Search

Aims: The aims of this study were to measure the prevalence of polypharmacy and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. Methods: This was a multinational retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain and the UK. We used anonymized longitudinal patient‐level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5–9 and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6‐month period. Selected medications were: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the healthcare context to interpret findings. Results: Age and gender distribution was similar across the six countries (mean age 75–76 years; 54–56% female). The prevalence of polypharmacy of 5–9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The healthcare context information explained possible underreporting for selected medications. Conclusions: We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worryingly high usage of PPIs and benzodiazepines supports current efforts to improve polypharmacy management across Europe. [ABSTRACT FROM AUTHOR]

Endothelin-1 (ET-1) is a newly described pain mediator that is involved in the pathogenesis of pain states ranging from trauma to cancer. ET-1 is synthesized by keratinocytes in normal skin and is locally released after cutaneous injury. While it is able to trigger pain through its actions on endothelin-A (ET[sub.A]) receptors of local nociceptors, it can coincidentally produce analgesia through endothelin-B (ET[sub.B]) receptors. Here we map a new endogenous analgesic circuit, in which ET[sub.B] receptor activation induces the release of [beta]-endorphin from keratinocytes and the activation of G-protein-coupled inwardly rectifying potassium channels (GIRKs, also named Kir-3) linked to opioid receptors on nociceptors. These results indicate the existence of an intrinsic feedback mechanism to control peripheral pain in skin, and establish keratinocytes as an ET[sub.B] receptor-operated opioid pool., Author(s): Alla Khodorova [1, 8]; Betsy Navarro [2, 8]; Laurence Sophie Jouaville [1, 3, 8]; Jo-Ellen Murphy [4]; Frank L Rice [5]; Joseph E Mazurkiewicz [5]; Denise Long-Woodward [4]; Markus [...]