Egberts A C, Lenderink A W, de Koning F H, Leufkens H G
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, (UIPS), Utrecht University, The Netherlands.
J Clin Psychopharmacol. 1997 Jun;17(3):149-55. doi: 10.1097/00004714-199706000-00002.
The demand for knowledge about differences in effectiveness, tolerability, safety, and economic outcomes between and within groups of antidepressant drugs when used in routine daily clinical practice is growing. For gaining this knowledge, observational pharmacoepidemiologic studies are often the most feasible option. However, the results of such studies can only be valid if either patient baseline characteristics associated with the outcome under study are similar or if differences can be adjusted for in the analysis. The aim of this study was to evaluate to what extent and for what type of patients three antidepressant drugs recently introduced in The Netherlands (mirtazapine, sertraline, and venlafaxine) were prescribed during the first year after their introduction and whether there were differences compared with longer-available antidepressant drugs. For this purpose, prescription drugs histories from 20 pharmacies serving a population of approximately 200,000 persons were analyzed. One year after their introduction, the newly introduced antidepressant t drugs accounted for approximately 6% of new uses of all antidepressant drugs. In comparison to longer-available antidepressant, the newly introduced antidepressant drugs were more often prescribed for patients with prior prescriptions of another antidepressant drug (rate ratio [RR] 2.7 [95% confidence interval [CI], 2.3-3.0]), for patients with prior prescriptions of other psychotropic medicines (RR 1.3 [95% CI, 1.1-1.4), and by psychiatrists (RR 1.9 [95% CI, 1.6-2.2]). In addition, the newly introduced antidepressant drugs seemed to be more often, although not significantly, prescribed for patients who had been hospitalized on a psychiatric ward (RR 1.5 [95% CI, 0.9-2.5]). No differences were observed with regard to age and gender distribution, the total number of medicines prescribed, and prescriptions of any cardiovascular or gastrointestinal medicine. These finding suggest that a significant proportion of the patients receiving one of the newly introduced antidepressant drugs did not respond satisfactorily to previous pharmacologic treatment. This channeling phenomenon may have important consequences for the interpretation of observational comparisons between different antidepressant drugs after their introduction.
在日常临床实践中，对于了解抗抑郁药物组间及组内有效性、耐受性、安全性和经济结果差异的知识需求日益增长。为获取此类知识，观察性药物流行病学研究通常是最可行的选择。然而，只有在与所研究结果相关的患者基线特征相似，或在分析中能够对差异进行调整时，此类研究结果才可能有效。本研究的目的是评估荷兰最近引入的三种抗抑郁药物（米氮平、舍曲林和文拉法辛）在引入后的第一年里，针对何种类型的患者、在多大程度上被开具了处方，以及与已上市更长时间的抗抑郁药物相比是否存在差异。为此，分析了来自20家药店、服务于约20万人的处方药历史记录。引入后一年，新引入的抗抑郁药物约占所有抗抑郁药物新用途的6%。与已上市更长时间的抗抑郁药物相比，新引入的抗抑郁药物更常被开给之前使用过其他抗抑郁药物的患者（率比[RR]2.7[95%置信区间[CI]，2.3 - 3.0]）、之前使用过其他精神药物的患者（RR 1.3[95% CI，1.1 - 1.4]）以及精神科医生开具（RR 1.9[95% CI，1.6 - 2.2]）。此外，新引入的抗抑郁药物似乎更常被开给曾在精神科病房住院的患者，尽管差异不显著（RR 1.5[95% CI，0.9 - 2.5]）。在年龄和性别分布、开具的药物总数以及任何心血管或胃肠道药物的处方方面未观察到差异。这些发现表明，接受新引入的抗抑郁药物之一的患者中，有很大一部分对先前的药物治疗反应不令人满意。这种用药倾向现象可能对不同抗抑郁药物引入后观察性比较的解释产生重要影响。
