Prevalence of Gabapentinoids and Central Nervous System Depressant Drugs, and Their Association with Risk Factors for Respiratory Depression in Primary Care Patients.

BACKGROUND AND OBJECTIVES: Warnings have been published regarding an increased risk of severe respiratory depression in patients receiving gabapentinoids either alone or in combination with opioids and/or anxiolytics/hypnotics, especially in individuals with a respiratory risk factor. The aim is to report the prevalence of the use of gabapentinoids alone and associated with central nervous system depressant drugs, and possible associated risk factors for respiratory depression, in order to identify the most fragile population and establish intervention strategies. METHODS: We performed a cross-sectional study using computerized prescription records from the northern area of Barcelona at Catalan Institute of Health for 363,007 inhabitants registered during 2021. Patients aged ≥ 18 years with one or more gabapentinoid prescription were included. Age, gender, polypharmacy, adjusted morbidity groups, quantity of chronic diseases, and the number of consultations per year were independent variables. Four age categories were defined (18-64 years, then 64-74, 75-84, and those aged 85 years or older). Descriptive and inferential statistics were employed. Level of statistical significance was 5% (p ≤ 0.05). For the analysis, the SPSS program (version 22) was employed. RESULTS: Of the study sample, 9218 were prescribed gabapentidoids. Overall prevalence of use was 3.0% (women 3.6%, men 2.4%). On the whole, women used more drugs than men. In contrast to their younger counterparts, consumption increased 2.6 times, 3.8 times, and 4.0 times in the 65-74 age group, 75-84 age group, and those aged ≥ 85 years, respectively. Mean age was 65.59 (±15.80) years. Polypharmacy (5-9 drugs) was present in 41.7% of the patients and extreme polypharmacy (≥ 10 drugs) was present in 39.3% of the patients. Regarding renal function, 2396 patients (25.9%) had glomerular filtration that required dose adjustment (76.1% with gabapentin and 23.8% with pregabalin). In 141 patients (5.9%), a total daily dose higher than that authorized (109 with gabapentin, 29 with pregabalin) had been prescribed. The prescription of gabapentinoids combined with opioids and/or anxiolytics/hypnotics was significantly associated with (i) polypharmacy (5-9 drugs, OR: 3.42 [95% CI 3.00-3.88]; ≥ 10 drugs, OR 8.72 [95% CI 7.42-10.25]); (ii) quantity of chronic diseases, OR: 1.14 (95% CI 1.11-1.17); (iii) augmented number of consultations/year, OR: 1.01 (95% CI 1.00-1.01); (iv) female gender, OR: <  1 for men, OR: 0.66 (95% CI 0.60-0.73); (v) being elderly: 65-74 years, OR: 0.71 (95% CI 0.62-0.81); 75-84 years, OR: 0.62 (95% CI 0.54-0.71); ≥85 years, OR: 0.68 (95% CI 0.58-0.81); and (vi) adjusted morbidity groups, OR: 0.90 (95% CI 0.88-0.92), (p <  0.0001). CONCLUSION: Exposure to gabapentinoids occurs in a non-negligible percentage of the population. Greater numbers of combinations of gabapentinoids and opioids and/or anxiolytics/hypnotics were associated with polypharmacy, quantity of chronic diseases, and augmented number of consultations, but not with male gender, older age, and adjusted morbidity groups.

Long-term effectiveness of an intervention to enhance mirabegron use revision and its deprescribing: 36-month follow-up of a quasi-experimental trial in primary care.

