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Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe

INTRODUCTION: Concerns over serious respiratory depression in children led to two European Union (EU) referral procedures (in 2013 and 2015) to review the benefit–risk balance of codeine in this population when used for pain relief, cough or cold. Consequently, codeine should no longer be used in ch...

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Autores principales: Plueschke, Kelly, Flynn, Robert, Hedenmalm, Karin, Deli, Aikaterini-Christina, Maciá-Martinez, Miguel-Angel, García-Poza, Patricia, Olsen, David, Nguyen, Pierre, Quinten, Chantal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9492592/
https://www.ncbi.nlm.nih.gov/pubmed/36001288
http://dx.doi.org/10.1007/s40264-022-01214-y
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author Plueschke, Kelly
Flynn, Robert
Hedenmalm, Karin
Deli, Aikaterini-Christina
Maciá-Martinez, Miguel-Angel
García-Poza, Patricia
Olsen, David
Nguyen, Pierre
Quinten, Chantal
author_facet Plueschke, Kelly
Flynn, Robert
Hedenmalm, Karin
Deli, Aikaterini-Christina
Maciá-Martinez, Miguel-Angel
García-Poza, Patricia
Olsen, David
Nguyen, Pierre
Quinten, Chantal
author_sort Plueschke, Kelly
collection PubMed
description INTRODUCTION: Concerns over serious respiratory depression in children led to two European Union (EU) referral procedures (in 2013 and 2015) to review the benefit–risk balance of codeine in this population when used for pain relief, cough or cold. Consequently, codeine should no longer be used in children aged < 12 years and restrictions were introduced for treatment in children ≥ 12 years. OBJECTIVE: This multinational collaborative study aimed to assess the effectiveness of these risk minimisation measures by evaluating changes in prescribing of codeine and alternative treatments. METHOD: Children under 12 and 12–18 years old were followed between 2010 and 2017 to analyse quarterly trends in prescribing of codeine and alternative treatments in electronic health records from France, Germany, Norway, Spain and the United Kingdom using interrupted time series analysis. RESULTS: Overall prescribing of codeine in children decreased in all five countries, reaching near zero prevalence in children under 12 years of age. This was accompanied by an increase in use of other opioid analgesics in France (from 0.15 to 0.56 prevalence per 100 person-years immediately after the first referral), Norway (from 0.0006 to 0.0013 at the end of the study), the United Kingdom (from 0.018 to 0.05 at the end of the study), and an increase in non-opioid analgesics in Norway (from 0.045 to 0.075 at the end of the study) after the referral on pain relief indication. The referral on cough/cold indication led to a decrease in use of opioid and non-opioid antitussives in children aged < 12 years in France (from 10 to 7 and 20 to 16, respectively) and had no impact in other countries. Overall prescribing trends for codeine and alternatives were similar across both age groups within each country. CONCLUSION: The decrease in use of codeine shows that healthcare professionals followed the adopted measures and switched prescribing practices for pain management in children aged < 18 years towards opioid or non-opioid analgesics depending on national clinical and reimbursement settings. Whist the magnitude of the first referral on pain differed between countries, the second referral on cough/cold had only a minimal impact on the use of codeine and antitussives. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40264-022-01214-y.
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spelling pubmed-94925922022-09-23 Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe Plueschke, Kelly Flynn, Robert Hedenmalm, Karin Deli, Aikaterini-Christina Maciá-Martinez, Miguel-Angel García-Poza, Patricia Olsen, David Nguyen, Pierre Quinten, Chantal Drug Saf Original Research Article INTRODUCTION: Concerns over serious respiratory depression in children led to two European Union (EU) referral procedures (in 2013 and 2015) to review the benefit–risk balance of codeine in this population when used for pain relief, cough or cold. Consequently, codeine should no longer be used in children aged < 12 years and restrictions were introduced for treatment in children ≥ 12 years. OBJECTIVE: This multinational collaborative study aimed to assess the effectiveness of these risk minimisation measures by evaluating changes in prescribing of codeine and alternative treatments. METHOD: Children under 12 and 12–18 years old were followed between 2010 and 2017 to analyse quarterly trends in prescribing of codeine and alternative treatments in electronic health records from France, Germany, Norway, Spain and the United Kingdom using interrupted time series analysis. RESULTS: Overall prescribing of codeine in children decreased in all five countries, reaching near zero prevalence in children under 12 years of age. This was accompanied by an increase in use of other opioid analgesics in France (from 0.15 to 0.56 prevalence per 100 person-years immediately after the first referral), Norway (from 0.0006 to 0.0013 at the end of the study), the United Kingdom (from 0.018 to 0.05 at the end of the study), and an increase in non-opioid analgesics in Norway (from 0.045 to 0.075 at the end of the study) after the referral on pain relief indication. The referral on cough/cold indication led to a decrease in use of opioid and non-opioid antitussives in children aged < 12 years in France (from 10 to 7 and 20 to 16, respectively) and had no impact in other countries. Overall prescribing trends for codeine and alternatives were similar across both age groups within each country. CONCLUSION: The decrease in use of codeine shows that healthcare professionals followed the adopted measures and switched prescribing practices for pain management in children aged < 18 years towards opioid or non-opioid analgesics depending on national clinical and reimbursement settings. Whist the magnitude of the first referral on pain differed between countries, the second referral on cough/cold had only a minimal impact on the use of codeine and antitussives. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40264-022-01214-y. Springer International Publishing 2022-08-24 2022 /pmc/articles/PMC9492592/ /pubmed/36001288 http://dx.doi.org/10.1007/s40264-022-01214-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Plueschke, Kelly
Flynn, Robert
Hedenmalm, Karin
Deli, Aikaterini-Christina
Maciá-Martinez, Miguel-Angel
García-Poza, Patricia
Olsen, David
Nguyen, Pierre
Quinten, Chantal
Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title_full Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title_fullStr Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title_full_unstemmed Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title_short Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe
title_sort prescribing patterns of codeine and alternative medicines in children in europe
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9492592/
https://www.ncbi.nlm.nih.gov/pubmed/36001288
http://dx.doi.org/10.1007/s40264-022-01214-y
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