Trend Analysis of Anti-Allergic Medicines During the 11-Year Period in Iran (2006-2017)
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Abstract
Up to 40% of the global and 7.4-41.3% of the Middle East population are affected by Allergic Rhinitis (AR). Patients with AR versus control group experience approximately twofold pharmaceutical expenditures and 1.8-fold number of visits. Since drug utilization can show various times of developing a disease in a country, it is used as an alternative for prevalence. In this study, we try to examine and explain the consumption of anti-allergic medicines during the past 11 years to have a perspective view of these kinds of medicines. In this descriptive and cross-sectional study that investigates anti-allergic medicines over a 11-year period (2006-2017), we used the Iranian pharmaceutical statistical datasheet published by the Iranian Ministry of Health. According to treatment guidelines of AR and WHO ATC code, we categorized anti-allergic medicines into five groups (antihistamines, Beta 2 agonists, Corticosteroids, Fixed-dose, and others), Then DIDs for these groups were calculated and analyzed. Based on our findings in this study, cetirizine, Loratadine, and Inhaled Salbutamol got the highest DID among all five groups, with 99.2, 65.4, and 57.6 retrospectively. Generally based on the third level of ATC code (second-generation anti-histamines, respiratory system drugs for obstructive airway disease, respiratory system nasal preparation, and corticosteroid for systemic use) are faced with ascending market sales. Generally, with the upward trend of anti-allergic medicines, we can conclude that the incidence of AR in Iran during the past 11 years has increased, and policymakers should follow this trend concerning a better supply chain.
1. Akdis CA, Hellings PW, Agache I. Global Atlas of Allergic Rhinitis and Chronic Rhinosinusitis. Zurich: European Academy of Allergy and Clinical Immunology, 2015:2.
2. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;86:8-160.
3. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001;108:S2-8.
4. Mohammadzadeh I, Barari-Savadkoohi R, Alizadeh-Navaei R. The prevalence of allergic rhinitis in Iranian children: A systematic review and descriptive meta-analysis. J Pediatr Rev 2013;1:19-24.
5. Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc 2007;28:3-9.
6. Dykewicz MS, Wallace DV, Baroody F, Bernstein J, Craig T, Finegold I, et al. Treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2017;30:1-23.
7. Landolina N, Levi-Schaffer F. Monoclonal antibodies: the new magic bullets for allergy: IUPHAR Review 17. Br J Pharmacol 2016;173:793-803.
8. Özdemir Ö. Omalizumab and sino-nasal allergy treatment. MOJ Immunol 2018;6:25-7.
9. Church MK, Church DS. Pharmacology of antihistamines. Indian J Dermatol 2013;58:219-24.
10. Slater JW, Zechnich AD, Haxby DG. Second-generation antihistamines: a comparative review. Drugs 1999;57:31-47.
11. Suarez-Castanon C, Modrono-Riano G, Solis-Sanchez G. Use of anti-allergic drugs in children. Allergol Immunopathol (Madr) 2017;45:506-7.
12. Yektadoost A, Ebrahimi F, Mashouf M, Hadidi N, Koopaei NN, Kebriaeezadeh A. Trend Analysis of Medicine Consumption Based on Therapeutic Categories in Iran: 2000-2016. J Res Pharm Pract 2018;7:95-103.
13. DeShazo RD, Kemp SF, Corren J, Feldweg AM. Pharmacotherapy of allergic rhinitis. UpToDate, 2018.
14. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2018. Oslo, Norway, 2017:14-21.
15. Pharmaceutical statistical database 2016. FDA. (Accessed at https://www.fda.gov.ir/.)
16. World Health Organization. Introduction to drug utilization research, 2003.
17. Sarayani A, Rashidian A, Gholami K. Low utilization of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study. BMJ open 2014;4:e005859.
18. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2018. Oslo, Norway, 2017:34-5.
19. Anil Kumar, Beenta. Prescription writing trends of antihistamines at the university health centre 2009;71:307-10.
20. Mihani J, Abazi B, Fida M, Myftari B, Këlliçi S. The Use of H1 Antihistamines in Albania: Risks and Role of Professional Counseling. Albanian J Med Health Sci 2015;46:83-92.
21. Lee YM, Song I, Lee EK, Shin JY. Comparison of first-and second-generation antihistamine prescribing in elderly outpatients: A health insurance database study in 2013. Int J Clin Pharmacol Ther 2017;55:781-90.
22. Huang W, Guo Y, Chen M, Wang B, Zhong M. Utilization analysis of oral antihistamines in our hospital from 2008 to 2011. Chin J Clin Pharm 2012;4.
23. Iakovlieva L, V. Perederii A. Pharmacoepidemiological study of the dynamics of consumption of antihistamines in Ukraine. Clin pharm 2015;19:33-7.
24. FDA. National Formulary of Iran (Accessed at http://irc.fda.gov.ir/nfi?Length=3.)
25. FDA. U.S Food and Drug Administration (Accessed at https://www.fda.gov/home.)
26. Chantaphakul H, Ruxrungtham K. Fixed-Dose combination of the inhaled corticosteroid and long-acting beta2-agonist therapy in adults with persistent asthma. Expert Opin Pharmacother 2016;17:631-42.
