Influence of combinations of drugs that act on the CYP2D6 metabolic pathway in the treatment of major depressive disorder: a population-based study.

OBJECTIVE: To describe the frequency of drug combinations (substrate-substrate or substrate-inhibitor) with the potential to interfere with the CYP2D6 metabolic pathway in patients receiving antidepressant medication for major depressive disorder. METHODS: We carried out an observational study using outpatient medical records. We included adult subjects who initiated antidepressant medication during 2008-2010. Patients were assigned to three study groups: no combination, substrate-substrate, and substrate-inhibitor. Follow-up period was 12 months. MAIN MEASURES: demographics, comorbidity and medication persistence. Statistical analysis included a logistic regression model, P<0.05. RESULTS: Five thousand six hundred and thirty patients were recruited (61.9 years, 76.9% female), 24.4% (CI: 23.8 - 26.0%) received some kind of drug combination (substrate-substrate: 15.4%, substrate-inhibitor: 9.0%). Variables significantly associated with drugs combinations that may act on the CYP2D6 metabolic pathway were: dementia (OR=4.2), neuropathy (OR=4.2) and stroke (OR=1.9), P<0.001. Medication persistence at 12 months was longer in patients with no combination (55.3%) than in patients receiving substrate-substrate (50.5%) or substrate-inhibitor (45.0%) combinations, P<0.001. CONCLUSIONS: Twenty-five percent of major depressive disorder patients received a combination of drugs with the potential to interfere with CYP2D6 metabolic pathway. These combinations increased with comorbidity and resulted in shorter medication persistence of antidepressant treatment.

C-reactive protein as a marker of cardiovascular disease in patients with a schizophrenia spectrum disorder treated in routine medical practice.

OBJECTIVE: Interest in cardiovascular diseases (CVD) in schizophrenia has grown recently due to documented incremental mortality. C-reactive protein (CRP) has been assessed as a marker in individuals with CVD and/or at high risk of developing it. However, its role in schizophrenia patients is unknown. The goal of this research was thus to explore the use of CRP as a marker of CVD risk in patients with schizophrenia. METHODS: A cross-sectional analysis of the Badalona Serveis Assistencials (BSA) administrative claims database was conducted including all subjects aged>18 years with a diagnosis of schizophrenia spectrum disorder. CRP measurement, sociodemographics, medical history, 10-year CVD risk (Framingham function) and clinical chemistry data were extracted for analysis. RESULTS: Seven hundred and five patients (53.0% men, 48.2 [15.8] years, 78.7% on atypicals) met criteria for analysis. Mean 10-year CVD risk was high; 11.9±5.7% and mean CRP levels were 2.6±2.5 mg/L with 30.4% showing above-normative levels (>3 mg/L). After adjusting for age, gender, smoking and presence of neoplasm or inflammatory diseases, CRP was linearly associated with 10-year CVD risk stratified by risk (low, moderate, high/very high): respectively, 2.3 (95% CI: 2.1-2.5), 3.1 (2.6-3.5) and 3.7 (3.2-4.1) mg/L; F=13.5, P<0.001. Patients with known CVD also showed higher CRP levels: 3.7 (2.9-4.5) vs. 2.5 (2.4-2.7) mg/L, P=0.008; and higher probability of above-normal values; odds ratio=4.71 (2.01-11.04), P<0.001. CONCLUSIONS: High CRP levels above normative were associated with both known CVD and high/very high 10-year risk of a CVD event in patients with schizophrenia, suggesting CRP could be a marker of CVD in this psychiatric disorder.

