Trends in the incidence of use of noninsulin glucose‐lowering drugs between 2006 and 2013 in France

This study aimed at describing trends in the incidence of use of noninsulin glucose‐lowering drugs (NIGLDs) between 2006 and 2013 in France. Repeated cross‐sectional studies on NIGLD new users were performed annually from 2006 to 2013 within the Echantillon Généraliste des Bénéficiaires (EGB) database, a 1/97th representative sample of the population covered by the French healthcare insurance system. NIGLD included metformin, sulfonylureas, α‐glucosidase inhibitors, thiazolidinediones, dipeptidylpeptidase‐4 (DPP‐4) inhibitors, glinides and glucagon‐like peptide‐1 analogues. New users were defined as patients with no delivery of any NIGLD (first‐line new users) or no delivery of a NIGLD of the same class (add‐on/switch new users) in the preceding year. Incidence rates of use and corresponding 95% confidence intervals (95% CI) were estimated per 1000 persons. Among the 507 043 persons included in the EGB in 2006, 2036 were identified as NIGLD first‐line new users and 2192 as add‐on/switch new users, which corresponded to an incidence of use of 4.0‰ (95%CI 3.8–4.2) and 4.3‰ (4.1–4.5), respectively. First‐line incidence increased to 5.3‰ (5.1–5.5) in 2010 and then decreased to 4.2‰ (4.0–4.4) in 2013; add‐on/switch incidence increased to 8.0‰ (7.8–8.2) in 2010 and then decreased to 5.3‰ (5.1–5.5) in 2013. This reduction was mainly related to DPP‐4 inhibitors, whose use as add‐on/switch NIGLDs was roughly halved between 2010 and 2013. Concomitantly, the use of sulfonylureas and glinides increased. In conclusion, after reaching a peak in 2010, the incidence of use of NIGLDs has markedly decreased in France. Since then, prescribers seem to have reverted to older and well‐known therapies.     

Drug utilization of oral hypoglycemic agents in a university teaching hospital in India

Background: India has witnessed a rapidly exploding epidemic of diabetes in recent years and currently leads the world with the largest number of diabetic subjects in a single country. World Health Organization estimates that in 2000, 31·7 million individuals were affected by diabetes in India and these numbers will rise to 79·4 millions by the year 2030. In view of the above situation, drug utilization review of antidiabetic medicines in Indian healthcare settings has a valid significance to promote rational drug use in diabetics. Objective: The present study is aimed to determine the drug utilization patterns in type 2 diabetic patients on oral hypoglycemic agents in the Medicine Outpatient Department (OPD) and Inpatient Department (IPD) of Majeedia Hospital, a teaching hospital of Hamdard University, New Delhi. Methods: Patients with established type 2 diabetes (n = 218) visiting the OPD and IPD were interviewed using a structured questionnaire during the period January–May 2006. Results:  A majority of the type 2 diabetic patients in this setting were treated with multiple antidiabetic drug therapy. The most commonly prescribed antidiabetic drug class was biguanides (metformin) followed by sulphonylureas (glimepiride), thiazolidinediones (pioglitazone), insulin and alpha‐glucosidase inhibitors (miglitol). As monotherapy insulin was the most common choice followed by metformin. The most prevalent multiple therapy was a three‐drug combination of glimepiride + metformin + pioglitazone. More than half of the type 2 diabetic patients showed poor adherence (compliance) to the prescribed therapy. Conclusion: This study strongly highlights the need for patient education or counselling on use of antidiabetic and concomitant drugs, monitoring of blood glucose and glycosylated haemoglobin (HbA1c) levels, diet control, and correction of diabetic complications. Metabolic control was poor and HbA1c monitoring was underutilized. Clinical monitoring of patients’ adherence to prescribed treatments is recommended and measures should be taken to improve it.     

