Selective prescribing of spasmolytics

• Published in: The Annals of pharmacotherapy 2000-06, Vol.34 (6), p.716-720
• Main Authors: Movig, KL, Egberts, AC, Lenderink, AW, Leufkens, HG
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Analysis of Variance; Antiparkinson Agents - therapeutic use; Benzhydryl Compounds - economics; Benzhydryl Compounds - therapeutic use; Biological and medical sciences; Chi-Square Distribution; Confidence Intervals; Cresols - economics; Cresols - therapeutic use; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Muscle; Parasympatholytics - economics; Parasympatholytics - therapeutic use; Pharmacology. Drug treatments; Phenylpropanolamine; Tolterodine Tartrate; Treatment Outcome
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.19267

BACKGROUND: Daily clinical practice often differs largely from the clinical trial setting, so extrapolation of outcomes from trial data, such as safety, effectiveness, and economic outcomes, can be deceptive. Prescribers may intend to treat a selected group of patients with new drugs; this practice could result in significant bias in assessing outcomes of these agents during their use in daily clinical practice. OBJECTIVE: To evaluate what type of patient received tolterodine compared with the spasmolytic drugs previously marketed (oxybutynin, flavoxate, emepronium). DESIGN: An observational, follow-up study. SETTING: Eighteen collaborating community pharmacies. PATIENTS: Aged ≥18 years, noninstitutionalized; initial therapy with tolterodine, oxybutynin, flavoxate, or emepronium. RESULTS: Tolterodine was often used as a second-line and even as a third-line treatment, and was prescribed to a “polluted” population in terms of concomitant psychotropic medication. Tolterodine users were 7.5 times more likely to have received another spasmolytic drug (RR 7.5, 95% CI 4.8 to 11.9). In addition, these patients more frequently used antiparkinsonian drugs (RR 4.1, 95% CI 1.6 to 10.4) as well as antipsychotic drugs (RR 2.9, 95% CI 1.4 to 6.2). There was a small difference in concomitant use of antidepressants and benzodiazepines between patients receiving tolterodine versus those taking other spasmolytic drugs. CONCLUSIONS: Tolterodine is prescribed for a population differing from that receiving previously marketed spasmolytic drugs. Selective prescribing should be recognized when evaluating new drugs in daily clinical practice. Policy makers, such as pharmacy and therapeutics committees, should consider this aspect in their formulary decisions since selective prescribing can lead to unjustified conclusions about a drug's therapeutic effects (e.g., efficacy, safety, cost-effectiveness).