Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system

Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.S...

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Veröffentlicht in:BMJ (Online) 2017-02, Vol.356, p.j603-j603
Hauptverfasser: Wong, Jenna, Motulsky, Aude, Abrahamowicz, Michal, Eguale, Tewodros, Buckeridge, David L, Tamblyn, Robyn
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container_end_page j603
container_issue
container_start_page j603
container_title BMJ (Online)
container_volume 356
creator Wong, Jenna
Motulsky, Aude
Abrahamowicz, Michal
Eguale, Tewodros
Buckeridge, David L
Tamblyn, Robyn
description Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care practices in and around two major urban centres in Quebec, Canada.Participants Patients aged 18 years or older who visited a study physician between 1 January 2003 and 30 September 2015 and were prescribed an antidepressant through the electronic prescribing system.Main outcome measures Prevalence of off-label indications for antidepressant prescriptions by class and by individual drug. Among off-label antidepressant prescriptions, the proportion of prescriptions in each of the following categories was measured: strong evidence supporting use of the prescribed drug for the respective indication; no strong evidence for the prescribed drug but strong evidence supporting use of another drug in the same class for the indication; or no strong evidence supporting use of the prescribed drug and all other drugs in the same class for the indication. Results 106 850 antidepressant prescriptions were written by 174 physicians for 20 920 adults. By class, tricyclic antidepressants had the highest prevalence of off-label indications (81.4%, 95% confidence interval, 77.3% to 85.5%), largely due to a high off-label prescribing rate for amitriptyline (93%, 89.6% to 95.7%). Trazodone use for insomnia was the most common off-label use for antidepressants, accounting for 26.2% (21.9% to 30.4%) of all off-label prescriptions. For only 15.9% (13.0% to 19.3%) of all off-label prescriptions, the prescribed drug had strong scientific evidence for the respective indication. For 39.6% (35.7% to 43.2%) of off-label prescriptions, the prescribed drug did not have strong evidence but another antidepressant in the same class had strong evidence for the respective indication. For the remaining 44.6% (40.2% to 49.0%) of off-label prescriptions, neither the prescribed drug nor any other drugs in the class had strong evidence for the indication.Conclusions When primary care physicians prescribed antidepressants for off-label indications, these indications were usually not supported by strong scientific evidence, yet often another antidepressant in the same class existed that had strong evidence for the respective indication. There is an important need to generate and provide
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Among off-label antidepressant prescriptions, the proportion of prescriptions in each of the following categories was measured: strong evidence supporting use of the prescribed drug for the respective indication; no strong evidence for the prescribed drug but strong evidence supporting use of another drug in the same class for the indication; or no strong evidence supporting use of the prescribed drug and all other drugs in the same class for the indication. Results 106 850 antidepressant prescriptions were written by 174 physicians for 20 920 adults. By class, tricyclic antidepressants had the highest prevalence of off-label indications (81.4%, 95% confidence interval, 77.3% to 85.5%), largely due to a high off-label prescribing rate for amitriptyline (93%, 89.6% to 95.7%). Trazodone use for insomnia was the most common off-label use for antidepressants, accounting for 26.2% (21.9% to 30.4%) of all off-label prescriptions. For only 15.9% (13.0% to 19.3%) of all off-label prescriptions, the prescribed drug had strong scientific evidence for the respective indication. For 39.6% (35.7% to 43.2%) of off-label prescriptions, the prescribed drug did not have strong evidence but another antidepressant in the same class had strong evidence for the respective indication. For the remaining 44.6% (40.2% to 49.0%) of off-label prescriptions, neither the prescribed drug nor any other drugs in the class had strong evidence for the indication.Conclusions When primary care physicians prescribed antidepressants for off-label indications, these indications were usually not supported by strong scientific evidence, yet often another antidepressant in the same class existed that had strong evidence for the respective indication. There is an important need to generate and provide physicians with evidence on off-label antidepressant use to optimise prescribing decisions.</description><identifier>ISSN: 0959-8138</identifier><identifier>EISSN: 1756-1833</identifier><identifier>DOI: 10.1136/bmj.j603</identifier><identifier>PMID: 28228380</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Aged ; Antidepressants ; Antidepressive Agents - therapeutic use ; Computerized physician order entry ; Electronic Prescribing - statistics &amp; numerical data ; Evidence-Based Medicine ; FDA approval ; Female ; Humans ; Male ; Middle Aged ; Off-Label Use - statistics &amp; numerical data ; Physicians, Primary Care ; Practice Patterns, Physicians' - statistics &amp; numerical data ; Prescription drugs ; Prevalence ; Primary care ; Primary Health Care - methods ; Primary Health Care - statistics &amp; numerical data ; Quebec - epidemiology</subject><ispartof>BMJ (Online), 2017-02, Vol.356, p.j603-j603</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.