Zhong Wenjun, Liu Xinyue, Bash Lori D, Bortnichak Ed, Horrow Jay, Koro Carol
Merck & Co., Inc., Kenilworth, NJ, USA.
Hosp Pharm. 2021 Oct;56(5):424-429. doi: 10.1177/0018578720918332. Epub 2020 May 5.
Sugammadex (Bridion) was approved by the US Food and Drug Administration (FDA) in December 2015 for the reversal of neuromuscular block (NMB) induced by rocuronium and vecuronium bromide in adults undergoing surgery and approved for use in both adults and children in the European Union in 2008. Sugammadex use in children has been reported in the United States, but to what extent is not clear. The aim was to describe the utilization pattern of NMB agents and factors associated with the use of reversal agents (neostigmine and sugammadex) in US children. Cross-sectional study of children with exposure to NMB agents between 2015 and 2017 in the Cerner Health Facts database, which is an electronic health record (EHR) database across 600 facilities in the United States. Logistic regression estimated factors associated with the use of sugammadex vs neostigmine. A total of 27 094 pediatric clinical encounters were exposed to neuromuscular blocking agents (NMBAs), in which 21 845 were exposed to rocuronium (76%), vecuronium (18%), or both (6%). Among children with exposure to rocuronium and vecuronium, the use of sugammadex was 1.7% in 2016 and 7.6% in 2017. The multivariable logistic model suggested that children who were older (age 12-17 years vs 0-1 year; odds ratio [OR] 1.96; 95% confidence interval [CI], 1.36-2.83), Hispanic or Latino ethnicity and other ethnicities (vs non-Hispanic or Latino; OR 2.03 and 1.56; 95% CI, 1.55-2.67 and 1.15-2.13, respectively), in teaching facilities (OR 1.26; 95% CI, 1.00-1.59), or admitted through emergency departments (OR 1.65; 95% CI, 1.06-2.58) were independently more likely to receive sugammadex than neostigmine after controlling for other covariates. In Cerner Health Facts database 2015 to 2017, among children, rocuronium was more commonly used than vecuronium, and sugammadex use was observed since 2016. Sugammadex and neostigmine users varied by demographic, clinical, and site-level characteristics.
舒更葡糖钠（布瑞亭）于2015年12月获美国食品药品监督管理局（FDA）批准，用于在接受手术的成人中逆转由罗库溴铵和维库溴铵诱导的神经肌肉阻滞（NMB），并于2008年在欧盟获批用于成人和儿童。在美国已有儿童使用舒更葡糖钠的报道，但使用程度尚不清楚。本研究旨在描述美国儿童中NMB药物的使用模式以及与使用逆转剂（新斯的明和舒更葡糖钠）相关的因素。对2015年至2017年期间在Cerner Health Facts数据库中接触过NMB药物的儿童进行横断面研究，该数据库是一个覆盖美国600家医疗机构的电子健康记录（EHR）数据库。采用逻辑回归分析与使用舒更葡糖钠和新斯的明相关的因素。共有27094例儿科临床病例接触过神经肌肉阻滞剂（NMBAs），其中21845例接触过罗库溴铵（76%）、维库溴铵（18%）或两者皆有（6%）。在接触过罗库溴铵和维库溴铵的儿童中，2016年舒更葡糖钠的使用率为1.7%，2017年为7.6%。多变量逻辑模型显示，年龄较大的儿童（12 - 17岁 vs 0 - 1岁；比值比[OR] 1.96；95%置信区间[CI]，1.36 - 2.83）、西班牙裔或拉丁裔以及其他种族（vs非西班牙裔或拉丁裔；OR分别为2.03和1.56；95% CI，1.55 - 2.67和1.15 - 2.13）、在教学机构（OR 1.26；95% CI，1.00 - 1.59）或通过急诊科入院（OR 1.65；95% CI，1.06 - 2.58）的儿童在控制其他协变量后，独立于新斯的明更有可能接受舒更葡糖钠。在2015年至2017年的Cerner Health Facts数据库中，儿童中罗库溴铵的使用比维库溴铵更常见，且自2016年起观察到有舒更葡糖钠的使用。舒更葡糖钠和新斯的明使用者在人口统计学、临床和机构层面特征方面存在差异。