Morbilidad y costes asociados al síndrome depresivo en sujetos con ictus en un ámbito poblacional / Morbidity and costs associated with depressive syndrome in stroke sufferers in a population

Objetivo: Medir la morbilidad y los costes asociados al síndrome depresivo (SD) en sujetos con ictus en población atendida por equipos de atención primaria y en condiciones de práctica clínica habitual. Método: Estudio transversal de carácter retrospectivo. Se incluyeron pacientes adultos con presencia de ictus y de SD atendidos por 5 equipos de atención primaria durante el año 2006. Se formó una cohorte comparativa con el resto de pacientes sin SD. Las principales medidas fueron: edad, sexo, historial/comorbilidad, índice de Charlson, parámetros clínicos y costes totales (visitas, pruebas complementarias, derivaciones y medicamentos). Se efectuó un análisis de regresión logística y de ANCOVA para la corrección de los modelos. Resultados: El total de pacientes atendidos con ictus fue de 2.566. Un 17,7% (intervalo de confianza del 95%, 16,2-19,2%) se identificaron con SD; promedio de edad: 69,5 años (desviación estándar: 12,6); el 57,2% eran mujeres. En la corrección del modelo, el sexo femenino (odds ratio [OR]: 2,1), la obesidad (OR: 1,1) y las neuropatías (OR: 2,2) se asociaron significativamente al SD en sujetos con ictus. Los costes totales ajustados del SD fueron superiores en la mayoría de sus componentes, 2.037,55 frente a 1.498,24 ¿, p < 0,001. El 73,4% de los costes se derivó de los medicamentos. Conclusiones: La prevalencia del SD en sujetos con ictus es elevada, se asocia al sexo femenino y a la presencia de obesidad y neuropatías. Los costes de estos pacientes son altos y ocasionan un elevado consumo de recursos sanitarios (AU)

Objective: To measure morbidity and the associated costs of depressive disorders (DD) in subjects who have had a stroke in a population treated by primary care settings under usual clinical practice conditions. Method: Cross-sectional, retrospective studies. Adult stroke patients with DD were included in the study, and treated by five primary care settings (PCS) during 2006. A comparative group was formed with the rest of non-DD patients. The main measurements taken were: age, sex, history/co-morbidity, Charlson index, clinical parameters and corresponding outpatient costs; drugs, diagnostic tests, referrals and visits. Multiple logistic regression analysis and ANCOVA were used to correct the models. Results: A total of 2,566 stroke patients were assessed. 17.7% (95% CI, 16.2-19.2%) were identified as having DD; average age: 69.5 years (12.6); 57.2% of those were female. In the correction of the model, females (OR: 2.1), obesity (OR: 1.1) and neuropathy (OR: 2.2), were significantly associated with DD in stroke patients. The adjusted total costs of DD were higher in most components, ¿ 2,037.55 versus ¿ 1,498.24, p < 0.001. 73.4% of the total cost was drugs-derived. Conclusions: Prevalence of DD was higher in stroke patients, and was more associated with females, obesity and neuropathy. The patient cost is high and patients use more health resources (AU)

Asociación entre el uso de fármacos antipsicóticos y las alteraciones metabólicas en población adulta española / Association between the use of antipsychotic drugs and the metabolic disorders in a Spanish adult population setting

No disponible

[Impact of the obesity on the use of antipsychotic drugs in adult population attended in several primary care centers]. / Impacto de la obesidad en la utilizaciónde fármacos antipsicóticos en población adulta atendida en varios centros de atención primaria.

INTRODUCTION: We describe the association between the obesity and the use of antipsychotic drug (APD) in patients attended by five primary care teams. METHODS: Multicenter-retrospective design, carried out between July 2004 and June 2005, in patients who consumed APD treatment. A Body Mass Index (BMI) >29 kg/m2 was considered obesity. The main measurements were: consumption of APD, generals (gender and age), comorbidities and clinical parameters. Regression logistic analysis and ANCOVA (Bonferroni-adjustment) were applied to correct the model. RESULTS: From a total of 42,437 attended patients (mean age: 50.9 (SD: 17.8) years; women: 59.9 %; with obesity: 27.3% [confidence interval [CI] of 95 %: 26.9- 27.7]), the 1.3% received APD treatment (typical: 48.8%; atypical: 51.2%; p=not significant). In the logistic-model the obesity was related with the ADP use (odds ratio [OR]: 1.5; CI: 1.3-1.8), hypertension (OR: 2.4; CI:2.2-2.5), diabetes (OR: 1.4; CI: 1.3-1.5) and dyslipidemia (OR: 1.3; CI: 1.2-1.4); p=0,000. The adjusted BMI, in presence of APD, was 27.8 kg/m2 vs. 27.4 kg/m2; p=0,002. CONCLUSIONS: Obesity was associated with the use of APD and with the presence of hypertension, diabetes and dyslipidemia. Differences could not be observed between the use of typical or atypical APD.