Role of follow-on drugs and indications on the WHO Essential Drug List

Introduction: The World Health Organization's Essential Drug List (EDL) contains first‐in‐class drugs and subsequent class entrants (follow‐on drugs) deemed necessary to combat diseases prevalent throughout the world, with a special emphasis on developing nations. The EDL also includes originally approved and follow‐on indications. There are opposing views regarding the value of follow‐on drugs and indications. Critics suggest many follow‐on drugs and indications offer little or no benefit to patients. Advocates counter that follow‐on drugs offer advantages in terms of improved effectiveness, compliance and patient satisfaction. Objective: In order to inform this debate on the value of follow‐on drugs and indications we examined the numbers of follow‐on drugs on the EDL and the extent to which follow‐on indications are recommended. Methods: We identified all 312 drugs on the 14th edition of the EDL, omitting 72 non‐pharmaceutical entities. For the 240 pharmaceutical entities we ascertained whether the Food and Drug Administration (FDA) had approved them, and, if so, when each was approved. We chose a validated therapeutic classification system – the United States Pharmacopeia's Model Guidelines for Medicare formulary management – in order to distinguish first‐in‐class and follow‐on drugs on the EDL. Specifically, we selected the formulary key drug type as our benchmark therapeutic class. We assigned each EDL drug to a formulary key drug type. We defined first‐in‐class drugs as the first in each formulary key drug type, and follow‐on drugs as all other drugs in each formulary key drug type. We identified follow‐on indications by comparing WHO‐listed indications with the original approved indication(s) by the FDA. Finally, we examined the therapeutic rating (priority vs. standard) given by the FDA to follow‐on drugs on the EDL. Results: Sixty‐three per cent of the EDL drugs were follow‐ons; 15% of the indications were follow‐on indications. Fourteen drugs were listed in multiple WHO (sub) groupings; and 49% of follow‐on drugs were given a priority rating by the FDA. Conclusions: In light of the fact that the EDL only includes drugs and indications deemed essential, the large number of follow‐on drugs, follow‐on indications, and priority‐rated follow‐on drugs on the EDL suggest their importance. From a public policy perspective, it may prove counterproductive to erect hurdles that impede follow‐on research and development.     

Clinical pharmacology and therapeutic use of the new antiepileptic drugs

Although older generation antiepileptic drugs (AEDs) such as carbamazepine, phenytoin and valproic acid continue to be widely used in the treatment of epilepsy, these drugs have important shortcomings such as a highly variable and nonlinear pharmacokinetics, a narrow therapeutic index, suboptimal response rates, and a propensity to cause significant adverse effects and drug interactions. In an attempt to overcome these problems, a new generation of AEDs has been introduced in the last decade. Compared with older agents, some of these drugs offer appreciable advantages in terms of less variable kinetics and, particularly in the case of gabapentin, levetiracetam and vigabatrin, a lower interaction potential. Lamotrigine, topiramate, zonisamide and felbamate protect against partial seizures and a variety of generalized seizure types, vigabatrin is effective against partial seizures (with or without secondary generalization) and infantile spasms, while the use of oxcarbazepine, tiagabine and gabapentin is mainly restricted to patients with partial epilepsy (and, in the case of oxcarbazepine, also primarily generalized tonic-clonic seizures). Levetiracetam, the latest AED to be introduced, has been found to be effective in partial seizures, but its potentially broader efficacy spectrum remains to be determined in clinical studies. Currently, the main use of new generation AEDs is in the adjunctive therapy of patients refractory to older agents. However, due to advantages in terms of tolerability and ease of use, some of these drugs are increasingly used for first-line management in certain subgroups of patients. Due to serious toxicity risks, felbamate and vigabatrin should be prescribed only in patients refractory to other drugs. In the case of vigabatrin, however, first line use may be justified in infants with spasms.     

