Rapport 22-09. Perception du risque médicamenteux par le public et rôle des médias

International audienc

Determinants of coprescription of anxiolytics with antidepressants in general practice

International audienceOBJECTIVES: Anxiolytics are the most frequently prescribed psychotropic drugs in France. General practitioners (GPs) tend to prescribe anxiolytics and other benzodiazepines to patients with major depressive disorders (MDD). However, the extent to and reasons for which they prescribe these medications together are not well documented. This article assesses how often and why GPs coprescribe an anxiolytic when starting patients on antidepressant (AD) treatment, and which patient- and GP-related factors are associated with this coprescription. METHODS: We used a survey of 131 GPs practising in southeastern France and of patients seen consecutively during June to October 2004 to whom they prescribed an AD. Data were collected from GPs (consultation-questionnaires focusing on their prescription, diagnosis, and symptom detection) and patients (self-administered questionnaires, including the Hospital Anxiety and Depression scale, and social and demographic characteristics). Factors associated with anxiolytic coprescription were analyzed with a multilevel logistic regression. RESULTS: GPs completed 438 consultation-questionnaires for patients; 258 patients (58.9%) returned their questionnaires. Sixty percent of the patients received anxiolytics with ADs. Anxiolytics were prescribed more frequently by male GPs who reported feeling ill at ease treating MDD, or detected suicidal ideation or anxiety in their patients, and finally to patients with stable jobs. CONCLUSIONS: Although some practice guidelines and authors acknowledge that there might be some justification for coprescribing anxiolytics with ADs at the beginning of MDD treatment in specific situations, the high percentage of coprescriptions for anxiolytics observed in our study suggests that training and knowledge of GPs about MDD treatment are not optimal

Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach

Methods: An exhaustive systematic search was performed. Inclusion criteria were: RCT or controlled study, duration of 5 days at least, inactive control, assessment of minor or major NSAID adverse effects, publication range January 1985 to January 2003. The publications retrieved were assessed during a specifically dedicated WHO meeting including leading experts in all related fields. Statistics were performed conservatively. Meta-regression was performed by regressing NSAID adjusted estimates against study duration categories. Results: Among RCT data, indolic derivates provided a significantly higher risk of GI complications related to NSAID use than for non-users: RR = 2.25 (1.00; 5.08) than did other compounds: naproxen: RR = 1.83 (1.25; 2.68); diclofenac: RR = 1.73 (1.21; 2.46); piroxicam: RR = 1.66 (1.14; 2.44); tenoxicam: RR = 1.43 (0.40; 5.14); meloxicam: RR = 1.24 (0.98; 1.56), and ibuprofen: RR = 1.19 (0.93; 1.54). Indometacin users had a maximum relative risk for complication at 14 days. The other compounds presented a better profile, with a maximum risk at 50 days. Significant additional risk factors included age, dose, and underlying disease. The controlled cohort studies provided higher estimates: RR = 2.22 (1.7; 2.9). Publication bias testing was significant, towards a selective publication of deleterious effects of NSAIDs from small sized studies. Conclusion: This meta-analysis characterised the "compound" and "time" aspects of the GI toxicity of non-selective NSAIDs. The risk/benefit ratio of such compounds should thus be carefully and individually evaluated at the start of long term treatment

Adherence to treatment of osteoporosis: a need for study

Adherence to anti-osteoporosis medications is currently low and is associated with poor anti-fracture efficacy. This manuscript reviews the potential design of clinical studies that aim to demonstrate improved adherence, with new chemical entities to be used in the management of osteoporosis. Introduction Several medications have been unequivocally shown to decrease fracture rates in clinical trials. However, in real life settings, long-term persistence and compliance to anti-osteoporosis medication is poor, hence decreasing the clinical benefits for patients. Methods An extensive search of Medline from 1985 to 2006 retrieved all trials including the keywords osteoporosis, compliance, persistence or adherence followed by a critical appraisal of the data obtained through a consensus expert meeting. Results The impact of non-adherence on the clinical development of interventions is reviewed, so that clinicians, regulatory agencies and reimbursement agencies might be better informed of the problem, in order to stimulate the necessary research to document adherence. Conclusion Adherence to therapy is a major problem in the treatment of osteoporosis. Both patients and medication factors are involved. Adherence studies are an important aspect of outcomes studies, but study methodologies are not well developed at the moment and should be improved. Performing adherence studies will be stimulated when registration authorities accept the result of these studies and include the relevant information in Sect. 5.1 of the summary of product characteristics. Reimbursement authorities might also consider such studies as important information for decisions on reimbursement