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绝经后激素疗法的发展趋势及最新临床证据对其
title：National Use of Postmenopausal Hormone Therapy--
Annual Trends and Response to Recent Evidence
author: Adam L. Hersh, MD, PhD; Marcia L. Stefanick, PhD; Randall S. Stafford, MD, PhD
source: JAMA. 2004;291:47-53
abstract: Context Postmenopausal hormone therapy use increased dramatically during the past 2 decades because of a prevailing belief in its health benefits. Recent evidence from randomized trials published in July 2002 demonstrated adverse cardiovascular disease events and other risks with hormone therapy in the form of oral estrogen combined with progestin.
Objective To describe patterns of hormone therapy use from 1995 until July 2003, including the impact of recent evidence.
Design, Setting, and Population Two databases were used to describe national trends in hormone therapy use from January 1995 to July 2003. The National Prescription Audit database provided data on the number of hormone therapy prescriptions filled by retail pharmacies and the National Disease and Therapeutic Index database provided data on patient visits to office-based physicians during which hormone therapy was prescribed.
Main Outcome Measures Annual number of hormone therapy prescriptions and characteristics of visits to physicians during which hormone therapy was prescribed.
Results Annual hormone therapy prescriptions increased from 58 million in 1995 to 90 million in 1999, representing approximately 15 million women per year, then remained stable through June 2002. Adoption of new oral estrogen/progestin combinations, primarily Prempro, accounted for most of this growth. Obstetrician/gynecologists provided more than 70% of hormone therapy prescriptions, and more than one third of patients were older than 60 years. Following the publication of trial results in July 2002, hormone therapy prescriptions declined in successive months. Relative to January-June 2002, prescriptions from January-June 2003 declined by 66% for Prempro and 33% for Premarin. Small increases were observed in vaginal formulations and in new prescriptions for low-dose Premarin. If prescription rates observed through July 2003 remain stable, a decline to 57 million prescriptions for 2003, similar to the rate in 1995, is projected.
Conclusions Clinical practice responded rapidly to recent evidence of harms associated with hormone therapy. Since July 2002, many patients have discontinued hormone therapy or are tapering to lower doses.
文题：绝经后激素疗法的发展趋势及最新临床证据
摘要：
研究背景：在过去的20年里，绝经后激素疗法发展迅速，因为普遍认为其对健康有益。在2002年7月份所报道的临床随机试验则显示了绝经后激素疗法（口服孕酮及雌激素）可能有导致心血管等疾病的副作用。
目的：回顾从1995年至2003年7月激素疗法的状况，并分析最新的临床证据。
设计、设置及人群：
为描述从1995年至2003年7月激素疗法的状况，使用了2个数据库，美国处方监控数据库提供了零售药商所开激素疗法的处方数目；美国疾病与治疗指南数据库提供了执业医师所开激素疗法的处方数目。
主要结果评价 ：每年激素疗法的处方数目，以及由执业医师开激素处方的就诊特点。
结果：1995年激素疗法的处方数目是5800万，而1999年增长至9000万，以后至2002年6月则维持稳定，每年大约有1500万妇女进行了激素治疗。增长主要是因为因为Prempro，一种孕酮及雌激素的混合物所引起的。妇产科医生所开的处方占所有处方70%，有1/3的病人超过60岁。在2002年7月份报道的临床随机试验结果之后，激素疗法的处方数目持续下降。与2002年1到6月份相比，2003年同期 Prempro 处方下降了66%，Premarin下降了33%。相反在阴道剂型或小剂量激素疗法的处方数目则略有增长。如果这种下降趋势保持稳定的话，那么，2003年的处方数目将降至5800万，与1995年持平。
结论：临床实践对最近激素治疗相关的副作用的临床证据反应迅速，从2002年7月起，许多病人停止激素治疗，或减少了剂量。
2.pdf (109.36k) editorial:
title:The Complex World of Prescribing Behavior
author: C. David Naylor, MD, DPhil
source:JAMA. 2004;291:104-106.
abstract:
The study by Hersh et al shows dramatic declines in US use of oral hormone therapy following termination and publication of the estrogen-progestin arm of the Women's Health Initiative (WHI) trial in July 2002. Drawing on national data sources, the study estimated a 56% decline in oral estrogen-progestin prescriptions within a year of the WHI publication, with smaller but still striking declines in use of estrogens. Similar declines have already been reported from Canada.5
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作者:admin@医学,生命科学 2011-05-23 05:11
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