Over-the-counter oral nonsteroidal anti-inflammatory drugs: A pharmacoepidemiologic study in southern Italy

The Pharmacoepidemiologic Service of the Second University of Naples analyzed the use and tolerability of over-the-counter (OTC) oral nonsteroidal antiinflammatory drugs (NSAIDs) purchased in Campania, a region of southern Italy. Forty private pharmacies uniformly distributed throughout the region were recruited. The study was conducted by means of a questionnaire completed by purchasers and lasted from December 1, 1999 to March 31, 2000; 2053 questionnaires were collected. The age of respondents averaged 45.3 ± 3.49 years (range, 17–85 years). The NSAIDs analyzed were acetylsalicylic acid, paracetamol, ibuprofen, ketoprofen, diclofenac, and piroxicam. Adverse effects, mainly gastrointestinal symptoms, were reported by 5.5% of the users and occurred primarily with diclofenac, piroxicam, ibuprofen, and ketoprofen. Because the use and availability of OTC NSAIDs are increasing, further studies of the tolerability of this important drug class are warranted.     

Use of antibacterial agents in Italian hospitals: a 2004 to 2011 drug utilization survey in the Emilia-Romagna region

To assess 8-year antibiotic consumption and expenditure in all of the hospitals of Emilia Romagna. The analysis was based on the pharmacy records of each hospital. Antibiotic drug consumption was expressed as DDDs per 100 bed-days used (BDU) and data were analyzed according to ATC classification and to single wards. Expenditure was expressed as Euros per 100 BDU. In the 8-years considered, overall consumption increased by 27% and expenditure by only 3%. Consumption was higher in surgical wards than in medical ones. Penicillins and β-lactamase inhibitors ranked first, followed by fluoroquinolones and third generation cephalosporins. The results of the study strongly suggest that antibiotic use could be improved by educational interventions to improve clinical practice in hospitals, assessments of guidelines and monitoring of the outcomes of the interventions are needed.     

Drug interactions between antihypertensive drugs and non‐steroidal anti‐inflammatory agents: a descriptive study using the French Pharmacovigilance database

Drug–drug interactions (DDIs) between antihypertensive drugs and non‐steroidal anti‐inflammatory drugs (NSAIDs) can lead to adverse drug reactions (ADRs). Guidelines are available to help prescribers deal with these drug associations, but their implementation is not well evaluated. The aims of this study were to assess the prevalence of NSAIDs exposure in patients treated with antihypertensive drugs, using the French Pharmacovigilance database, and explore the ADRs related to DDIs between antihypertensive drugs and NSAIDs. Over the 11, 442 notifications of ADRs recorded in this database in patients treated with oral antihypertensive drugs between 2008 and 2010, 517 (4.5 and 95% CI: 4.1–4.9) also included exposure to NSAIDs. These subjects were more frequently women, took more drugs in general, and were younger and less frequently treated with antiplatelet drugs. In 24.2% of them (125 patients), a DDI between NSAIDs and antihypertensive drugs was potentially the cause of the reported ADR. Acute renal failure caused by DDIs between NSAIDs and angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or diuretics was the most frequently reported ADR (20.7%). Finally, in the French Pharmacovigilance database, around one‐fourth of associations NSAIDs  +  antihypertensive drugs are associated with a ‘serious’ ADR (mainly acute renal failure), suggesting that this well‐known DDI is not enough taken into account by prescribers.     

Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study

Introduction: People who inject drugs (PWID) are highly exposed to drug-dealing networks. In Colombia, a recent dramatic increase in drug consumption has been reported. However, involvement of PWID in drug dealing, their demographics, and drug using behaviors has not been studied. Methods: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted in 2014. Correlates of demographic characteristics, drug dealing, and injection behaviors were examined by multivariate analysis, and a binary logistic regression model. Results: Drug-dealing PWID were predominantly male (86%) with a mean age of 26 years. 56% of participants—of whom 64% had low familial socioeconomic status—had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher daily injection rate (AOR: 1.3), higher odds of injection equipment confiscation by the police (AOR: 1.4), and were less likely to pay for the drugs they injected (AOR: 0.6). Conclusions: Involvement of Colombian PWID in drug dealing was higher than previously reported, and drug-dealing PWID presented sociodemographic vulnerabilities and risky injection practices. Addressing these findings may lead to effective policy design and implementation, decreased drug-dealing involvement, harm reduction, and consumption prevention.     

