Prescribing Patterns of Proton Pump Inhibitors in Germany: A Retrospective Study Including 472 146 Patients.

The aims of this study were to analyze proton pump inhibitor (PPI) users in Germany, defining and classifying them in terms of treatment appropriateness, and to analyze the PPI prescription practices of healthcare providers. The updated DGVS (Deutsche Gesellschaft für Gastroenterologie, Verdauungs-und Stoffwechselkrankheiten) gastroesophageal reflux disease (GERD) treatment guideline (published March 2023) for mild heartburn symptoms recommends carrying out a probatory treatment of mild symptoms via other medication such as antacids, alginates, and H2 blockers before escalating to PPI treatments, if the patient profile allows. This retrospective cross-sectional study was based on data from the IQVIA™ Disease Analyzer database (DA) and included adult patients (18 years or older) in 1006 general and 39 gastroenterological practices in Germany who received at least 1 PPI prescription or alginate between September 2019 and September 2021 (hereinafter referred to as the index period). Analyses included indications associated with PPI prescription, co-diagnoses, co-therapies of PPI patients, duration of PPI therapy, dosages of PPI prescriptions, and proportions of practices prescribing PPIs and alginates. A total of 472 146 patients taking PPIs and 9101 patients taking alginates were available for analysis. Very few patients (4.5%) of the total cohort were treated in complete adherence to treatment guidelines. Conditions such as gastritis and duodenitis (47.2%) and reflux diseases (38.4%) were more frequently associated with PPI prescriptions. The average PPI treatment period lasted 141 days, and 36.6% of patients were treated for >6 months. High doses were prescribed relatively often (ie, 42.8% of esomeprazole prescriptions were 40 mg, 59.1% of lansoprazole prescriptions 30 mg, 28.6% of omeprazole prescriptions 40 mg). With each practice prescribing PPIs to at least 10% of their patients; 72% of general practitioners (GPs) and 8% of GENTS (Gastroenterologists) prescribed alginates. This study highlights that discrepancies exist between clinical guidelines and real-life prescribing practices of PPIs in Germany. Particular attention should be given to the incidence of patients being prescribed high-dose or long-duration PPI with mild indications. These findings are particularly apt considering the publication (March 2023) of new guidelines on the "management of gastroesophageal reflux disease and eosinophilic esophagitis," by the DGVS.

Association Between Ginkgo Biloba Extract Prescriptions and Dementia Incidence in Outpatients with Mild Cognitive Impairment in Germany: A Retrospective Cohort Study.

BACKGROUND: Clinical trials have demonstrated a significant effectiveness of Ginkgo biloba therapy versus placebo in patients with dementia. OBJECTIVE: The present study aims to analyze the impact of Ginkgo biloba drug prescriptions on dementia incidence in patients with mild cognitive impairment (MCI) in a real-world setting. METHODS: This retrospective study was based on the IQVIA Disease Analyzer database and included patients aged 65 or older with a first diagnosis of MCI from January 2000 to December 2019. Each patient was followed for up to 20 years after MCI diagnosis until February 2021. Date of the first diagnosis of dementia or loss to follow-up, whichever occurred first, was noted. To estimate the association between Ginkgo biloba prescriptions during the follow-up and dementia incidence, a multivariable Cox regression analysis was performed, adjusted for age, sex, health insurance, documented co-diagnoses, and prescription of cholinesterase inhibitors. RESULTS: Overall, 24,483 MCI patients (mean age: 77.0 years, 56.3% women) were included. It was found that > 2 prescriptions of Ginkgo biloba were significantly associated with a reduced dementia incidence (HR: 0.71 (95% CI: 0.55-0.91), p = 0.007), as compared with no Ginkgo biloba prescription. The effect of receiving > 3 Ginkgo biloba prescriptions was even stronger, with an HR of 0.64 (95% CI: 0.48-0.86), p = 0.003), while for > 4 prescriptions the HR was 0.58 (95% CI: 0.41-0.82) (p = 0.002). CONCLUSION: All-cause dementia incidence decreased with higher numbers of Ginkgo biloba prescriptions in MCI patients.

