Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database.
France
THIN database
United Kingdom
essential tremor
treatment
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
Jan 2024
Jan 2024
Historique:
revised:
28
08
2023
received:
31
05
2023
accepted:
31
08
2023
pubmed:
22
9
2023
medline:
22
9
2023
entrez:
22
9
2023
Statut:
ppublish
Résumé
Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom. Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment. A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication. This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom.
METHODS
METHODS
Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment.
RESULTS
RESULTS
A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication.
CONCLUSION
CONCLUSIONS
This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16064Informations de copyright
© 2023 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
Références
Reich SG. Essential Tremor. Med Clin North Am. 2019;103(2):351-356. doi:10.1016/j.mcna.2018.10.016
Haubenberger D, Hallett M. Essential Tremor. N Engl J Med. 2018;378(19):1802-1810. doi:10.1056/NEJMcp1707928
Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010;25(5):534-541. doi:10.1002/mds.22838
Song P, Zhang Y, Zha M, et al. The global prevalence of essential tremor, with emphasis on age and sex: a meta-analysis. J Glob Health. 2021;11:4028. doi:10.7189/jogh.11.04028
Louis ED, McCreary M. How common is Essential tremor? Update on the worldwide prevalence of Essential tremor. Tremor Other Hyperkinet Mov (N Y). 2021;9(11):28. doi:10.5334/tohm.632
Bhatia KP, Bain P, Bajaj N, et al. Consensus statement on the classification of tremors. from the task force on tremor of the international parkinson and movement disorder society. Mov Disord. 2018;33(1):75-87. doi:10.1002/mds.27121
Angelini L, Paparella G, De Biase A, et al. Longitudinal study of clinical and neurophysiological features in essential tremor. Eur J Neurol. 2023;30(3):631-640. doi:10.1111/ene.15650
Louis ED, Rios E, Henchcliffe C. How are we doing with the treatment of essential tremor (ET)?: persistence of patients with ET on medication: data from 528 patients in three settings. Eur J Neurol. 2010;17(6):882-884. doi:10.1111/j.1468-1331.2009.02926.x
Ferreira JJ, Mestre TA, Lyons KE, et al. MDS evidence-based review of treatments for essential tremor. Mov Disord. 2019 Jul;34(7):950-958. doi:10.1002/mds.27700
Shanker V. Essential tremor: diagnosis and management. BMJ. 2019 Aug;5(366):l4485. doi:10.1136/bmj.l4485
Sharma S, Pandey S. Treatment of essential tremor: current status. Postgrad Med J. 2020 Feb;96(1132):84-93. doi:10.1136/postgradmedj-2019-136647
Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol. 2011;10(2):148-161. doi:10.1016/S1474-4422(10)70322-7
Gironell A, Kulisevsky J, Barbanoj M, López-Villegas D, Hernández G, Pascual-Sedano B. A randomized placebo-controlled comparative trial of gabapentin and propranolol in essential tremor. Arch Neurol. 1999 Apr;56(4):475-480. doi:10.1001/archneur.56.4.475
Koller WC, Royse VL. Efficacy of primidone in essential tremor. Neurology. 1986 Jan;36(1):121-124. doi:10.1212/wnl.36.1.121
Sullivan KL, Hauser RA, Zesiewicz TA. Essential tremor. Epidemiology, diagnosis, and treatment. Neurologist. 2004;10(5):250-258. doi:10.1097/01.nrl.0000138736.07840.b2
Zappia M, Albanese A, Bruno E, et al. Treatment of essential tremor: a systematic review of evidence and recommendations from the Italian movement disorders association. J Neurol. 2013;260(3):714-740. doi:10.1007/s00415-012-6628-x
Benito-León J, Louis ED. Clinical update: diagnosis and treatment of essential tremor. Lancet. 2007;369(9568):1152-1154. doi:10.1016/S0140-6736(07)60544-3 Erratum in: Lancet 2007 Aug 18;370(9587):566.