Awareness,perception and utilization of a mobile health clinic by people who use drugs

IntroductionPeople who use drugs (PWUD) face a multitude of barriers to accessing healthcare and other services. Mobile health clinics (MHC) are an innovative, cost-effective health care delivery approach that increases healthcare access to vulnerable populations and medically underserved areas. There is limited understanding, however, of how PWUD perceive and experience MHCs.MethodsSemi-structured interviews were conducted with 31 PWUD – 16 who had received care (clients) on an MHC (The Spot) and 15 who had not (non-clients) – to explore their perceptions and utilization of an MHC partnered with a mobile syringe services program in Baltimore, Maryland. Data analysis of the text was conducted using an iterative thematic constant comparison process informed by grounded theory.ResultsClients and non-clients, once aware of the MHC, had positive perceptions of The Spot and its benefits for their individual health as well as for the wellbeing of their community. These sentiments among clients were largely driven by access to low-barrier buprenorphine and service delivery without stigma around drug use. However, lack of general awareness of the spot and specific service offering were barriers to its use among non-clients.DiscussionMHCs provide an important opportunity to engage PWUD in healthcare and to expand buprenorphine use; however, even with accessibility near where PWUD access injection equipment, barriers to its use remain. Peer dissemination may be able to facilitate program information sharing and recruitment.

KEY MESSAGES

• People who use drugs perceive a mobile health clinic in their neighbourhood as a benefit to their communities and themselves by improving access to healthcare services, providing access to low-threshold buprenorphine dispensation, and offering services without drug use stigma.
• People who use drugs learned about a mobile health clinic in their neighbourhood largely through word-of-mouth. As a result, people received limited information about the mobile health clinic services creating a barrier to its use.

     

Drug abuse in chronic headache: a clinico-epidemiologic study

Among the patients referred to the Headache Centre in Parma between 1979 and 1984, 95 (5%) were found to be drug abusers, having taken analgesics every day for at least a year. They had had chronic headache for at least 12 months: migraine with interparoxysmal headache in 83.1% and chronic tension headache in 16.9%. Almost all patients were combination-analgesics abusers, and only about a quarter of them were taking ergotamine. The largest single factor favouring the transformation of episodic headache into a chronic one was the drug abuse. The patients studied during 1984 were subjected to detoxification with 6 months' follow-up study. Our investigation suggests that all instant-relief drugs can sustain and possibly initiate a chronic headache.     

抗高血压药物门诊处方用药分析

目的：了解门诊抗高血压药的使用情况,分析门诊处方中抗高血压药物之间的联合用药规律,促进高血压药物的合理应用,更好地选择用药方案。方法：随机抽查山西省煤炭中心医院2010年10月的门诊处方4589张,筛查出抗高血压药物处方305张,按不同年龄段分组。统计患者总用药量及用药天数,将不同降压药按用药频度（DDDs）排序计算药物利用指数（DUD值,根据《中国高血压指南》、《新编药物学》（第15版）的相关标准分析抗高血压药使用的合理性。结果：经过筛查,抗高血压药处方中男性159张（52．1％）,女性146张（47．9％）;随着年龄的增高,降压药处方有增加的趋势,降压药处方最多的年龄段为71岁以上。用药频度最高的为氢氯噻嗪;联合用药以血管紧张素转换酶抑制剂＋钙拮抗药;钙拮抗药＋复方制剂（厄贝沙坦／氢氯噻嗪）最多,血管紧张素转换酶抑制剂＋钙拮抗药有15张,占联合用药处方的19．7％。结论：抗高血压药物使用基本合理。