Switching Patterns of Oral Retinoids to Alternative Medications: An Interrupted Time-Series Analysis of Four European Countries.
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Riera-Arnau Judit, Abtahi Shahab, Sabaté Gallego Mònica, Ballarín Elena, Gamba Magdalena, Pajouheshnia Romin, Hoxhaj Vjola, Alsina Ema, Martin-Perez Mar, Garcia-Poza Patricia, Llorente-Garcia Ana, Gonzalez-Bermejo Diana, Sanfélix-Gimeno Gabriel, Rodríguez-Bernal Clara, Peiró Salvador, García-Sempere Aníbal, Sánchez-Sáez Francisco, Ientile Valentina, Ingrasciotta Ylenia, Guarneri Claudio, Tanaglia Matilde, Tari Michele, Houben Eline, Gini Rosa, Roberto Giuseppe, Bartolini Claudia, Paoletti Olga, Limoncella Giorgio, Girardi Anna, Hyeraci Giulia, Kristiansen Sarah Brøgger, Klungel Olaf, Sturkenboom Miriam, Durán Carlos E
Аннотация
METHODS: A cross-sectional study was conducted in six databases across four European countries: the Netherlands (NL-PHARMO), Spain (ES-VID and ES-BIFAP), Italy (IT-ARS and IT-Caserta) and Denmark (DK-DNR), covering women of childbearing potential prescribed/dispensed oral retinoid between 2010 and 2020. The utilisation of retinoid alternative medications and switching from oral retinoids to retinoid alternative medications after discontinuation were measured. Changes in the rates of switching before and after implementation of the Pregnancy Prevention Program were analysed using an interrupted time series analysis.
RESULTS: From 88,992 women of childbearing potential previously exposed to retinoids, 32.0% (28,446) switched to a retinoid alternative medication over the study period. Overall, ten out of 80 median discontinuers per month switched. Median switching monthly rates ranged from 1.8 to 6.5% and from 1.2 to 2.3% pre-implementation and post-implementation, respectively. For overall switching rates, the interrupted time series analysis revealed a small but statistically significant decrease in slope post-intervention in IT-Caserta (- 0.035%; p < 0.01), ES-VID (- 0.04%; p < 0.01) and ES-BIFAP (- 0.03%; p = 0.02). These changes disappeared when excluding the coronavirus disease 2019 lockdown period from the analysis.
CONCLUSIONS: The 2018 risk minimisation measures showed a limited impact on switching patterns, with possible differences between northern and southern countries. Further research is needed to investigate the reasons and choices behind switching, and the impact of the Pregnancy Prevention Program on the utilisation patterns of individual retinoid alternative medications, particularly those with teratogenic potential.