Koller WC, Vetere-Overfield B. Acute and chronic effects of propranolol and primidone in essential tremor. Neurology. 1989;39(12):1587-1588. doi:10.1212/wnl.39.12.1587
Zesiewicz TA, Chari A, Jahan I, Miller AM, Sullivan KL. Overview of essential tremor. Neuropsychiatr Dis Treat. 2010;6:401-408. doi:10.2147/ndt.s4795
Dai D, Samiian A, Fernandes J, Coetzer H. Multiple comorbidities, psychiatric disorders, healthcare resource utilization and costs among adults with Essential tremor: a retrospective observational study in a large US commercially insured and Medicare advantage population. J Health Econ Outcomes Res. 2022;9(2):37-46. doi:10.36469/001c.37307
Kestenbaum M, Ford B, Louis ED. Estimating the proportion of Essential tremor and Parkinson's disease patients undergoing deep brain stimulation surgery: five-year data from Columbia University medical center (2009-2014). Mov Disord Clin Pract. 2015;2(4):384-387. doi:10.1002/mdc3.12185
Diaz NL, Louis ED. Survey of medication usage patterns among essential tremor patients: movement disorder specialists vs. general neurologists. Parkinsonism Relat Disord. 2010;16(9):604-607. doi:10.1016/j.parkreldis.2010.07.011
Shah C, Jackson GR, Sarwar AI, Mandava P, Jamal F. Treatment patterns in Essential tremor: a retrospective analysis. Tremor Other Hyperkinet Mov (N Y). 2022;12:10. doi:10.5334/tohm.682
Delgado N, Berry DS, Hernandez DI, Louis ED. Prospective, longitudinal analysis of medication use in a cohort of elderly essential tremor cases. J Neurol Sci. 2022;15(442):120387. doi:10.1016/j.jns.2022.120387
Gupta HV, Pahwa R, Dowell P, Khosla S, Lyons KE. Exploring essential tremor: results from a large online survey. Clin Park Relat Disord. 2021;25(5):100101. doi:10.1016/j.prdoa.2021.100101
Blak BT, Thompson M, Dattani H, Bourke A. Generalisability of the health improvement network (THIN) database: demographics, chronic disease prevalence and mortality rates. Inform Prim Care. 2011;19(4):251-255. doi:10.14236/jhi.v19i4.820
Schrag A, Horsfall L, Walters K, Noyce A, Petersen I. Prediagnostic presentations of Parkinson's disease in primary care: a case-control study. Lancet Neurol. 2015;14(1):57-64. doi:10.1016/S1474-4422(14)70287-X
Iordache L, Strazzulla A, Lekens B, Bergmann J, Diamantis S. Évaluation du suivi des recommandations de prise en charge des infections urinaires en médecine de ville en France. Med Malad Infect. 2018;48:S101-S102.
Greenfield G, Foley K, Majeed A. Rethinking primary care's gatekeeper role. BMJ. 2016;23(354):i4803. doi:10.1136/bmj.i4803
Antonazzo IC, Conti S, Rozza D, et al. Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol. 2022;20(13):987618. doi:10.3389/fneur.2022.987618
Metcalfe D, Masters J, Delmestri A, et al. Coding algorithms for defining Charlson and Elixhauser co-morbidities in read-coded databases. BMC Med Res Methodol. 2019 Jun 6;19(1):115. doi:10.1186/s12874-019-0753-5
Khan NF, Perera R, Harper S, Rose PW. Adaptation and validation of the Charlson index for read/OXMIS coded databases. BMC Fam Pract. 2010 Jan;5(11):1. doi:10.1186/1471-2296-11-1
Glasheen WP, Cordier T, Gumpina R, Haugh G, Davis J, Renda A. Charlson comorbidity index: ICD-9 update and ICD-10 translation. Am Health Drug Benefits. 2019 Jun-Jul;12(4):188-197.
