Taux de pénétration des génériques de la buprénorphine haut dosage : principales tendances de 2006 à 2008

Objectif. Évaluer le taux de pénétration national (TP) des génériques (GNR) de la buprénorphine haut dosage (BHD) en 2008 et son évolution depuis leur commercialisation (2006), tout en faisant un focus par dosage et par région. Méthodes. Étude rétrospective à partir des données nationales et régionales de la base de remboursement de l’Assurance maladie sur trois ans (2006–2008). Résultats. En 2008, le TP des GNR de la BHD était de 31 %. Le TP par dosage était de 45 % pour 0,4 mg, 36 % pour 2 mg et 19 % pour 8 mg. Le TP ajusté sur la daily defined dose (DDD) était de 23 % en 2008, 11 % en 2007 et 4 % en 2006. En 2008, au niveau régional, le TP ajusté varie de 15 % en Île de France à 39 % en Champagne Ardennes Lorraine. Conclusion. Le TP des GNR de la BHD a augmenté. Il existe des disparités régionales et des différences selon les dosages. Néanmoins, ce TP reste bas par rapport à celui des autres molécules génériquées (82 %)

Consommation d’antipsychotiques chez les sujets atteints de maladie d’Alzheimer et maladies apparentées de la cohorte PACA-Alz 2010

Objectifs. Notre étude identifie et caractérise les patients atteints de la maladie d’Alzheimer et maladies apparentées (MAMA) en décrivant leur exposition aux antipsychotiques et aux autres médicaments psychotropes. Méthodes. Cette étude a été réalisée en 2010 à partir de la cohorte Paca-Alz constituée de patients atteints de MAMA, bénéficiant d’une affection de longue durée (ALD) 15 et/ou ayant eu au moins une délivrance de traitement spécifique anti-Alzheimer et affiliés au régime général de l’Assurance maladie de la région Provence-Alpes-Côte d’Azur (PACA)-Corse. Les psychotropes ont été identifiés par leur code anatomique thérapeutique et chimique (ATC). Une consommation chronique d’antipsychotiques a été définie par plus de 3 remboursements consécutifs. Résultats. En 2010, parmi les 34 696 patients inclus, 26,9 % étaient des hommes et 69 % avaient 80 ans et plus. Parmi eux, 26 % ont reçu ≥1 antipsychotique avec 61,3 % de consommation chronique. Cette exposition est en 3e position après les antidépresseurs (47 %) et les anxiolytiques (45,3 %). L’antipsychotique le plus utilisé était la rispéridone (11,2 %). Le recours aux soins (hospitalisations, infirmiers, consultations médicales) était significativement plus important chez les patients sous antipsychotiques. Conclusion. La consommation d’antipsychotiques chez les patients déments reste importante. Le suivi de cette cohorte permettra d’identifier si les pratiques de prescription et de prise en charge s’améliorent avec les successives recommandations

Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database.

INTRODUCTION: Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries. OBJECTIVE: To evaluate the rate of screening and treatment of GIOP. DESIGN: Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011. PATIENTS: We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids. MAIN OUTCOME MEASURES: Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment. RESULTS: We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9-18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty. CONCLUSIONS: The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP

Osteoporosis prevention among chronic glucocorticoid users: results from a public health insurance database

INTRODUCTION: Long-term glucocorticoid therapy is the leading cause of secondary osteoporosis. The management of glucocorticoid-induced osteoporosis (GIOP) seems to be inadequate in many European countries. OBJECTIVE: To evaluate the rate of screening and treatment of GIOP. DESIGN: Information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and in Corsica, from September 2009 through August 2011. PATIENTS: We identified participants aged 15 years and over starting glucocorticoid therapy (≥7.5 mg of prednisone equivalent per day during at least 90 days consecutive). This cohort was compared with an age-matched and sex-matched population that did not receive glucocorticoids. MAIN OUTCOME MEASURES: Bone mass, prescription of bone antiresorptive medication and use of calcium and/or vitamin D treatment. RESULTS: We identified 32 812 patients who were prescribed glucocorticoid therapy, yielding 1% prevalence. Incidence of glucocorticoid therapy was 2.8/1000 inhabitants/year. Males represented 44%, the mean age was 58 years. The median prednisone-equivalent dose was 11 mg/day (IQR 9–18 mg/day). 8% underwent bone mass measurement. Calcium and/or vitamin D, and bisphosphonates were prescribed in 18% and 12%, respectively. Results were lower for the control population: 3% underwent bone mass measurement and 3% received bisphosphonate therapy. The rates of osteodensitometry and treatments were higher in women over 55 years of age than in men and women 55 years of age and younger, and also when glucocorticoid therapy was initiated by a rheumatologist versus other physician specialty. CONCLUSIONS: The management of GIOP remains very inadequate, despite the availability of a statutory health insurance system. Targeted interventions are needed to improve the management of GIOP