OBJECTIVE: This is a follow-up study from a multicenter, prospective, before-and-after quasi-experimental, controlled trial to assess effectiveness at 36 months of an intervention designed to promote the revision and deprescribing of mirabegron in primary care in patients with overactive bladder. METHODS: Intervention included patients who attended in 17 PHCs located in North Barcelona; control included patients who attended in the other 34 PHCs located in South, East and West Barcelona. The primary endpoint was mirabegron review and deprescribing when GPs considered appropriate, which was measured by the percentage of change of the number of patients with treatment at 36 months compared to the baseline. The intervention consisted of meetings with all the directors of the PHCs; distribution of the infographic to the GPs; providing information regarding the intervention for urologist and gynaecologist; and review of the treatments by the GPs. A monthly follow-up was done during the first year, and every three months thereafter until month 36. RESULTS: Overall, 1932 patients were included, mean age 71.6 years (female 53.8%). A total of 540 patients included in the intervention discontinued mirabegron at some point during the 36 months follow-up (540/762, 70.8%) compared to 759 patients in the control (759/1170, 64.9%), (p < 0.001). A total of 324/433 patients (74.8%) who discontinued mirabegron use at 12 months remained without pharmacological treatment at 36 months. With respect to the baseline cohort, there was a lower introduction of new patients with mirabegron in the intervention (546/762, 71.6%) compared to the control (1246/1170, 106.5%), (p < .001). Regarding the treated patients, there was an increase of 41.6% in the control and a slight increase of 0.8% in the intervention at 36 months, (p < .001). CONCLUSION: Our data indicate that an intervention can enhance the review use of mirabegron in the primary care setting, and promote their deprescribing.

Influencia del sexo en la incapacidad laboral por depresión / Influence of gender in sick leave due to depression

Objetivo: Determinar si hay diferencias por sexo en la incapacidad laboral transitoria (IT) por depresión respecto a la edad, el diagnóstico, la duración y la frecuentación. Pacientes y método: Estudio descriptivo y transversal, realizado en 2004. Población diana: población de más de 15 años de la región sanitaria (RS) de Lleida, laboralmente activa, con baja por depresión. Medidas: estadística descriptiva; comparación de medias y proporciones. Resultados: De las 182.895 personas de la RS, 1.902 estuvieron de baja por depresión. El 62,7% eran mujeres. La edad media ± desviación estándar (DE) fue 40,5 años ± 11,3 años, sin diferencias significativas por sexos (mujeres, 40 años; varones, 41 años; p = 0,3188). El 50,1% presentaba un trastorno depresivo; el 48,1%, un trastorno mixto por ansiedad-depresión y el 1,8%, un trastorno bipolar. La distribución de diagnósticos por sexo mostraba un predominio del trastorno bipolar en los varones (el 3,94 frente al 0,5%) y del mixto en las mujeres (el 49,66 frente al 45,49%) (*2 = 31,86; p < 0,0001). La duración media fue de 88 ± 98 días (mediana, 46 días), con un promedio de 7 ± 7 visitas (mediana, 4 visitas), sin diferencias significativas por sexo (p = 0,3186 y p = 0,3382, respectivamente). Conclusiones: A pesar que la mayoría de casos de IT por depresión corresponden a mujeres, el sexo no determina diferencias en el proceso de IT. La distribución de diagnósticos por sexo refleja la de la población general

Objective: To determine whether there are any gender differences in sick leave due to depression in relation to age, diagnosis, duration, and attendance rates. Patients and method: A descriptive cross-sectional study was performed in 2004. Population: Population over 15 years old in the health area of Lerida, Spain, registered as active workers who took sick leave for depression. Measurements: Descriptive statistics with comparisons of means and percentages. Results: Of 182,895 people in the health area, 1,902 took sick leave due to depression. Women represented 62.7%. The mean age was 40.5 ± 11.3 years old with no significant differences by gender (women: 40 years, men: 41 years; P=.3188). A total of 50.1% had depressive disorder, 48.1% had mixed anxiety-depressive disorder, and 1.8% had bipolar disorder. The distribution of diagnoses by gender showed a predominance of bipolar disorder among men (3.94% versus 0.5%) and mixed anxiety-depressive disorder among women (49.66% versus 45.49%) (x2 = 31.86; P<.0001). The mean duration of sick leave was 88 ± 98 days (median: 46 days) with a mean attendance rate of 7 ± 7 visits (median: 4 visits) with no significant differences by gender (P=.3186 and P=.3382 respectively). Conclusions: Although women predominate among persons taking sick leave for depression, differences in sick leave are not determined by gender. The distribution of diagnoses by gender reflects that of the general population

[Evolution in consumption of anti-depressants during the years 2002 to 2004]. / Evolución en el consumo de antidepresivos durante los años 2002 a 2004.

