J Clin Pharm Ther 2001 Dec;26(6):437-44
Tremlett HL, Luscombe DK, Wiles
CM.
Welsh School of Pharmacy, Cardiff
University, Cardiff, U.K. Department of Medicine (Neurology), University
of Wales College of Medicine, Cardiff, U.K.
Objectives:
To examine the prescribing patterns
for multiple sclerosis (MS) patients resident in Wales by general practitioners
(GPs), compared to an age, gender and GP surgery matched control population.
Methods:
Anonymised data for 1996 were obtained
for all patients from 24 GP practices in the all-Wales General Practice
Morbidity Database (GPMD). This covered 220 538 patient years at risk for
1996. Cases were selected as those with a Read code of MS at some point
from 1993 to 1996 (therefore had consulted the GP at least once during
this time). The controls were age, gender and surgery matched patients
randomly selected from the GPMD.
Results:
A total of 216 cases were identified,
giving a prevalence of 97.9 per 105. Cases were prescribed a mean of 15
drugs each in 1996 compared to eight drugs for controls (P < 0.0005).
Compared with controls, MS patients were prescribed significantly more
laxatives, diuretics, hypnotics and anxiolytics, antidepressants, antiepileptics
(mainly carbamazepine), corticosteroids, oxybuty- nin, vitamin B12 and
skeletal muscle relaxants (predominantly baclofen; P < 0.05). Certain
'MS specific' drugs were not frequently prescribed, such as cytotoxic immunosuppressants
(two cases), amantadine (one case) and isoniazid (no cases). No case was
prescribed medication for erectile dysfunction. Over 80% (44/53) of corticosteroid
prescriptions for MS were for oral prednisolone. Over one-third (39%, 9/23)
of cases prescribed a corticosteroid received a 'chronic' course. Over
one-third (5/14) of courses of selective-serotonin re-uptake inhibitors
(SSRI) for cases were identified as subtherapeutic.
Conclusions:
MS patients were high users of prescribed
medicines, having almost twice as many prescriptions from the GP compared
to controls. GP prescribing often reflected available evidence from published
controlled trials, hence cytotoxic immunosuppressants, drugs for fatigue
and tremor were seldom prescribed, whereas drugs such as oxybutynin and
skeletal muscle relaxants were frequently prescribed. However, the increased
use of certain drugs compared to controls such as diuretics, vitamin B12,
hypnotics and anxiolytics were unsubstantiated in the literature. Furthermore,
no published well-controlled clinical trials were found utilizing oral
prednisolone or assessing the possible therapeutic benefit of chronic courses
of corticosteroids in MS, both of which were prescribed by the GP. The
absence of medication for sexual dysfunction (prelicensing of sildenafil),
a reportedly common MS problem, was discussed. The relatively high incidence
of subtherapeutic courses of SSRIs needs further investigation, given the
increased incidence of depression and suicide associated with MS.
PMID: 11722681 [PubMed - in process]