与瑞士药品监督管理局发布的非黑色素瘤皮肤癌安全警示相关的瑞士氢氯噻嗪及其他降压药物使用变化：一项基于瑞士理赔数据的中断时间序列分析

Changes in the Use of Hydrochlorothiazide and Other Antihypertensive Drugs in Switzerland in Association With the Swissmedic Safety Alert Regarding Non-melanoma Skin Cancer: An Interrupted Time-Series Analysis Using Swiss Claims Data.

机构信息

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.

Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.

出版信息

Pharmacoepidemiol Drug Saf. 2024 Sep;33(9):e70005. doi: 10.1002/pds.70005.

DOI:10.1002/pds.70005

PMID:39223977

Abstract

PURPOSE

Long-term use of hydrochlorothiazide increases the risk of non-melanoma skin cancer. We aimed to evaluate potential changes in the use of hydrochlorothiazide in Switzerland after a direct healthcare professional communication (DHPC) in November 2018 by Swissmedic.

METHODS

We performed interrupted time-series analyses using a large Swiss healthcare claims database (2015-2021). Within monthly intervals, we quantified the total number of claims and the total dispensed 'defined daily doses' (DDD) for preparations containing (1) hydrochlorothiazide, (2) angiotensin-converting enzyme (ACE) inhibitors and angiotensin-II-receptor blockers (ARB), (3) calcium-channel blockers (CCB) and (4) thiazide-like diuretics per 10 000 persons. Using segmented linear regression, we quantified the pre-DHPC trend, the immediate change and the post-DHPC change in trend for total claims and DDD for the four drug classes weighted for the demographic distribution of the Swiss population.

RESULTS

ACE inhibitors and ARB were the most frequently claimed antihypertensive drugs with 300-400 claims per 10 000 persons, which increased by 5.4% during the study period. The average number of hydrochlorothiazide claims (157/10 000 persons in 2015) declined by 35% between 2015 and 2021. The decrease started prior to the DHPC, but the DHPC was associated with an immediate 6.1% decline and an accelerated decline in claims over time after the DHPC (similar results for DDD). This coincided with a 23% increase in claims of CCB (dihydropyridine type) over 7 years, whereas use of other antihypertensives increased less.

CONCLUSION

Our results suggest that the DHPC by Swissmedic in 2018 accelerated a pre-existing decline in the use of hydrochlorothiazide in Switzerland.

摘要

目的

长期使用氢氯噻嗪会增加非黑色素瘤皮肤癌的风险。我们旨在评估 2018 年 11 月瑞士药品管理局（Swissmedic）进行直接医疗专业人员沟通（DHPC）后，瑞士氢氯噻嗪使用情况的潜在变化。

方法

我们使用大型瑞士医疗保健索赔数据库（2015-2021 年）进行了中断时间序列分析。在每月间隔内，我们量化了包含以下药物的总索赔数量和总配药 '定义日剂量'（DDD）：（1）氢氯噻嗪，（2）血管紧张素转换酶（ACE）抑制剂和血管紧张素 II 受体阻滞剂（ARB），（3）钙通道阻滞剂（CCB）和（4）噻嗪类利尿剂，每 10000 人。使用分段线性回归，我们对四种药物类别的总索赔和 DDD 进行了量化，根据瑞士人口的人口分布对其进行了加权，以确定 DHPC 前的趋势、DHPC 后的即时变化以及 DHPC 后的趋势变化。

结果

ACE 抑制剂和 ARB 是最常被索赔的抗高血压药物，每 10000 人中有 300-400 人被索赔，在此期间增加了 5.4%。氢氯噻嗪的平均索赔数量（2015 年为 157/10000 人）在 2015 年至 2021 年间下降了 35%。这种下降始于 DHPC 之前，但 DHPC 与 6.1%的即时下降以及 DHPC 后索赔的加速下降有关（DDD 也有类似结果）。与此同时，7 年内二氢吡啶类钙通道阻滞剂（CCB）的索赔增加了 23%，而其他抗高血压药物的使用增加较少。