OBJECTIVE: To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. DESIGN: Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. SETTING: Lleida Health Region, Spain. PARTICIPANTS: A total of 54,890 patients received an antidepressant drug between 2002 and 2004. MEASUREMENTS: Age, sex, medicine, prescription period, centre. RESULTS: The prevalence of antidepressant treatment was: 8.4% in 2002 (368,976 inhabitants); 8.6% in 2003 (376,638 inhabitants); and 8.7% in 2004 (388,148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). CONCLUSIONS: A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system.

Evolución en el consumo de antidepresivos durante los años 2002 a 2004 / Evolution in consumption of anti-depressants during the years 2002 to 2004

Objetivo. Analizar el consumo de fármacos antidepresivos y la duración del tratamiento antidepresivo durante los años 2002 a 2004. Diseño. Estudio descriptivo, transversal, de las dispensaciones de medicamentos antidepresivos realizadas mediante receta del Sistema Nacional de Salud. Emplazamiento. Región Sanitaria de Lleida. Participantes. Han participado 54.890 individuos que han recibido algún fármaco antidepresivo durante los años 2002 a 2004. Mediciones principales. Edad, sexo, medicamento, período de dispensación, centro. Resultados. La prevalencia anual de tratamiento antidepresivo ha sido del 8,4% en 2002 (368.976 habitantes), del 8,6% en 2003 (376.638 habitantes) y del 8,7% en 2004 (388.148 habitantes). El incremento en el porcentaje de pacientes en tratamiento en 2004 respecto al 2002 es de un 9,4%. La prevalencia en los varones es del 5,4% y en las mujeres del 12,7%. La distribución por grupos de fármacos antidepresivos es la siguiente: inhibidores selectivos de la recaptación de serotonina un 73,7%, antidepresivos tricíclicos un 26,2%, heterocíclicos un 10% e inhibidores de la monoaminooxidasa un 0,1%. La duración del tratamiento ha sido de 1-3 meses en el 43%, 4-12 meses en el 22,7%, 13-24 meses en el 14,4% y > 24 meses en el 19,9%. Conclusiones. Hay un incremento progresivo en las prescripciones de antidepresivos, con predominio de nuevas moléculas. Respecto a la duración del tratamiento, un porcentaje elevado de individuos realiza tratamientos < 4 meses, hecho contradictorio con las recomendaciones de la literatura científica para el tratamiento de la depresión. Este hecho conlleva una importante ineficiencia del sistema sanitario

Objective. To analyse the use of antidepressants from 2002 to 2004 and the length of treatment. Design. Cross-sectional, descriptive study of antidepressant drugs prescribed through the National Health System during 2002-2004. Setting. Lleida Health Region, Spain. Participants. A total of 54 890 patients received an antidepressant drug between 2002 and 2004. Measurements. Age, sex, medicine, prescription period, centre. Results. The prevalence of antidepressant treatment was: 8.4% in 2002 (368 976 inhabitants); 8.6% in 2003 (376 638 inhabitants); and 8.7% in 2004 (388 148 inhabitants). The increase in antidepressant treatment in 2004 over 2002 was 9.4%. Prevalence among men was 5.4% and women, 12.7%. The distribution according to antidepressant classes was: selective serotonin reuptake inhibitors, 73.7%; tricyclic antidepressants, 26.2%; heterocyclic antidepressants, 10%, and monoamine oxidase inhibitors, 0.1%. The duration of treatment was 1 to 3 months (43%), 4 to 12 months (22.7%), 13 to 24 months (14.4%), and over 24 months (19.9%). Conclusions. A steady increase in the use of antidepressants is being observed, predominantly new drugs. Regarding the length of treatment, a high proportion of patients are treated for under 4 months, which does not follow recent recommendations in the scientific literature for treatment of depression. This is a major element of inefficiency in the health system