In:
European Journal of Clinical Pharmacology, Springer Science and Business Media LLC, Vol. 79, No. 8 ( 2023-08), p. 1091-1105
Abstract:
Despite being discouraged by guidelines, long-term use of benzodiazepines and related Z-drugs (BZDR) remains frequent in the real-world. An improved understanding of factors associated with the transition from new to long-term BZDR use and of temporal BZDR use trajectories is needed. We aimed to assess the proportion of long-term BZDR use ( 〉 6 months) in incident BZDR-recipients across the lifespan; identify 5-year BZDR use trajectories; and explore individual characteristics (demographic, socioeconomic and clinical) and prescribing-related factors (pharmacological properties of the initial BZDR, prescriber’s healthcare level, and concurrent dispensing of other medications) associated with long-term BZDR use and distinct trajectories. Methods Our nationwide register-based cohort included all BZDR-recipients in Sweden with first dispensation in 2007–2013. Trajectories of BZDR use days per year were built using group-based trajectory modelling. Cox regression and multinomial logistic regression were fitted to assess the predictors of long-term BZDR use and trajectories’ membership. Results In 930,465 incident BZDR-recipients, long-term use increased with age (20.7%, 41.0%, and 57.4% in 0–17, 18–64, and ≥ 65-year-olds, respectively). Four BZDR use trajectories emerged, labelled ‘discontinued’, ‘decreasing’, ‘slow decreasing’ and ‘maintained’. The proportion of the ‘discontinued’ trajectory members was the largest in all ages, but reduced from 75.0% in the youths to 39.3% in the elderly, whereas the ‘maintained’ increased with age from 4.6% to 36.7%. Prescribing-related factors, in particular multiple BZDRs at initiation and concurrent dispensing of other medications, were associated with increased risks of long-term ( vs short-term) BZDR use and developing other trajectories ( vs ‘discontinued’) in all age groups. Conclusions The findings highlight the importance of raising awareness and providing support to prescribers to make evidence-based decisions on initiating and monitoring BZDR treatment across the lifespan.
Type of Medium:
Online Resource
ISSN:
0031-6970
,
1432-1041
DOI:
10.1007/s00228-023-03515-2
Language:
English
Publisher:
Springer Science and Business Media LLC
Publication Date:
2023
detail.hit.zdb_id:
1459058-X
SSG:
15,3
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