Utilization Patterns of Skeletal Muscle Relaxants Among Commercially Insured Adults in the United States from 2006 to 2018
Utilization Patterns of Skeletal Muscle Relaxants Among Commercially Insured Adults in the United States from 2006 to 2018
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DOI：
10.1093/pm/pnab088
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发表时间：
2021-03-04
期刊：
影响因子：
3.1
通讯作者：
Winterstein, Almut G.
中科院分区：
文献类型：
--
作者：
Li, Yan;Delcher, Chris;Winterstein, Almut G.
客观的。旨在调查美国有商业保险的成年人中骨骼肌松弛剂 (SMR) 治疗的患病率和持续时间。方法。我们使用 MarketScan 研究数据库来识别 2005 年至 2018 年间连续入组≥2 年的 18 至 64 岁成年人队列。我们使用重复横断面设计估计了 SMR 治疗的流行率，并使用 Kaplan-Meier 方法得出治疗持续时间。分析按年龄组、性别、地理区域、个体 SMR 药物和肌肉骨骼疾病进行分层。结果。 4870 万人被纳入其中。治疗率范围为每 1,000 人 61.5 至 68.3。大约三分之一的用户之前没有被诊断出肌肉骨骼疾病。环苯扎林是主要药物，占处方量的 50% 以上。巴氯芬、替扎尼定和美索巴莫的使用量大幅增长，而卡立普多和美他沙酮的使用量却下降。南方地区发病率最高，东北地区发病率最低。中位治疗持续时间为 14 天，其中分别有 4.0%、1.9% 和 1.0% 的个体使用 SMR 超过 90 天、180 天和 365 天。与环苯扎林相比，开始使用巴氯芬、替扎尼定和卡立普多的患者的治疗持续时间更长。结论。 SMR在美国广泛使用。近年来，它们的使用略有增加，但不同药物、患者群体和地理区域之间的趋势有所不同。尽管支持疗效的证据有限，但仍有相当多的美国成年人在长期和标签外情况下使用 SMR。需要进一步研究以了解治疗的决定因素以及与此类使用相关的结果。
Objective. To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults in the United States. Methods. We used the MarketScan Research Database to identify a cohort of adults 18 to 64years who had >= 2-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder. Results. 48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1,000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for >50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365days, respectively. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration. Conclusions. SMRs are widely used in the United States. Their use slightly increased in recent years, but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.