Pazzagli L, Brandt L, Linder M, et al. Methods for constructing treatment episodes and impact on exposure-outcome associations. Eur J Clin Pharmacol. 2020;76(2):267-275. doi:10.1007/s00228-019-02780-4
Merlo J, Wessling A, Melander A. Comparison of dose standard units for drug utilisation studies. Eur J Clin Pharmacol. 1996;50(1-2):27-30. doi:10.1007/s002280050064
Lolekha P, Dharmasaroja P, Uransilp N, Sukphulloprat P, Muengtaweepongsa S, Kulkantrakorn K. The differences in clinical characteristics and natural history between essential tremor and essential tremor plus. Sci Rep. 2022;12(1):7669. doi:10.1038/s41598-022-11775-8
Pasina L, Brucato AL, Falcone C, et al. Medication non-adherence among elderly patients newly discharged and receiving polypharmacy. Drugs Aging. 2014;31(4):283-289. doi:10.1007/s40266-014-0163-7
Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med. 2012;28(2):287-300. doi:10.1016/j.cger.2012.01.008
Vetterick C, Lyons KE, Matthews LG, Pendal R, Ravina B. The hidden burden of disease and treatment experiences of patients with Essential tremor: a retrospective claims data analysis. Adv Ther. 2022;39(12):5546-5567. doi:10.1007/s12325-022-02318-8
Huang H, Yang X, Zhao Q, et al. Prevalence and risk factors of depression and anxiety in Essential tremor patients: a cross-sectional study in Southwest China. Front Neurol. 2019;10:1194. doi:10.3389/fneur.2019.01194
Louis ED. Commentary: time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol. 2023;14:1136150. doi:10.3389/fneur.2023.1136150
Amlang CJ, Trujillo Diaz D, Louis ED. Essential tremor as a "waste basket" diagnosis: diagnosing Essential tremor remains a challenge. Front Neurol. 2020;25(11):172. doi:10.3389/fneur.2020.00172
Jain S, Lo SE, Louis ED. Common misdiagnosis of a common neurological disorder: how are we misdiagnosing essential tremor? Arch Neurol. 2006;63(8):1100-1104. doi:10.1001/archneur.63.8.1100
Louis ED, Applegate LM, Rios E. ICD-9 CM code 333.1 as an identifier of patients with essential tremor: a study of the positive predictive value of this code. Neuroepidemiology. 2007;28(3):181-185. doi:10.1159/000104096
Buja A, Elvini S, Caberlotto R, et al. Healthcare service usage and costs for elderly patients with obstructive lung disease. Int J Chron Obstruct Pulmon Dis. 2020;18(15):3357-3366. doi:10.2147/COPD.S275687
Little P, Dorward M, Warner G, Stephens K, Senior J, Moore M. Importance of patient pressure and perceived pressure and perceived medical need for investigations, referral, and prescribing in primary care: nested observational study. BMJ. 2004;328(7437):444. doi:10.1136/bmj.38013.644086.7C
Gandy M, Karin E, Fogliati VJ, et al. Emotional and cognitive difficulties, help-seeking, and barriers to treatment in neurological disorders. Rehabil Psychol. 2018;63(4):563-574. doi:10.1037/rep0000241
Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 2006;15(1):83-91. doi:10.1007/s11136-005-8661-z
Shalash AS, Mohamed H, Mansour AH, et al. Clinical profile of non-motor symptoms in patients with Essential tremor: impact on quality of life and age-related differences. Tremor Other Hyperkinet Mov (N Y). 2019;9. doi:10.7916/tohm.v0.736
Lee S, Chung SJ, Shin HW. Neuropsychiatric symptoms and quality of life in patients with adult-onset idiopathic focal dystonia and Essential tremor. Front Neurol. 2020;11:1030. doi:10.3389/fneur.2020.01030
Khan NF, Harrison SE, Rose PW. Validity of diagnostic coding within the general practice research database: a systematic review. Br J Gen Pract. 2010;60(572):e128-e136. doi:10.3399/bjgp10X483562
Lewis JD, Schinnar R, Bilker WB, Wang X, Strom BL. Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf. 2007;16(4):393-401. doi:10.1002/pds.1335
Shetty N. Essential tremor-do we have better therapeutics? A review of recent advances and future directions. Curr Neurol Neurosci Rep. 2022;22(3):197-208. doi:10.1007/s11910-022-01185-8
Louis ED. The pharmacotherapeutic landscape for Essential tremor: quantifying the level of unmet need from a patient and epidemiologic perspective. Clin Neuropharmacol. 2022;45(4):99-104. doi:10.1097/WNF.0000000000000509