Prevalence and prescription patterns of oral glucocorticoids in adults: a retrospective cross-sectional and cohort analysis in France.
Prevalence and prescription patterns of oral glucocorticoids in adults: a retrospective cross-sectional and cohort analysis in France.
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DOI：
10.1136/bmjopen-2017-015905
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发表时间：
2017-07-31
期刊：
影响因子：
2.9
通讯作者：
Noize P
中科院分区：
文献类型：
--
作者：
Bénard-Laribière A;Pariente A;Pambrun E;Bégaud B;Fardet L;Noize P
研究成人口服糖皮质激素（GC）的使用趋势、口服GC启动剂的特点以及预防GC治疗相关潜在不良反应的处方。首先，从2007年到2014年，在全国代表性样本中进行了每年重复的横断面研究。其次，在2007年至2013年期间开始GC治疗的患者队列中，描述了开始治疗后一年GC治疗的发起者和模式的特征。基于人群的研究，使用来自法国报销医疗保健系统（覆盖约90%的人口）的数据，研究对象为年龄≥18岁的患者。在研究期间，口服GC使用的患病率为14.7%至17.1% (95% CI 17.0%-17.2%)，显著增加14.1% （95% CI +13.5%至+14.8%）。2007-2013年口服GC启动者队列包括206759人。口服GC的使用大多是短期的（占唯一报销的68%），超过一半的短期使用者同时服用抗生素或呼吸/耳科药物。慢性使用者（≥6次/年报销）占队列的1.8% （n=3789）。有可能因使用GC而加重合并症（糖尿病、精神障碍、骨质疏松症）的慢性使用者比例为25%。在骨质疏松风险增加的患者中，62%接受了特定的预防/监测措施，只有27%使用了双膦酸盐。一半的慢性口服GC使用者在没有使用非甾体抗炎药的情况下同时报销质子泵抑制剂。从2007年到2014年，口服GC的使用在成年人中非常普遍且有所增加。压倒性的短期使用可能主要涉及越来越多地使用不合理的处方，而不是具有有利的效益/风险比的情况。对于慢性使用者，我们的研究结果呼吁开发干预措施，以改善对常见合并症风险和不适当的预防性治疗措施处方的监测。
To study trends in use of oral glucocorticoids (GCs) among adults, characteristics of oral GC initiators and prescriptions for the prevention of potential adverse effects associated with GC therapy. First, a cross-sectional study repeated yearly was performed from 2007 to 2014 in a nationwide representative sample. Second, characteristics of initiators and patterns of GC therapy during the year following treatment initiation were described in a cohort of patients who began GC between 2007 and 2013. Population-based study using data from the French reimbursement healthcare system (covering approximately 90% of the population) in patients aged ≥18 years. Over the study period, the prevalence of oral GC use ranged from 14.7% to 17.1% (95% CI 17.0%–17.2%) with a significant increase of 14.1% (95% CI +13.5% to +14.8%). The 2007–2013 cohort of oral GC initiators comprised 206 759 individuals. Oral GC use was mostly short-term (68% of unique reimbursement) and more than half of short-term users took concurrent antibiotics or respiratory/otological drugs. Chronic users (≥6 reimbursements/year) represented 1.8% (n=3789) of the cohort. The proportion of chronic users with comorbidities likely to be worsened by GC use (diabetes, psychotic disorders, osteoporosis) was 25%. Among patients at increased risk of osteoporosis, 62% received specific prevention/monitoring measures and only 27% had a bisphosphonate. Half of chronic oral GC users had a concurrent reimbursement of a proton pump inhibitor in the absence of non-steroidal anti-inflammatory drug use. Oral GC use was highly widespread and increased among adults from 2007 to 2014. The overwhelming short-term use could mainly concern a growing use of unjustified prescriptions rather than situations with a favourable benefit/risk ratio. For chronic users, our findings plead for the development of interventions designed to improve monitoring with regard to the frequent comorbidities at risk and inappropriate prescribing of preventive therapeutic measures.
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影响因子：
6.2
作者：
Trijau S;de Lamotte G;Pradel V;Natali F;Allaria-Lapierre V;Coudert H;Pham T;Sciortino V;Lafforgue P
通讯作者：
Lafforgue P
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作者：
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Gudjonsson, FV
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作者：
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5.5
作者：
Fardet, Laurence;Petersen, Irene;Nazareth, Irwin
通讯作者：
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影响因子：
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作者：
Walsh, LJ;Wong, CA;Tattersfield, AE
通讯作者：
Tattersfield, AE