背景:本研究的目的是调查中国抗偏头痛药物的趋势和处方模式。
方法:从中国医院处方分析合作项目中提取2018-2022年门诊偏头痛患者处方数据。偏头痛患者的人口学特征,处方趋势,并分析了抗偏头痛药物的相应支出。我们还调查了联合治疗和药物过度使用的处方模式。
结果:本研究共纳入103家医院的32,246名确诊为偏头痛的门诊患者。总门诊人次没有显著的趋势变化,偏头痛处方,或研究期间的相应支出。在开了治疗药的病人中,70.23%接受了镇痛药,26.41%接受了偏头痛特异性药物治疗.非甾体抗炎药(NSAIDs;28.03%),含咖啡因的药物(22.15%),阿片类药物(16.00%)是最常见的处方镇痛药,相应的成本比例为11.35%,4.08%,和19.61%,分别。口服曲坦类药物(26.12%)是最常用的偏头痛特异性药物,占总治疗支出的62.21%。接受镇痛处方的患者比例从2018年的65.25%上升至2022年的75.68%,同时接受曲坦类药物的患者比例从2018年的29.54%下降至2022年的21.55%(均P<0.001)。最常用的预防药物类别是钙通道阻滞剂(CCB;51.59%),其次是抗抑郁药(20.59%)和抗惊厥药(15.82%),占21.90%,34.18%,和24.15%,分别,预防支出总额。氟桂利嗪(51.41%)是最常用的预防药物。氟哌噻吨/美利曲辛(7.53%)是最常用的抗抑郁药。最常用的抗惊厥药是托吡酯(9.33%),从6.26%上升到12.75%(均P<0.001)。共有3.88%的患者接受急性偏头痛综合治疗,18.63%接受联合治疗预防.69.21%的阿片类药物的处方,38.53%的含咖啡因剂,26.61%的NSAIDs,13.97%的对乙酰氨基酚,6.03%的曲坦类药物被认为是书面药物过度使用。
结论:偏头痛治疗逐渐趋于循证和指南推荐治疗。应该注意阿片类药物处方,基于证据的抗抑郁药使用薄弱,以及在偏头痛治疗中过度使用药物。
BACKGROUND: The objective of this study was to investigate the trends and prescribing patterns of antimigraine medicines in China.
METHODS: The prescription data of outpatients diagnosed with migraine between 2018 and 2022 were extracted from the Hospital Prescription Analysis Cooperative Project of China. The demographic characteristics of migraine patients, prescription trends, and corresponding expenditures on antimigraine medicines were analyzed. We also investigated prescribing patterns of combination therapy and medicine overuse.
RESULTS: A total of 32,246 outpatients who were diagnosed with migraine at 103 hospitals were included in this study. There were no significant trend changes in total outpatient visits, migraine prescriptions, or corresponding expenditures during the study period. Of the patients who were prescribed therapeutic medicines, 70.23% received analgesics, and 26.41% received migraine-specific agents. Nonsteroidal anti-inflammatory drugs (NSAIDs; 28.03%), caffeine-containing agents (22.15%), and opioids (16.00%) were the most commonly prescribed analgesics, with corresponding cost proportions of 11.35%, 4.08%, and 19.61%, respectively. Oral triptans (26.12%) were the most commonly prescribed migraine-specific agents and accounted for 62.21% of the total therapeutic expenditures. The proportion of patients receiving analgesic prescriptions increased from 65.25% in 2018 to 75.68% in 2022, and the proportion of patients receiving concomitant triptans decreased from 29.54% in 2018 to 21.55% in 2022 (both P < 0.001). The most frequently prescribed preventive medication classes were calcium channel blockers (CCBs; 51.59%), followed by antidepressants (20.59%) and anticonvulsants (15.82%), which accounted for 21.90%, 34.18%, and 24.15%, respectively, of the total preventive expenditures. Flunarizine (51.41%) was the most commonly prescribed preventive drug. Flupentixol/melitracen (7.53%) was the most commonly prescribed antidepressant. The most commonly prescribed anticonvulsant was topiramate (9.33%), which increased from 6.26% to 12.75% (both P < 0.001). A total of 3.88% of the patients received combined therapy for acute migraine treatment, and 18.63% received combined therapy for prevention. The prescriptions for 69.21% of opioids, 38.53% of caffeine-containing agents, 26.61% of NSAIDs, 13.97% of acetaminophen, and 6.03% of triptans were considered written medicine overuse.
CONCLUSIONS: Migraine treatment gradually converges toward evidence-based and guideline-recommended treatment. Attention should be given to opioid prescribing, weak evidence-based antidepressant use, and medication overuse in migraine treatment.