RESUMO
Purpose of the Research: This paper aims at comparing different approaches to measure potentially inappropriate medication (PIM) with routinely collected data on prescriptions, patient age institutionalization status (ie in nursing home or in the community). A secondary objective is to measure the rate and prevalence of PIM dispensing and to identify problematic practices in Switzerland. Material and Methods: The studied population includes about 90,000 insured over 17 years old from a Swiss health maintenance organization in 2019 and 2020. We computed and compared the number of PIM per patient for Beers criteria, Priscus list, Laroche, NORGEP and Prescrire approaches. We also created a composite indicator that accounts for the specificities of the Swiss context (adaptation to the Swiss drugs' market, recommendations in force related to sleeping pills, anxiolytics and NSAIDs). We also stratified the analysis per physician, including initiation and cessation of PIM prescription. Results: Our comparison revealed similarities between the approaches, but also that each of them had specific gaps that provides further motivation for the development of a composite approach. PIM rate was particularly high for sleeping pills, anxiolytics, NSAIDs, even when analyses were limited to chronic use. Drugs with anticholinergic effect were also frequently prescribed. Based on our composite indicator, 27% of insured over 64 years old received at least one PIM in 2020, and 8% received more than one. Our analyses also reveal that for sleeping pills and anxiolytics, half of the volume (or prevalence?) occurs in the <65 population. We observed strong variations between physicians and a significant proportion of new users among patients with PIM. Conclusion: Our results show that PIMs prescribing is very frequent in Switzerland and is driven mostly by a few drug categories. There is important physician variation in PIM prescribing that warrants the development of intervention targeted at high PIM-prescribers.
RESUMO
Pulmonary fibrosis is an extraarticular manifestation of rheumatoid arthritis (RA), which appears between 20 to 40% of cases. MTX is an ordinary treatment used for patients with RA. It has been suggested in some studies that a link between the use of MTX and the appearance of pulmonary fibrosis exists. Furthermore, the chronic use of MTX has been associated with the development of hepatic cirrhosis. Adenosine, a key molecule in the anti-inflammatory action of MTX seems to have a pro-fibrotic effect in some experimental models, thereby suggesting a mechanism through which MTX could lead to a fibrotic process. However, in spite of these experimental models, clinical studies have not permitted to confirm the pathogenic role of MTX in pulmonary fibrosis.