</rights><rights>Copyright: 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2017 BMJ</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b454t-fa04cd8285b8fbd24c7bb2d5aa820769d4c6820afe66681988f83235c95a3abc3</citedby><cites>FETCH-LOGICAL-b454t-fa04cd8285b8fbd24c7bb2d5aa820769d4c6820afe66681988f83235c95a3abc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28228380$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Jenna</creatorcontrib><creatorcontrib>Motulsky, Aude</creatorcontrib><creatorcontrib>Abrahamowicz, Michal</creatorcontrib><creatorcontrib>Eguale, Tewodros</creatorcontrib><creatorcontrib>Buckeridge, David L</creatorcontrib><creatorcontrib>Tamblyn, Robyn</creatorcontrib><title>Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system</title><title>BMJ (Online)</title><addtitle>BMJ</addtitle><description>Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care practices in and around two major urban centres in Quebec, Canada.Participants Patients aged 18 years or older who visited a study physician between 1 January 2003 and 30 September 2015 and were prescribed an antidepressant through the electronic prescribing system.Main outcome measures Prevalence of off-label indications for antidepressant prescriptions by class and by individual drug. Among off-label antidepressant prescriptions, the proportion of prescriptions in each of the following categories was measured: strong evidence supporting use of the prescribed drug for the respective indication; no strong evidence for the prescribed drug but strong evidence supporting use of another drug in the same class for the indication; or no strong evidence supporting use of the prescribed drug and all other drugs in the same class for the indication. Results 106 850 antidepressant prescriptions were written by 174 physicians for 20 920 adults. By class, tricyclic antidepressants had the highest prevalence of off-label indications (81.4%, 95% confidence interval, 77.3% to 85.5%), largely due to a high off-label prescribing rate for amitriptyline (93%, 89.6% to 95.7%). Trazodone use for insomnia was the most common off-label use for antidepressants, accounting for 26.2% (21.9% to 30.4%) of all off-label prescriptions. For only 15.9% (13.0% to 19.3%) of all off-label prescriptions, the prescribed drug had strong scientific evidence for the respective indication. For 39.6% (35.7% to 43.2%) of off-label prescriptions, the prescribed drug did not have strong evidence but another antidepressant in the same class had strong evidence for the respective indication. For the remaining 44.6% (40.2% to 49.0%) of off-label prescriptions, neither the prescribed drug nor any other drugs in the class had strong evidence for the indication.Conclusions When primary care physicians prescribed antidepressants for off-label indications, these indications were usually not supported by strong scientific evidence, yet often another antidepressant in the same class existed that had strong evidence for the respective indication. There is an important need to generate and provide physicians with evidence on off-label antidepressant use to optimise prescribing decisions.</description><subject>Adult</subject><subject>Aged</subject><subject>Antidepressants</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Computerized physician order entry</subject><subject>Electronic Prescribing - statistics &amp; numerical data</subject><subject>Evidence-Based Medicine</subject><subject>FDA approval</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Off-Label Use - statistics &amp; numerical data</subject><subject>Physicians, Primary Care</subject><subject>Practice Patterns, Physicians' - statistics &amp; numerical data</subject><subject>Prescription drugs</subject><subject>Prevalence</subject><subject>Primary care</subject><subject>Primary Health Care - methods</subject><subject>Primary Health Care - statistics &amp; numerical data</subject><subject>Quebec - epidemiology</subject><issn>0959-8138</issn><issn>1756-1833</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV1rFDEUhoModqmF_gIJeOPN1HxMMhkvBCltFQq9sdchnzXLTLImmcL-D3-w2e72Q8GrHHLe85z38AJwitEZxpR_0vP6bM0RfQVWeGC8w4LS12CFRjZ2AlNxBE5KWSOECB3EyNlbcEQEIYIKtAK_b7zvJqXdBEO0wagaUizQpwxVrMG6TXaltLK0PtzkMKu8hUZl9xlaV0wOmxruHSx1sVuYPNzp978PnJzmBnrBhloVZ6GbnKk5xWAeJ3SId7BsS3XzO_DGq6m4k8N7DG4vL36cf-uub66-n3-97nTP-tp5hXpjBRFMC68t6c2gNbFMKUHQwEfbG94q5R3nXOBRCC8oocyMTFGlDT0GX_bczaJnZ42LNatJHq6USQX5dyeGn_Iu3UtGCRpp3wAfD4Ccfi2uVDmHYtw0qejSUiQWA2YMN4tN-uEf6TotObbz9qqeEjw8A01OpWTnn8xgJHdpy5a23KXdpO9fmn8SPmb7vHE38l_MH91xtbI</recordid><startdate>20170221</startdate><enddate>20170221</enddate><creator>Wong, Jenna</creator><creator>Motulsky, Aude</creator><creator>Abrahamowicz, Michal</creator><creator>Eguale, Tewodros</creator><creator>Buckeridge, David L</creator><creator>Tamblyn, Robyn</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group Ltd</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170221</creationdate><title>Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system</title><author>Wong, Jenna ; Motulsky, Aude ; Abrahamowicz, Michal ; Eguale, Tewodros ; Buckeridge, David L ; Tamblyn, Robyn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b454t-fa04cd8285b8fbd24c7bb2d5aa820769d4c6820afe66681988f83235c95a3abc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antidepressants</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Computerized physician order entry</topic><topic>Electronic Prescribing - statistics &amp; numerical data</topic><topic>Evidence-Based Medicine</topic><topic>FDA approval</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Off-Label Use - statistics &amp; numerical data</topic><topic>Physicians, Primary Care</topic><topic>Practice Patterns, Physicians' - statistics &amp; numerical data</topic><topic>Prescription drugs</topic><topic>Prevalence</topic><topic>Primary care</topic><topic>Primary Health Care - methods</topic><topic>Primary Health Care - statistics &amp; numerical data</topic><topic>Quebec - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Jenna</creatorcontrib><creatorcontrib>Motulsky, Aude</creatorcontrib><creatorcontrib>Abrahamowicz, Michal</creatorcontrib><creatorcontrib>Eguale, Tewodros</creatorcontrib><creatorcontrib>Buckeridge, David L</creatorcontrib><creatorcontrib>Tamblyn, Robyn</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ (Online)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Jenna</au><au>Motulsky, Aude</au><au>Abrahamowicz, Michal</au><au>Eguale, Tewodros</au><au>Buckeridge, David L</au><au>Tamblyn, Robyn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system</atitle><jtitle>BMJ (Online)</jtitle><addtitle>BMJ</addtitle><date>2017-02-21</date><risdate>2017</risdate><volume>356</volume><spage>j603</spage><epage>j603</epage><pages>j603-j603</pages><issn>0959-8138</issn><eissn>1756-1833</eissn><abstract>Objective To examine off-label indications for antidepressants in primary care and determine the level of scientific support for off-label prescribing.Design Descriptive study of antidepressant prescriptions written by primary care physicians using an indication based electronic prescribing system.Setting Primary care practices in and around two major urban centres in Quebec, Canada.Participants Patients aged 18 years or older who visited a study physician between 1 January 2003 and 30 September 2015 and were prescribed an antidepressant through the electronic prescribing system.Main outcome measures Prevalence of off-label indications for antidepressant prescriptions by class and by individual drug. Among off-label antidepressant prescriptions, the proportion of prescriptions in each of the following categories was measured: strong evidence supporting use of the prescribed drug for the respective indication; no strong evidence for the prescribed drug but strong evidence supporting use of another drug in the same class for the indication; or no strong evidence supporting use of the prescribed drug and all other drugs in the same class for the indication. Results 106 850 antidepressant prescriptions were written by 174 physicians for 20 920 adults. By class, tricyclic antidepressants had the highest prevalence of off-label indications (81.4%, 95% confidence interval, 77.3% to 85.5%), largely due to a high off-label prescribing rate for amitriptyline (93%, 89.6% to 95.7%). Trazodone use for insomnia was the most common off-label use for antidepressants, accounting for 26.2% (21.9% to 30.4%) of all off-label prescriptions. For only 15.9% (13.0% to 19.3%) of all off-label prescriptions, the prescribed drug had strong scientific evidence for the respective indication. For 39.6% (35.7% to 43.2%) of off-label prescriptions, the prescribed drug did not have strong evidence but another antidepressant in the same class had strong evidence for the respective indication. For the remaining 44.6% (40.2% to 49.0%) of off-label prescriptions, neither the prescribed drug nor any other drugs in the class had strong evidence for the indication.Conclusions When primary care physicians prescribed antidepressants for off-label indications, these indications were usually not supported by strong scientific evidence, yet often another antidepressant in the same class existed that had strong evidence for the respective indication. There is an important need to generate and provide physicians with evidence on off-label antidepressant use to optimise prescribing decisions.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>28228380</pmid><doi>10.1136/bmj.j603</doi><oa>free_for_read</oa></addata></record>
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language eng
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source MEDLINE; JSTOR Archive Collection A-Z Listing
subjects Adult
Aged
Antidepressants
Antidepressive Agents - therapeutic use
Computerized physician order entry
Electronic Prescribing - statistics & numerical data
Evidence-Based Medicine
FDA approval
Female
Humans
Male
Middle Aged
Off-Label Use - statistics & numerical data
Physicians, Primary Care
Practice Patterns, Physicians' - statistics & numerical data
Prescription drugs
Prevalence
Primary care
Primary Health Care - methods
Primary Health Care - statistics & numerical data
Quebec - epidemiology
title Off-label indications for antidepressants in primary care: descriptive study of prescriptions from an indication based electronic prescribing system
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