title: Triptans use and overuse: A pharmacoepidemiology study from the French health insurance system database covering 4.1 million people.
abstract: BACKGROUND
  The objective of this study was to estimate and to characterize the actual patterns of triptan use and overuse in France using a drug reimbursement database.
  
  
  METHODS
  We included all people covered by the French General Health Insurance System (GHIS) from the Provence-Alpes-Côte-d'Azur (PACA) and Corsica administrative areas who had at least one dispensed dose of triptans between May 2010 and December 2011. All dispensed doses of triptans, migraine prophylactic treatment and psychotropic medications were extracted from the GHIS database. Triptan overuse was defined as triptan use >20 defined daily doses (DDD) per month on a regular basis for more than three consecutive months. Risk of overuse was assessed using logistic regression adjusted for gender and age.
  
  
  RESULTS
  We included 99,540 patients who had at least one prescription of a triptan over the 20 months of the study. Among them, 2243 patients (2.3%) were identified as overusers and received 20.2% of the total DDD prescribed. Twelve percent of overusers and 6.9% of non-overusers were aged more than 65 years (OR: 1.81). Overusers did not have a greater number of prescribers and pharmacists than non-overusers. They were more frequently prescribed a prophylactic medication for migraine treatment (56.8% vs 35.9%, OR: 2.36), benzodiazepines (69.9% vs 54.7%, OR: 1.93) and antidepressants (49.4% vs 30.2%, OR: 2.33).
  
  
  CONCLUSIONS
  This work suggests that triptan overuse may be due to insufficient prescriber awareness of appropriate prescribing. The off-label prescription of triptans among the elderly necessitates investigating their cardiovascular risk profile in this sub-group.
authors: Aix Marseille Université, CNRS 7289 - Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France.
authors: David
authors: D
authors: Braunstein
authors: Centre d'évaluation et de traitement de la douleur, hôpital Timone, Pôle Neurosciences Cliniques, Hôpital de la Timone, France INSERM/UdA, France.
authors: Anne
authors: A
authors: Donnet
authors: Aix Marseille Université, CNRS 7289 - Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France.
authors: Vincent
authors: V
authors: Pradel
authors: Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France.
authors: Vincent
authors: V
authors: Sciortino
authors: Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France.
authors: Véronique
authors: V
authors: Allaria-Lapierre
authors: INSERM/UdA, France Département d'Evaluation et traitement de la Douleur, Pôle Neurosciences Cliniques du CHU de Nice, Hôpital Cimiez, France.
authors: Michel
authors: M
authors: Lantéri-Minet
authors: Aix Marseille Université, CNRS 7289 - Institut de Neurosciences Timone, Centre d'Evaluation et d'Information sur la Pharmacodépendance & Addictovigilance PACA-Corse, Service de Pharmacologie Clinique et Pharmacovigilance, France joelle.micallef@ap-hm.fr.
authors: Joëlle
authors: J
authors: Micallef
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000639:trends*; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D009313:National Health Programs / Q000639:trends*; D017891:Pharmacoepidemiology / Q000639:trends*; D012307:Risk Factors; D014363:Tryptamines / Q000191:economics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014363:Tryptamines
keywords: Migraine; overuse; pharmacoepidemiology; prescription database; triptan