[Covid-19 Pandemic: Anxiety Experience of Resident and Hospital Psychiatrists]. / Covid-19-Pandemie: Angsterleben von niedergelassenen und Krankenhaus-Psychiatern.

BACKGROUND: To date, no studies have examined the pandemic-related stress experience of inpatient versus outpatient psychiatrists. Therefore, the aim is to investigate the extent of Covid-19 exposure, anxiety, stress experience, and coping abilities among psychiatrists in private practice compared to physicians in psychiatric and psychosomatic hospitals. METHODS: E-mail-based questionnaires with 13 items were used to assess anxiety and stress experience. A total of 105 practicing psychiatrists, and 73 physicians and psychologists from four clinics (including the Clinic for Psychosomatic Medicine and Psychotherapy) were surveyed between early April and mid-May 2020. RESULTS: Compared to hospital psychiatrists, psychiatrists in private practice more often felt severely restricted (52.4 vs. 32.9% p=0.010), at risk of infection (35.2 vs. 13.7%, p<0.001) and financially threatened (24.7 vs. 6.9%, p=0.002). The proportion of well-informed practicing psychiatrists was lower (47.6 vs. 63.0%, p=0.043) and the proportion with lack of protective equipment was higher (27.6 vs. 4.1%, p<0.001). At the same COVID-19 exposure level (8.6 vs. 8.2%), office-based psychiatrists were more likely to report high anxiety, although not significantly, compared to hospital psychiatrists (18.1 vs. 9.6%, p=0.114). Risk factors for experiencing anxiety in both groups were feeling restricted (OR=5.52, p=0.025) and experienced risk of infection (OR=5.74, p=0.005). Exposure level, clinic or practice affiliation, age, gender, and other dimensions of threat experience and coping behavior had no influence. DISCUSSION: Psychiatrists in private practice felt more stressed and threatened by the COVID-19 pandemic compared with hospital-based colleagues. The experience of anxiety was dependent on feeling constrained and at risk of exposure, but not on exposure, protective equipment. Objective indicators seem to play less of an important role in the expression of anxiety than subjective experience.

Association between ivy leaves dry extract EA 575 prescriptions and antibiotic use, sick leave duration, and repeated infections in adult patients.

OBJECTIVES: The present study aimed to analyze the association between the prescription of ivy leaf dry extract EA 575 (licensed under the trade name Prospan® in Germany) and the incidence of antibiotic use, incident bacterial complications, and days of sick leave in adult patients with cold diseases. METHODS: This retrospective cohort study was based on the IQVIA Disease Analyzer database and included adult patients from 1032 general practices in Germany with a documentation of common cold between 2017 and 2020 (index date) and prescription of either EA 575 or an antibiotic drug within 3 days after index date. 1:1 propensity score matching based on age, sex, index month, physician, health insurance status, and the Charlson Comorbidity Index was carried out. Univariable regression models were used to investigate the association between EA 575 prescription and defined outcomes. RESULTS: Data of 7034 patients treated with EA 575 and 7034 matched patients receiving an antibiotic were available. EA 575 prescription was associated with significantly lower odds of an antibiotic prescription in the time periods of 4-30 days (OR: 0.83; 95% CI: 0.72-0.96) and 31-365 days (OR: 0.44; 95% CI: 0.40-0.48) after the index date. EA 575 prescription was significantly associated with a lower rate of sick leave of more than 7 days (33.0% vs. 37.7%, OR: 0.81; 95% CI: 0.73-0.90) in patients with any sick leave, as well as with lower odds of a new cough diagnosis (OR: 0.91, 95% CI: 0.85-0.98) when compared to antibiotic prescription. CONCLUSION: Our study provides further evidence that the use of phytopharmaceuticals, in particular ivy leaf dry extract EA 575, could contribute to a reduction in the number of inappropriate antibiotic prescriptions for respiratory infection with cough symptoms.

To Be Continued? Long-Term Treatment Effects of Antidepressant Drug Classes and Individual Antidepressants on the Risk of Developing Dementia: A German Case-Control Study.