Impacto de la obesidad en la utilización de fármacos antipsicóticos en población adulta atendida en varios centros de atención primaria / Impact of the obesity on the use of antipsychotic drugs in adult populationattended in several primary care centers

Introducción. Se describe la asociación de la obesidad con el uso de fármacos antipsicóticos (ATP) en pacientes atendidos por cinco equipos de atención primaria. Métodos. Diseño retrospectivo-multicéntrico realizado entre julio de 2004 y junio de 2005 en pacientes en tratamiento con ATP. Se consideró obesidad un índice de masa corporal (IMC) >29 kg/m2. Las principales mediciones fueron: consumo de ATP, generales (sexo y edad), comorbilidades y parámetros clínicos. Se efectuó un análisis de regresión logística y ANCOVA (ajuste-Bonferroni) para la corrección del modelo. Resultados. De 42.437 pacientes atendidos (promedioedad:50,9 años [DE: 17,8]; mujeres: 59,9 %; con presencia de obesidad el 27,3% [intervalo de confianza [IC] del 95%:26,9-27,7]); un 1,3 % recibían tratamiento ATP (típicos:48,8 %; atípicos: 51,2%; p=no significativo). En el modelo logístico la obesidad se relacionó con el uso de ATP (odds ratio [OR]: 1,5; IC: 1,3-1,8), hipertensión (OR: 2,4; IC: 2,2-2,5), diabetes (OR: 1,4; IC: 1,3-1,5) y dislipidemia (OR: 1,3; IC: 1,2-1,4); p=0,000. El IMC corregido en presencia de ATP fue de 27,8 frente a 27,4 kg/m2; p=0,002.Conclusiones. La obesidad se asoció con el uso de ATP y con la presencia de hipertensión, diabetes y dislipidemia. No se observaron diferencias entre el uso de ATP típicos o atípicos (AU)

Introduction. We describe the association between the obesity and the use of antipsychotic drug (APD) inpatients attended by five primary care teams. Methods. Multicenter-retrospective design, carried out between July 2004 and June 2005, in patients who consumed APD treatment. A Body Mass Index (BMI)>29 kg/m2 was considered obesity. The main measurements were: consumption of APD, generals (gender and age), comorbidities and clinical parameters. Regression logistic analysis and ANCOVA (Bonferroni-adjustment)were applied to correct the model. Results. From a total of 42,437 attended patients (mean age: 50.9 (SD: 17.8) years; women: 59.9 %; with obesity: 27.3% [confidence interval [CI] of 95 %: 26.9-27.7]), the 1.3% received APD treatment (typical: 48.8%;atypical: 51.2%; p=not significant). In the logistic-model the obesity was related with the ADP use (odds ratio [OR]: 1.5; CI: 1.3-1.8), hypertension (OR: 2.4; CI:2.2-2.5),diabetes (OR: 1.4; CI: 1.3-1.5) and dyslipidemia (OR: 1.3;CI: 1.2-1.4); p=0,000. The adjusted BMI, in presence of APD, was 27.8 kg/m2 vs. 27.4 kg/m2; p=0,002.Conclusions. Obesity was associated with the use of APD and with the presence of hypertension, diabetes and dyslipidemia. Differences could not be observed between the use of typical or atypical APD (AU)

[Morbidity and costs associated with depressive syndrome in stroke sufferers in a population]. / Morbilidad y costes asociados al síndrome depresivo en sujetos con ictus en un ámbito poblacional.

