDDIs and the underlying causative factors. To assess the real-world prevalence of pDDIs and its characteristics in the general population of Poland, using analgesic drugs as a model, and to find out whether pDDIs are caused by prescribing coming from the very same prescribers (co-prescribing). A retrospective analysis of the 2018 dispensation data of the National Health Fund (NHF) - the only Polish public healthcare payer organization with nationwide coverage. We searched for selected pDDIs of non-steroidal anti-inflammatory drugs (NSAIDs) with antihypertensives, other NSAIDs (double use), oral glucocorticoids, oral anticoagulants, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and antiplatelet drugs; as well as opioides with SSRIs, SNRIs, gabapentinoids, and benzodiazepines. A pDDI was deemed present if two drugs standing in a possible conflict were dispensed within the same calendar month. Out of 38.4 million citizens of Poland, 23.3 million were dispensed prescribed drugs reimbursed by NHF in 2018. In this cohort, we have identified 2,485,787 cases of analgesic drug pDDIs, corresponding with 6.47% of the Polish population. Out of these, the most prevalent pDDI was caused by "NSAIDs + antihypertensives" (1,583,575 cases, i.e., 4.12% of the Polish population), followed by "NSAIDs + NSAIDs" (538,640, 1.40%) and "NSAIDs + glucocorticoids" (213,504, 0.56%). The most persistent pDDIs among those studied were caused by "Opioids + Gabapentinoids" (2.19, 95%CI: 2.16-2.22 months). On average, 76.63% of all cases of pDDIs were caused by drugs prescribed by the very same prescribers. Based on high-quality, nationwide data, we have found a high prevalence of analgesic drugs-related pDDIs in Poland. Over ¾ of the identified pDDIs were caused by co-prescribing, i.e., prescriptions issued by the same prescribers. The significance of the problem, illustrated with our findings on analgesic drugs-related pDDIs in Poland, deserves much more scientific and policymaker attention.
药物相互作用可能导致健康状况不佳，以及医疗保健服务成本增加和利用率提高。不幸的是，现实世界的数据不断证明全球潜在药物相互作用（pDDIs）的高流行率。在已确定的驱动因素中，老龄化、多种疾病和多药合用起着非常重要的作用。由于这些因素广泛存在，实施将pDDIs负担降至最低的策略变得迫在眉睫。然而，这需要更好地了解pDDIs的流行率及其潜在的致病因素。为了评估波兰普通人群中pDDIs的现实世界流行率及其特征，以镇痛药为模型，并找出pDDIs是否由同一开处方者的处方（联合处方）引起。对国家卫生基金（NHF）2018年的配药数据进行回顾性分析，NHF是波兰唯一一家覆盖全国的公共医疗保健支付机构。我们搜索了非甾体抗炎药（NSAIDs）与抗高血压药、其他NSAIDs（双重使用）、口服糖皮质激素、口服抗凝剂、选择性5-羟色胺再摄取抑制剂（SSRIs）、5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）和抗血小板药物之间的选定pDDIs；以及阿片类药物与SSRIs、SNRIs、加巴喷丁类药物和苯二氮卓类药物之间的pDDIs。如果在同一个日历月内配出了两种可能存在冲突的药物，则认为存在pDDI。在波兰的3840万公民中，2330万人在2018年获得了NHF报销的处方药。在这个队列中，我们确定了2485787例镇痛药pDDIs病例，相当于波兰人口的6.47%。其中，最常见的pDDI是由“NSAIDs+抗高血压药”引起的（1583575例，即波兰人口的4.12%），其次是“NSAIDs+NSAIDs”（538640例，1.40%）和“NSAIDs+糖皮质激素”（213504例，0.56%）。在研究的pDDIs中，最持久的是由“阿片类药物+加巴喷丁类药物”引起的（2.19，95%CI：2.16-2.22个月）。平均而言，所有pDDIs病例中有76.63%是由同一开处方者开出的药物引起的。基于高质量的全国性数据，我们发现波兰与镇痛药相关的pDDIs流行率很高。超过四分之三的已确定pDDIs是由联合处方引起的，即由同一开处方者开出的处方。我们关于波兰与镇痛药相关的pDDIs的研究结果所表明的这个问题的重要性，值得科学界和政策制定者给予更多关注。
