TY - JOUR

T1 - Claims Data Analysis on the Dispensing of Tricyclic Antidepressants Among Patients with Dementia in Germany

AU - Hessmann, Philipp

AU - Zeidler, Jan

AU - Stahmeyer, Jona

AU - Eberhard, Sveja

AU - Vogelgsang, Jonathan

AU - Abdel-Hamid, Mona

AU - Wolff-Menzler, Claus

AU - Wiltfang, Jens

AU - Kis, Bernhard

N1 - Funding information: The authors would like to thank all colleagues at the CHERH assisting with the data analysis. Especially, the authors would like to thank the Research School for Translational Medicine at the University Medical Center in Goettingen (Goettinger Kolleg für Translationale Medizin) and the Lower Saxony Ministry of Science and Culture (Niedersaechsisches Ministerium für Wissenschaft und Kultur) for supporting this research project. We acknowledge support by the German Research Foundation and the Open Access Publication Funds of the Goettingen University. We would like to thank Editage (www.editage.com) for English language editing.

PY - 2019/7

Y1 - 2019/7

N2 - Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of 1 year and the use of TCA before and after the incident diagnosis of dementia. Methods: This analysis was based on administrative data from a German statutory health insurance for a period of 2 years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing. Results: In 2015, 1,125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensings per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis. Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients' safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA.

AB - Objective: A restrictive use of tricyclic antidepressants (TCA) in patients with dementia (PwD) is recommended due to the hazard of anticholinergic side effects. We evaluated the frequency of TCA dispensing in PwD over a period of 1 year and the use of TCA before and after the incident diagnosis of dementia. Methods: This analysis was based on administrative data from a German statutory health insurance for a period of 2 years. Totally, 20,357 patients with an incident diagnosis of dementia in 2014 were included. We evaluated the dispensing of TCA in 2015. Subgroup analyses were conducted to evaluate associations between the incident diagnosis of dementia and modifications in TCA dispensing. Results: In 2015, 1,125 dementia patients (5.5%) were treated with TCA and 31% were medicated with TCA in all four quarters of 2015. Most dispensings were conducted by general practitioners (67.9%). On average, patients received 3.7 ± 2.6 dispensings per year. Amitriptyline (56.3%), doxepin (26.8%), and trimipramine (16.8%) were dispensed most often. Subgroup analyses revealed that the dispensing of TCA remained mainly unchanged following the incident diagnosis. Conclusion: A relevant number of PwD were treated with TCA. To maintain the patients' safety, an improved implementation of guidelines for the pharmaceutical treatment of PwD in healthcare institutions might be required. Since 68% of the patients suffered from depression, future studies should further evaluate the indications for TCA.

KW - Antidepressants

KW - Claims data

KW - Dementia

KW - Pharmacotherapy

KW - Tricyclic

UR - http://www.scopus.com/inward/record.url?scp=85069782664&partnerID=8YFLogxK

U2 - 10.3389/fphar.2019.00841

DO - 10.3389/fphar.2019.00841

M3 - Article

AN - SCOPUS:85069782664

VL - 10

JO - Frontiers in Pharmacology

JF - Frontiers in Pharmacology

SN - 1663-9812

M1 - 841

ER -