Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL.
Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice & Science, College of Pharmacy, University of Kentucky, Lexington, KY.
Pain Med. 2021 Oct 8;22(10):2153-2161. doi: 10.1093/pm/pnab088.
To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults in the United States.
We used the MarketScan Research Database to identify a cohort of adults 18 to 64 years who had ≥2-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder.
48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1,000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for >50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14 days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365 days, respectively. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration.
SMRs are widely used in the United States. Their use slightly increased in recent years, but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.
在美国商业保险成年人中，检查骨骼肌松弛剂（SMR）治疗的流行率和持续时间。
我们使用 MarketScan Research Database 确定了一个 18 至 64 岁成年人队列，这些成年人在 2005 年至 2018 年间有至少 2 年的连续入组。我们使用重复横截面设计估计 SMR 治疗的流行率，并使用 Kaplan-Meier 方法得出治疗持续时间。分析按年龄组、性别、地理位置、个体 SMR 药物和肌肉骨骼疾病进行分层。
纳入了 4870 万人。治疗流行率范围为每 1000 人 61.5 至 68.3 例。约三分之一的使用者没有先前的肌肉骨骼疾病诊断。环苯扎林是主要药物，占处方的 50%以上。巴氯芬、替扎尼定和甲氯芬酸的使用量显著增加，而卡洛芬和甲灭酸的使用量下降。南方的流行率最高，而东北部最低。中位数治疗持续时间为 14 天，4.0%、1.9%和 1.0%的个体分别使用 SMR 超过 90、180 和 365 天。与环苯扎林相比，开始使用巴氯芬、替扎尼定和卡洛芬的患者治疗时间更长。
SMR 在全美广泛使用。近年来，它们的使用略有增加，但在个别药物、患者群体和地理位置之间存在差异。尽管疗效的证据有限，但仍有相当数量的美国成年人将 SMR 用于长期和非适应证情况。需要进一步研究以了解治疗的决定因素以及与这种使用相关的结果。
