University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States.
University of Maryland, Baltimore, Department of Pharmaceutical Health Services Research, 220N. Arch St., Baltimore, MD 21201, United States; University of Maryland, Baltimore, School of Medicine, 655W. Baltimore St, Baltimore, MD 21201, United States.
Drug Alcohol Depend. 2022 Jan 1;230:109180. doi: 10.1016/j.drugalcdep.2021.109180. Epub 2021 Nov 17.
Our goal was to describe specific patterns associated with co-prescriptions of gabapentin, opioids, and benzodiazepines among disabled Medicare beneficiaries.
Using 2013-2015 Medicare data, we conducted a retrospective cohort study among fee-for-service disabled beneficiaries continuously enrolled in Medicare Parts A, B, and D. The index date was defined as the earliest fill date for a gabapentin, opioid, or benzodiazepine prescription. Monotherapy, dual therapy, and tri-therapy were defined as utilization of one, two, and three medication classes, respectively. Augmentation was defined as a prescription for a different medication class in addition to prescription for initial medication; switching referred to a change in prescription for a different medication class with no subsequent fills of initial medication. We used descriptive statistics, Kaplan Meier analyses and Cox proportional hazards to examine the association between initial therapy and monotherapy, dual therapy, tri-therapy, switching and augmentation.
Among 151,552 disabled beneficiaries, gabapentin initiators were more likely to augment therapy (50.1%) when compared to opioid (28.7%) and benzodiazepine (38.7%) users. When compared to opioid initiators, the risk of augmentation (HR[95%CI]: 1.85[1.82-1.89]) and switching (1.62 [1.51-1.73]) was significantly higher among gabapentin initiators. Risk of augmentation was also significantly higher among beneficiaries with co-morbid pain and mental health conditions (p < 0.01). Overall, the majority of beneficiaries augmented and switched within 2-months and 4-months after initiating therapy, respectively.
Given safety concerns associated with gabapentin, opioids, and benzodiazepines, it is imperative that the benefits and risks of co-prescribing these medications be examined comprehensively, especially for those in vulnerable sub-groups.
我们的目标是描述残疾医疗保险受益人中加巴喷丁、阿片类药物和苯二氮䓬类药物共同处方的具体模式。
使用 2013-2015 年医疗保险数据，我们对连续参加医疗保险 A、B 和 D 部分的收费服务残疾受益人群进行了回顾性队列研究。索引日期定义为加巴喷丁、阿片类药物或苯二氮䓬类药物处方的最早填写日期。单药治疗、双药治疗和三药治疗分别定义为使用一种、两种和三种药物类别。增效治疗定义为除初始药物处方外还开具其他药物类别的处方；转换是指更换不同药物类别的处方，且初始药物无后续配药。我们使用描述性统计、Kaplan-Meier 分析和 Cox 比例风险模型来检查初始治疗与单药治疗、双药治疗、三药治疗、转换和增效治疗之间的关联。
在 151552 名残疾受益人中，与阿片类药物（28.7%）和苯二氮䓬类药物（38.7%）使用者相比，加巴喷丁使用者更有可能增效治疗（50.1%）。与阿片类药物使用者相比，加巴喷丁使用者的增效（HR[95%CI]：1.85[1.82-1.89]）和转换（1.62[1.51-1.73]）风险显著更高。患有共病疼痛和精神健康状况的受益人的增效风险也显著更高（p<0.01）。总体而言，大多数受益人的增药和换药分别发生在起始治疗后的 2 个月和 4 个月内。
鉴于加巴喷丁、阿片类药物和苯二氮䓬类药物相关的安全问题，全面检查这些药物共同处方的益处和风险至关重要，特别是对于那些处于脆弱亚群的人群。
