Rise of escitalopram and the fall of citalopram.
Rise of escitalopram and the fall of citalopram.
复制标题
艾司西酞普兰的崛起和西酞普兰的衰落。
DOI：
10.1101/2023.05.07.23289632
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Piper,BrianJ
中科院分区：
文献类型：
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作者：
Cavanah,LukeR;Ray,Parita;Goldhirsh,JessicaL;Huey,LeightonY;Piper,BrianJ
西酞普兰和艾司西酞普兰是最常用的药物之一，是许多精神疾病的关键治疗方法。先前的研究结果表明，西酞普兰和艾司西酞普兰的处方率正在发生变化，因为西酞普兰的专利到期，而不是证据表明其具有明显的治疗优势，即常绿效应。这项回顾性研究的重点是描述美国医疗补助和医疗保险患者使用西酞普兰和艾司西酞普兰的时间和地理差异。我们假设西酞普兰的处方率会随着艾司西酞普兰的增加而降低，这与常绿疗法一致。方法从医疗补助州药物使用数据库和医疗保险提供者使用和支付数据中获取西酞普兰和艾司西酞普兰处方率和各州费用。超过95%置信区间的年处方率被认为与平均值有显著差异。结果总体而言，在医疗保险和医疗补助患者中，西酞普兰处方率呈下降趋势，而艾司西酞普兰处方率呈上升趋势。两种药物的成本差异都被注意到，仿制药比品牌药便宜。尽管有限的证据表明西酞普兰和艾司西酞普兰在治疗或不良反应方面有任何有意义的差异，但西酞普兰的使用明显下降，同时艾司西酞普兰的处方增加，这与我们的假设一致。此外，在这些一般的药物流行病学趋势中存在显著的地理差异。与仿制药相比，这些药物的品牌版本的支出（相对于它们的使用）不成比例。
IntroductionCitalopram and escitalopram are among the most used medications and are key treatments for many psychiatric disorders. Previous findings suggest citalopram and escitalopram prescription rates are changing because of the patent for citalopram ending as opposed to evidence of a clear therapeutic advantage, which is called evergreening. This retrospective study focuses on characterizing the chronologic and geographic variation in the use of citalopram and escitalopram among US Medicaid and Medicare patients. We hypothesized that prescription rates of citalopram will decrease with a concurrent increase in escitalopram, consistent with evergreening.MethodsCitalopram and escitalopram prescription rates and costs per state were obtained from the Medicaid State Drug Utilization Database and Medicare Provider Utilization and Payment Data. Annual prescription rates outside a 95% confidence interval were considered significantly different from the average.ResultsOverall, a decreasing trend for citalopram and an increasing trend for escitalopram prescription rates were noted in both Medicare and Medicaid patients. Cost differences between generic and brand were noted for both drugs, with generic forms being cheaper compared to the brand-name version.DiscussionDespite limited evidence suggesting that citalopram and escitalopram have any meaningful differences in therapeutic or adverse effects, there exists a noticeable decline in the use of citalopram that cooccurred with an increase in escitalopram prescribing, consistent with our hypothesis. Moreover, among these general pharmacoepidemiologic trends exists significant geographic variability. There was disproportionate spending (relative to their use) on the brand versions of these medicines compared to their generic forms.