BACKGROUND: Given the need for disease-modifying therapies for dementia, drug repurposing appears to be a promising approach, at least as a risk reduction treatment. Preclinical studies suggest that antidepressants-in particular selective serotonin reuptake inhibitors-have beneficial effects on dementia-related biomarkers and functional outcomes, although clinical data are inconclusive. The present case-control study aimed to evaluate the effects of antidepressant drug classes and individual compounds with different treatment durations on the risk of developing dementia. METHODS: Analyses are based on data from the German Disease Analyzer database (owned and maintained by IQVIA) and included 62,317 subjects with an incident dementia diagnosis (ICD-10: F01, F03, G30, F06.7) and controls matched by age, sex, and physician between January 2013 and December 2017. Logistic regression analyses adjusting for health insurance status and comorbid diseases associated with dementia or antidepressant use were performed to investigate the association between dementia incidence and treatment with 4 major antidepressant drug classes and 14 of the most frequently prescribed individual substances. RESULTS: In 17 of 18 comparisons, long-term treatment (≥ 2 years) with any antidepressant was associated with a lower incidence of dementia than short-term treatment. Tricyclic and herbal antidepressants were associated with a decrease in dementia incidence, especially with long-term treatment. The lowest risks for dementia on an individual substance basis were identified for long-term treatment with escitalopram (odds ratio [OR] = 0.66; 95% CI, 0.50-0.89) and Hypericum perforatum (OR = 0.6; 95% CI, 0.51-0.70). CONCLUSIONS: Long-term treatment with tricyclic antidepressants, Hypericum perforatum, or escitalopram may be associated with reduced incidence of dementia. If antidepressant therapy is well tolerated, continuation-even if depressive symptoms have resolved-may be considered even beyond the purpose of relapse prevention. Future combined analyses of multinational registries and long-term clinical trials are needed to substantiate these findings.

Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals- a retrospective cohort study.

OBJECTIVES: We examined the relationship between the initial treatment of acute lower and upper tract respiratory infections with phytopharmaceuticals and the duration of the disease as well as between the initial treatment and the use of antibiotics in the further course of the disease. METHOD: Outpatients from the IMS® Disease Analyzer database with diagnoses of acute respiratory infections between January 2015 and March 2019 were observed for 30 days. Patients who had been prescribed phytopharmaceuticals on the day of their diagnosis were matched with controls who had not received such prescriptions by treating practice, diagnosis, age, sex, insurance status, index year, and Charlson comorbidity score. Patients antibiotic precriptions on the day of diagnosis were excluded. Logistic regression was used to investigate the relationship between phytopharmaceutical prescription, antibiotic prescription in the further course of the disease, and duration of sick leave. RESULTS: A total of 117,182 patients who had been prescribed phytopharmaceuticals and an equal number of controls were available for analysis. Phytotherapeutics were associated with fewer antibiotic prescriptions. Extract of Pelargonium sidoides root (odds ratio (OR) 0.49 [0.43-0.57]) and thyme extract (OR 0.62 [0.49-0.76]) exhibited the strongest effect among patients treated by general practitioners, while Pelargonium sidoides root extract (OR 0.57 [0.38-0.84]), thyme and ivy extract (OR 0.66 [0.60-0.73]), and thyme and primrose root extract (OR 0.67 [0.47-0.96]) proved most effective in pediatric patients. Patients receiving phytopharmaceuticals had a significantly lower risk of prolonged periods of sick leave. The risk of sick leave durations of >7 days was most markedly reduced in patients taking cineole (OR 0.74 [0.63-0.86]) and Pelargonium root extract (OR 0.79 [0.54-0.96]). CONCLUSION: The use of selected phytopharmaceuticals for acute respiratory infections is associated with a significantly reduced need for antibiotic prescriptions in the further course of the disease, as well as significantly shorter sick leaves.

Persistence and treatment-free interval in patients being prescribed biological drugs in rheumatology practices in Germany.