27. Frois C, Wu EQ, Ray S, Colice GL. Inhaled corticosteroids or long-acting β-agonists alone or in fixed-dose combinations in asthma treatment: A systematic review of fluticasone/budesonide and formoterol/salmeterol. Clin Ther 2009;31:2779-803.
28. Xu Y, Zhang J, Wang J. The efficacy and safety of selective H1-antihistamine versus leukotriene receptor antagonist for seasonal allergic rhinitis: a meta-analysis. PloS one 2014;9:e112815.
29. Li, Jiang. “Utilization of Antihistamine Drugs in Institute of Dermatology of Chinese Academy of Medical Sciences in Our Hospital During the Period 2008-2010.” Evaluation and Analysis of Drug-Use in Hospitals of China 2011;11.
30. Henriksen DP, Davidsen JR, Laursen CB, Christiansen A, Damkier P, Hallas J, et al. Montelukast use—a 19-year nationwide drug utilisation study. Eur J Clin Pharmacol 2017;73:1297-304.
31. Lu Y, Yin M, Cheng L. [Meta-analysis of leukotriene receptor antagonist montelukast in the treatment of allergic rhinitis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014;49:659-67.
32. Compalati E, Baena-Cagnani R, Penagos M, Badellino H, Braido F, Gomez RM, et al. Systematic review on the efficacy of fexofenadine in seasonal allergic rhinitis: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Int Arch Allergy Immunol 2011;156:1-15.
33. Layton D, Osborne VM, Gilchrist A, Shakir SAW. Examining the utilization and tolerability of the non-sedating antihistamine levocetirizine in England using prescription-event monitoring data. Drug Saf 2011;34:1177-89.
34. Lee CF, Sun HL, Lu KH, Ku MS, Lue KH. The comparison of cetirizine, levocetirizine and placebo for the treatment of childhood perennial allergic rhinitis. Pediatr Allergy Immunol 2009;20:493-9.
35. Snidvongs K, Seresirikachorn K, Khattiyawittayakun L, Chitsuthipakorn W. Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 2017;77:175-86.
36. Natt RS, Karkos PD, Natt DK, Theochari EG, Karkanevatos A. Treatment trends in allergic rhinitis and asthma: a British ENT survey. BMC Ear Nose Throat Disord 2011;11:3.
37. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998;317:1624-9.
38. Bhatia S, Baroody FM, deTineo M, Naclerio RM. Increased nasal airflow with budesonide compared with desloratadine during the allergy season. Arch Otolaryngol Head Neck Surg 2005;131:223-8.
39. Wilson AM, O'Byrne PM, Parameswaran K. Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis. Am J Med 2004;116:338-44.
2. Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008;86:8-160.
3. Skoner DP. Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis. J Allergy Clin Immunol 2001;108:S2-8.
4. Mohammadzadeh I, Barari-Savadkoohi R, Alizadeh-Navaei R. The prevalence of allergic rhinitis in Iranian children: A systematic review and descriptive meta-analysis. J Pediatr Rev 2013;1:19-24.
5. Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc 2007;28:3-9.
6. Dykewicz MS, Wallace DV, Baroody F, Bernstein J, Craig T, Finegold I, et al. Treatment of seasonal allergic rhinitis. Ann Allergy Asthma Immunol 2017;30:1-23.
7. Landolina N, Levi-Schaffer F. Monoclonal antibodies: the new magic bullets for allergy: IUPHAR Review 17. Br J Pharmacol 2016;173:793-803.
8. Özdemir Ö. Omalizumab and sino-nasal allergy treatment. MOJ Immunol 2018;6:25-7.
9. Church MK, Church DS. Pharmacology of antihistamines. Indian J Dermatol 2013;58:219-24.
10. Slater JW, Zechnich AD, Haxby DG. Second-generation antihistamines: a comparative review. Drugs 1999;57:31-47.
11. Suarez-Castanon C, Modrono-Riano G, Solis-Sanchez G. Use of anti-allergic drugs in children. Allergol Immunopathol (Madr) 2017;45:506-7.
12. Yektadoost A, Ebrahimi F, Mashouf M, Hadidi N, Koopaei NN, Kebriaeezadeh A. Trend Analysis of Medicine Consumption Based on Therapeutic Categories in Iran: 2000-2016. J Res Pharm Pract 2018;7:95-103.
13. DeShazo RD, Kemp SF, Corren J, Feldweg AM. Pharmacotherapy of allergic rhinitis. UpToDate, 2018.
14. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2018. Oslo, Norway, 2017:14-21.
15. Pharmaceutical statistical database 2016. FDA. (Accessed at https://www.fda.gov.ir/.)
16. World Health Organization. Introduction to drug utilization research, 2003.
17. Sarayani A, Rashidian A, Gholami K. Low utilization of diabetes medicines in Iran, despite their affordability (2000-2012): a time-series and benchmarking study. BMJ open 2014;4:e005859.
18. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2018. Oslo, Norway, 2017:34-5.
19. Anil Kumar, Beenta. Prescription writing trends of antihistamines at the university health centre 2009;71:307-10.
20. Mihani J, Abazi B, Fida M, Myftari B, Këlliçi S. The Use of H1 Antihistamines in Albania: Risks and Role of Professional Counseling. Albanian J Med Health Sci 2015;46:83-92.
21. Lee YM, Song I, Lee EK, Shin JY. Comparison of first-and second-generation antihistamine prescribing in elderly outpatients: A health insurance database study in 2013. Int J Clin Pharmacol Ther 2017;55:781-90.
22. Huang W, Guo Y, Chen M, Wang B, Zhong M. Utilization analysis of oral antihistamines in our hospital from 2008 to 2011. Chin J Clin Pharm 2012;4.
23. Iakovlieva L, V. Perederii A. Pharmacoepidemiological study of the dynamics of consumption of antihistamines in Ukraine. Clin pharm 2015;19:33-7.
24. FDA. National Formulary of Iran (Accessed at http://irc.fda.gov.ir/nfi?Length=3.)
25. FDA. U.S Food and Drug Administration (Accessed at https://www.fda.gov/home.)
26. Chantaphakul H, Ruxrungtham K. Fixed-Dose combination of the inhaled corticosteroid and long-acting beta2-agonist therapy in adults with persistent asthma. Expert Opin Pharmacother 2016;17:631-42.
27. Frois C, Wu EQ, Ray S, Colice GL. Inhaled corticosteroids or long-acting β-agonists alone or in fixed-dose combinations in asthma treatment: A systematic review of fluticasone/budesonide and formoterol/salmeterol. Clin Ther 2009;31:2779-803.
28. Xu Y, Zhang J, Wang J. The efficacy and safety of selective H1-antihistamine versus leukotriene receptor antagonist for seasonal allergic rhinitis: a meta-analysis. PloS one 2014;9:e112815.
29. Li, Jiang. “Utilization of Antihistamine Drugs in Institute of Dermatology of Chinese Academy of Medical Sciences in Our Hospital During the Period 2008-2010.” Evaluation and Analysis of Drug-Use in Hospitals of China 2011;11.
30. Henriksen DP, Davidsen JR, Laursen CB, Christiansen A, Damkier P, Hallas J, et al. Montelukast use—a 19-year nationwide drug utilisation study. Eur J Clin Pharmacol 2017;73:1297-304.
31. Lu Y, Yin M, Cheng L. [Meta-analysis of leukotriene receptor antagonist montelukast in the treatment of allergic rhinitis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014;49:659-67.
32. Compalati E, Baena-Cagnani R, Penagos M, Badellino H, Braido F, Gomez RM, et al. Systematic review on the efficacy of fexofenadine in seasonal allergic rhinitis: a meta-analysis of randomized, double-blind, placebo-controlled clinical trials. Int Arch Allergy Immunol 2011;156:1-15.
33. Layton D, Osborne VM, Gilchrist A, Shakir SAW. Examining the utilization and tolerability of the non-sedating antihistamine levocetirizine in England using prescription-event monitoring data. Drug Saf 2011;34:1177-89.
34. Lee CF, Sun HL, Lu KH, Ku MS, Lue KH. The comparison of cetirizine, levocetirizine and placebo for the treatment of childhood perennial allergic rhinitis. Pediatr Allergy Immunol 2009;20:493-9.
35. Snidvongs K, Seresirikachorn K, Khattiyawittayakun L, Chitsuthipakorn W. Sedative Effects of Levocetirizine: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Drugs 2017;77:175-86.
36. Natt RS, Karkos PD, Natt DK, Theochari EG, Karkanevatos A. Treatment trends in allergic rhinitis and asthma: a British ENT survey. BMC Ear Nose Throat Disord 2011;11:3.
37. Weiner JM, Abramson MJ, Puy RM. Intranasal corticosteroids versus oral H1 receptor antagonists in allergic rhinitis: systematic review of randomised controlled trials. BMJ 1998;317:1624-9.
38. Bhatia S, Baroody FM, deTineo M, Naclerio RM. Increased nasal airflow with budesonide compared with desloratadine during the allergy season. Arch Otolaryngol Head Neck Surg 2005;131:223-8.
39. Wilson AM, O'Byrne PM, Parameswaran K. Leukotriene receptor antagonists for allergic rhinitis: a systematic review and meta-analysis. Am J Med 2004;116:338-44.
| Files | ||
| Issue | Vol 59, No 1 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v59i1.5404 | |
| Keywords | ||
| Drug utilization Trend analysis Allergic rhinitis Defined daily dose (DDD) The anatomical therapeutic chemical code (ATC code) | ||
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How to Cite
1.
Faraji H, Kebriaeezadeh A, Abdollahiasl A. Trend Analysis of Anti-Allergic Medicines During the 11-Year Period in Iran (2006-2017). Acta Med Iran. 2021;59(1):54-59.
