Suboptimal Treatment of Diabetic Peripheral Neuropathic Pain in the United States
Suboptimal Treatment of Diabetic Peripheral Neuropathic Pain in the United States
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DOI：
10.1111/pme.12845
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发表时间：
2015-11-01
期刊：
影响因子：
3.1
通讯作者：
Liu, Yifei
中科院分区：
文献类型：
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作者：
Yang, Mei;Qian, Chunlin;Liu, Yifei
Objective.大约三分之一的糖尿病周围神经病变（DPN）患者还经历神经性疼痛，导致显著的医疗保健负担和生活质量降低。普瑞巴林、度洛沙坦和他喷他多缓释剂被批准用于治疗糖尿病周围神经性疼痛（DPNP），但许多其他药物通常被“标签外”使用，并取得了不同程度的成功。我们研究了美国的健康保险索赔，以确定目前的DPNP治疗模式。这项回顾性分析使用MarketScan索赔数据库来识别在索引前和索引后连续12个月登记健康计划的成年人，这些成年人在2006年至2011年期间最初被诊断为DPN，并提供了据报道对治疗DPNP有益的药物处方（抗惊厥药，抗抑郁药，阿片类药物或局部药物）。我们评估了首次诊断后1年内分发药物的频率和类型、治疗依从性和治疗改变的模式。总体而言，12，074例患者符合入选标准，66.6%的患者开始使用抗惊厥药（加巴喷丁45.0%;普瑞巴林21.6%），5.2%的患者开始使用度洛沙坦。患者通常接受的处方药物剂量低于推荐剂量，并且所有治疗的依从性均不理想。据估计，高达50%的患者在开始治疗后3个月内停止了他们的初始治疗。新诊断的DPNP患者最常使用抗惊厥药。许多患者接受的剂量低于推荐剂量，可能会导致不良结果。初始治疗经常中断，表明满意度低和/或耐受性差。DPNP迫切需要具有改善的疗效和更好的耐受性的新疗法。
Objective. Approximately one third of patients with diabetic peripheral neuropathy (DPN) also experience neuropathic pain, resulting in a significant health care burden, and reduced quality of life. Pregabalin, duloxetine, and tapentadol extended-release are approved for treating diabetic peripheral neuropathic pain (DPNP), but many other medications are commonly used "off-label" with various degrees of success. We examined US health insurance claims to determine the current DPNP treatment patterns.Methods. This retrospective analysis used the MarketScan claims database to identify adults with continuous health plan enrollment for 12 months pre-and postindex who were initially diagnosed with DPN between 2006 and 2011 and were provided a prescription for a medication reported to be beneficial for treating DPNP (anticonvulsants, antidepressants, opioids, or topical agents). We evaluated the frequency and types of medication dispensed within 1 year after first diagnosis, treatment adherence, and patterns of treatment alteration.Results. Overall, 12,074 patients met inclusion criteria, with 66.6% initiating an anticonvulsant (gabapentin 45.0%; pregabalin 21.6%), and 5.2% initiating duloxetine. Patients commonly received less than the recommended dose of prescribed medication, and adherence was suboptimal for all treatments. It is estimated that up to 50% of patients discontinued their initial treatment within 3 months of initiation.Conclusions. Newly diagnosed patients with DPNP are most commonly prescribed anticonvulsants. Many patients receive lower than recommended dosages, potentially resulting in poor outcomes. Initial treatments are frequently discontinued, indicating low levels of satisfaction and/or poor tolerability. New therapies with improved efficacy and better tolerability are urgently needed for DPNP.