OBJECTIVE: To measure morbidity and the associated costs of depressive disorders (DD) in subjects who have had a stroke in a population treated by primary care settings under usual clinical practice conditions. METHOD: Cross-sectional, retrospective studies. Adult stroke patients with DD were included in the study, and treated by five primary care settings (PCS) during 2006. A comparative group was formed with the rest of non-DD patients. The main measurements taken were: age, sex, history/co-morbidity, Charlson index, clinical parameters and corresponding outpatient costs; drugs, diagnostic tests, referrals and visits. Multiple logistic regression analysis and ANCOVA were used to correct the models. RESULTS: A total of 2,566 stroke patients were assessed. 17.7% (95% CI, 16.2-19.2%) were identified as having DD; average age: 69.5 years (12.6); 57.2% of those were female. In the correction of the model, females (OR: 2.1), obesity (OR: 1.1) and neuropathy (OR: 2.2), were significantly associated with DD in stroke patients. The adjusted total costs of DD were higher in most components, euro 2,037.55 versus euro 1,498.24, p < 0.001. 73.4% of the total cost was drugs-derived. CONCLUSIONS: Prevalence of DD was higher in stroke patients, and was more associated with females, obesity and neuropathy. The patient cost is high and patients use more health resources.

[Comorbidity and related costs as a burden in the treatment of outpatients with depressive disorders in a primary care setting]. / Comorbilidad y coste ambulatorio asociado a los pacientes con trastornos depresivos en un ámbito poblacional.

OBJECTIVE: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. METHOD: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. RESULTS: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%-75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean +/- SD; 7.4 +/- 4.3 vs. 4.7 +/- 3.3, p < 0.0001) and global medical visits/patient/year (12.0 +/- 9.3 vs. 7.4 +/- 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; 1,083.8 euro (SEM; 8.4 euro) vs. 684.1 euro (3.4 euro), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. CONCLUSIONS: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age.

Comorbilidad y coste ambulatorio asociado a los pacientes con trastornos depresivos en un ámbito poblacional / No disponible

Objetivo: Medir el impacto económico de los trastornos depresivos (TD) y la comorbilidad asociada en en población atendida por equipos de atención primaria (EAP) en condiciones de práctica clínica habitual. Método: Estudio de cohortes retrospectivo. Se incluyeron pacientes mayores de 14 años, con diagnóstico de TD (CIAP; P76) atendidos por EAP durante el año 2004. Se formó una cohorte comparativa con el resto de pacientes sin TD. Las variables fueron: edad, sexo, historial/comorbilidad, utilización de recursos sanitarios y costes correspondientes (medicamentos, procedimientos diagnósticos, visistas a especialistas y a EAP). Se efectuó un análisis de regresión logística múltiple y modelos ANCOVA para comparar los costes, totales y desagregados, y las comorbilidades. Resultados: Se incluyeron 64.072 pacientes; 6.592 con TD [10,3% (CI: 8,2-12,4%); 7,5% (CI: 73,4-756%) mujeres]. Los pacientes con TD presentaron un mayor número de episodios de comorbilidades/año (media ± DE; 7,4 ± 4,3 vs. 4,7 ± 3,3; p < 0,0001) y de todo tipo de visitas médicas/paciente/año (12,0 ± 9,3 vs. 7,4 ± 7,6; < 0,0001). Las principales episodios de comorbilidad asociados con los TD fueron los trastornos neurológicos [Odd ratio (IC 95%); 2,1 (1,5-2,6); p < 0,0001], alcoholismo [1,6 (1,3-1,9), p < 0,0001] y neoplasias malignas [1,3 (1,1-1,5); p < 0,0001]. Los TD se asociaron con unos costes totales ajustados significativamente mayores; 1.083,8 (EEM; 8,4 ) vs. 684,1 (3,4 ); p < 0,0001. Las personas mayores mostraron mayores costes. El 62% de los costes totales se derivó de los medicamentos. Conclusiones: La prevalencia de los TD es elevada, particularmente en mujeres. Después del ajuste por comorbilidad, edad y sexo, los pacientes con TD utilizaron más recursos sanitarios y ocasionaron unos costes más altos. Los costes más elevados se asociaron con la edad

Objective: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. Method: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. Results: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%- 75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean ± SD; 7.4 ± 4.3 vs. 4.7 ± 3.3, p < 0.0001) and global medical visits/patient/year (12.0 ± 9.3 vs. 7.4 ± 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; € 1,083.8 (SEM; € 8.4) vs. € 684.1 (€ 3.4), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. Conclusions: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age