AIMS: The goal of this study was to analyze persistence and the treatment-free interval in patients being prescribed biological drugs in rheumatology practices in Germany. METHODS: Patients who received a first prescription of biological drugs between 2008 and 2016 in 21 rheumatologists in Germany were included in this study (index date). The main outcome was the rate of persistence with biological drugs as a function of the duration of the treatment-free interval used to define discontinuation. The secondary outcomes were the duration of the treatment-free interval, the probability of restarting therapy, and their respective association with age, gender, and diagnosis (i.e., rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis). RESULTS: A total of 4925 patients were included in this study. After 5 years of follow-up, the rate of persistence was 32.6%, 51.1%, and 65.7% if discontinuation was defined as a gap of 90, 180, and 360 days respectively. The majority of patients restarted therapy between 91 and 180 days after the discontinuation date. Advanced age was associated with a decreased probability of restarting biological therapy after a treatment-free interval of at least 91 days, with odds ratios ranging from 0.34 in people aged 61-70 years to 0.66 in those aged 31-40 years (reference value: ≤ 30 years). Finally, patients over 70 and those suffering from ankylosing spondylitis had shorter treatment-free intervals compared to those 30 years or younger (adjusted difference of - 117 days) and those suffering from rheumatoid arthritis (- 48 days) respectively. CONCLUSION: Persistence varied widely depending on the definition of discontinuation, with the majority of nonpersistent patients restarting biological therapy shortly after discontinuation.

Current healthcare pathways in the treatment of rhinosinusitis in Germany.

BACKGROUND: In the outpatient setting in Germany, patients with rhinosinusitis usually present at general practices (GP) or ear, nose, and throat practices (ENT) for initial diagnosis and treatment. OBJECTIVES: The aim of this study was to analyze the referral patterns of rhinosinusitis patients in GPs and ENT practices in Germany, with respect to existing recommendations. MATERIAL AND METHODS: The study sample included patients from 940 GP and 106 ENT practices from Disease Analyzer database (IQVIA) who received an acute sinusitis (AS) or chronic sinusitis (CS), or nasal polyp (NP) in 2015. RESULTS: The total numbers of patients in GP versus ENT practices were 24,648 versus 12,095 (AS), 26,768 versus 19,826 (CS), and 516 versus 1773 patients (NP). Referrals to ENT practices were made by GP in 12.3% (AS), 14.8% (CS), and 40.5% (NP). The percentages of patients in GP versus ENT practices with subsequent hospital admissions were 6.9 versus 3.3% (AS), 6.3 versus 6.5% (CS), and 9.5 versus 13.8% (NP), respectively. CONCLUSIONS: Although 40% of patients with NP who consult GPs are referred to ENT practices, it remains unclear how the other 60% are being treated. The hospital admission rates of patients with CS as well as of patients with NP were found to be surprisingly low.

Prescription Patterns and the Cost of Migraine Treatments in German General and Neurological Practices.

OBJECTIVES: The aim of this study was to analyze prescription patterns and the cost of migraine treatments in general practices (GPs) and neurological practices (NPs) in Germany. METHODS: This study included 43,149 patients treated in GPs and 13,674 patients treated in NPs who were diagnosed with migraine in 2015. Ten different families of migraine therapy were included in the analysis: triptans, analgesics, anti-emetics, beta-blockers, antivertigo products, gastroprokinetics, anti-epileptics, calcium channel blockers, tricyclic antidepressants, and other medications (all other classes used in the treatment of migraine including homeopathic medications). The share of migraine therapies and their costs were estimated for GPs and NPs. RESULTS: The mean age was 44.4 years in GPs and 44.1 years in NPs. Triptans and analgesics were the 2 most commonly prescribed families of drugs in all patients and in the 9 specific subgroups. Interestingly, triptans were more commonly prescribed in NPs than in GPs (30.9% to 55.0% vs. 30.0% to 44.7%), whereas analgesics were less frequently given in NPs than in GPs (11.5% to 17.2% vs. 35.3% to 42.4%). Finally, the share of patients who received no therapy was higher in NPs than in GPs (33.9% to 58.4% vs. 27.5% to 37.9%). The annual cost per patient was €66.04 in GPs and €94.71 in NPs. Finally, the annual cost per patient increased with age and was higher in women and in individuals with private health insurance coverage than in men and individuals with public health insurance coverage. CONCLUSION: Triptans and analgesics were the 2 most commonly prescribed drugs for the treatment of migraine. Furthermore, approximately 30% to 40% of patients did not receive any therapy. Finally, the annual cost per patient was higher in NPs than in GPs.