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Van Ganse E, Belhassen M, Ginoux M, Chrétien E, Cornu C, Ecoffey C, Aubrun F. Use of analgesics in France, following dextropropoxyphene withdrawal. BMC Health Serv Res 2018; 18:231. [PMID: 29609613 PMCID: PMC5880096 DOI: 10.1186/s12913-018-3058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/23/2018] [Indexed: 12/05/2022] Open
Abstract
Background In 2009, the European Medicines Agency recommended withdrawal of dextropropoxyphene (DXP); in March 2011 it was withdrawn from the market in France. Up until that time the combination dextropropoxyphene-paracetamol (DXP/PC) was widely used for analgesia. At withdrawal, French regulators recommended that DXP/PC be replaced by other step 2 analgesics, i.e. tramadol, codeine, or opium-containing drugs, or by PC for a weak level of pain. To investigate prescribing behaviours after DXP/PC withdrawal, dispensations of analgesics before and after withdrawal were analysed. Methods Aggregated dispensation data of analgesics prescribed between January 2009 and December 2012 in the Rhône-Alpes region were obtained from the general health insurance claims data; changes in analgesic dispensation over time were analysed with the ATC/DDD methodology. Pre (Jan-June 2009) and post-withdrawal (Jan-June 2012) changes of DDDs where computed for each analgesic step. Results The dispensations of DXP/PC experienced a two-step decrease until 2011. Over the withdrawal period 2009-2012, there was a 14% decrease in the overall use of analgesic (from 109 to 94 DDDs), while the use of step 2 analgesics declined by 46% (− 22 DDDs, from 47 to 25 DDDs). This latter decline included a cessation of use of DXP/PC (29 DDDs in 2009) that were only in part (+ 7 DDDs, from 18 to 25 DDDs) compensated by increased use of codeine, tramadol and opium, in monotherapy or combined with PC. For step 1 analgesics, use increased with 9%, mostly PC (+ 8 DDDs, from 31 to 39 DDDs). Step 3 analgesics dispensations remained largely unchanged over this period (around 3 DDDs). Conclusions In the Rhône-Alpes region, DXP/PC withdrawal was accompanied in part by an increased use of same level analgesics, and in part by an increased use of PC in monotherapy. The extent of DXP/PC use before withdrawal, and the increased use of PC after DXP withdrawal, underline the complexity of pain management.
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Affiliation(s)
- E Van Ganse
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France. .,PELyon, PharmacoEpidemiologie Lyon, Lyon, France. .,Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
| | - M Belhassen
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - M Ginoux
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,PELyon, PharmacoEpidemiologie Lyon, Lyon, France
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
| | - C Cornu
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University, CNRS, Lyon, France.,Louis Pradel Hospital, Lyon University, Lyon, France INSERM Clinical Investigation Centre (CIC1407), Lyon, France
| | - C Ecoffey
- Department of Anaesthesiology and Critical Care, Ponchaillou University Hospital, CIC Inserm, Rennes, France
| | - F Aubrun
- HESPER 7425, Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France.,Department of Anesthesiology and Critical Care, Croix Rousse University Hospital, Claude Bernard Lyon 1 University, Lyon, France
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Aubrun F, Chrétien E, Letrilliart L, Ginoux M, Belhassen M, Lanteri-Minet M, Van Ganse E, Beloeil H. What are the therapeutic alternatives to dextropropoxyphene in France? A prescribers' survey. Anaesth Crit Care Pain Med 2016; 36:15-19. [PMID: 27320052 DOI: 10.1016/j.accpm.2016.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/01/2016] [Indexed: 11/17/2022]
Abstract
About a year after dextropropoxyphene (DXP) withdrawal from the French market, we conducted a survey among members of the French Society of Anesthesia & Intensive Care Medicine (Sfar) and of the French Society of the Study and Treatment of Pain (SFETD) to identify the indications for which this WHO level II analgesic had been prescribed, the prescriber's feedback following withdrawal, and the substitutive analgesics prescribed. DXP had been prescribed by more than 75% of the 430 anaesthesiologists and 230 pain specialists interviewed, mainly for acute and chronic non-cancer pain of moderate intensity. While two thirds of pain specialists were not satisfied with DXP withdrawal, this decision did not affect the majority of anaesthesiologists. In both groups, the main substitutive analgesic was tramadol combined with acetaminophen, while only 24% of prescribers considered acetaminophen alone as a substitute.
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Affiliation(s)
- F Aubrun
- Department of Anesthesiology and Critical Care, Université Claude-Bernard-Lyon 1, hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - E Chrétien
- Department of Anesthesiology and Critical Care, Université Claude-Bernard-Lyon 1, hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - L Letrilliart
- Université Claude-Bernard-Lyon 1, collège universitaire de médecine générale, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
| | - M Ginoux
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
| | - M Belhassen
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France
| | - M Lanteri-Minet
- Department of Pain Management, université Nice-Sophia-Antipolis, Inserm/UdA, U1107, Neuro-Dol, université d'Auvergne, pôle neurosciences cliniques, CHU de Nice, hôpital de Cimiez, 4, avenue Reine-Victoria, 06000 Nice, France
| | - E Van Ganse
- Université Claude-Bernard-Lyon 1, UMR CNRS 5558, faculté d'odontologie, 11, rue Guillaume-Paradin, 69372 Lyon cedex 08, France; Hospices civils de Lyon, CHU de Lyon, groupe hospitalier Nord-hôpital de la Croix-Rousse, service de pneumologie, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - H Beloeil
- Université Rennes 1, CHU de Rennes, pôle d'anesthésie-Samu-urgences-réanimations, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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