Yan Li1, Chris Delcher2, Gary M Reisfield3, Yu-Jung Wei1,4, Joshua D Brown1,4, Almut G Winterstein1,4,5. 1. Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida. 2. Institute for Pharmaceutical Outcomes & Policy, Department of Pharmacy Practice & Science, College of Pharmacy, University of Kentucky, Lexington, Kentucky. 3. Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida. 4. Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida. 5. Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida.
Abstract
OBJECTIVE: To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults. METHODS: We used the MarketScan Research Database to identify a cohort of adults 18 to 64 years who had ≥ two-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder. RESULTS: 48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for >50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14 days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365 days. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration. CONCLUSIONS: SMRs are widely used in the United States. Their use slightly increased in recent years but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.
OBJECTIVE: To examine the prevalence and duration of skeletal muscle relaxant (SMR) treatment among commercially insured adults. METHODS: We used the MarketScan Research Database to identify a cohort of adults 18 to 64 years who had ≥ two-year continuous enrollment between 2005 and 2018. We estimated the prevalence of SMR treatment using a repeated cross-sectional design and derived treatment duration using the Kaplan-Meier method. Analyses were stratified by age group, sex, geographic region, individual SMR agent, and musculoskeletal disorder. RESULTS: 48.7 million individuals were included. Treatment prevalence ranged from 61.5 to 68.3 per 1000. About one-third of users did not have a preceding musculoskeletal disorder diagnosis. Cyclobenzaprine was the dominant agent accounting for >50% of prescriptions. The considerable growth in the use of baclofen, tizanidine, and methocarbamol paralleled with a decline in carisoprodol and metaxalone use. The prevalence was highest in the South while lowest in the Northeast. The median treatment duration was 14 days with 4.0%, 1.9%, and 1.0% of individuals using SMRs for more than 90, 180, and 365 days. Compared with cyclobenzaprine, patients initiating baclofen, tizanidine, and carisoprodol had longer treatment duration. CONCLUSIONS: SMRs are widely used in the United States. Their use slightly increased in recent years but trends varied among individual agents, patient groups, and geographic regions. Despite limited evidence to support efficacy, a sizable number of U.S. adults used SMRs for long-term and off-label conditions. Further study is needed to understand determinants of treatment as well as outcomes associated with such use.
Authors: Cheng Chen; Sean Hennessy; Colleen M Brensinger; Ghadeer K Dawwas; Emily K Acton; Warren B Bilker; Sophie P Chung; Sascha Dublin; John R Horn; Todd A Miano; Thanh Phuong Pham Nguyen; Samantha E Soprano; Charles E Leonard Journal: Br J Clin Pharmacol Date: 2022-06-01 Impact factor: 3.716
Authors: Ghadeer K Dawwas; Sean Hennessy; Colleen M Brensinger; Emily K Acton; Warren B Bilker; Sophie Chung; Sascha Dublin; John R Horn; Melanie M Manis; Todd A Miano; David W Oslin; Thanh Phuong Pham Nguyen; Samantha E Soprano; Douglas J Wiebe; Charles E Leonard Journal: CNS Drugs Date: 2022-03-06 Impact factor: 6.497