Evidence map›Paper›PMID 36001288›Full record

ArticleDrug safety2022

Prescribing Patterns of Codeine and Alternative Medicines in Children in Europe.

Kelly Plueschke, Robert Flynn, Karin Hedenmalm, Aikaterini-Christina Deli, Miguel-Angel Maciá-Martinez, Patricia García-Poza, David Olsen, Pierre Nguyen, Chantal Quinten

Open access · hybridAbstract read
In one paragraph

Article in Drug safety, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.8field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 5 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 5 countries.

Kelly PlueschkeEuropean Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands. Kelly.plueschke@ema.europa.eu.ORCID http://orcid.org/0000-0002-1824-4148
Robert FlynnEuropean Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
Karin HedenmalmEuropean Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
Aikaterini-Christina DeliEuropean Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
Miguel-Angel Maciá-MartinezAgencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain.
Patricia García-PozaAgencia Española de Medicamentos y Productos Sanitarios, Madrid, Spain.
David OlsenNorwegian Medicines Agency (Legemiddelverket), Oslo, Norway.
Pierre NguyenEPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM), French National Health Insurance (CNAM), Saint-Denis, France.
Chantal QuintenEuropean Medicines Agency, Domenico Scarlattilaan 6, 1083 HS, Amsterdam, The Netherlands.
European Medicines Agency · NLAgencia Española de Medicamentos y Productos Sanitarios · ESConservatoire National des Arts et Métiers · FRDirektoratet for medisinske produkter · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionConcerns over serious respiratory depression in children led to two European Union (EU) referral procedures (in 2013 and 2015) to review the benefit-risk balance of codeine in this population when used for pain relief, cough or cold. Consequently, codeine should no longer be used in children aged < 12 years and restrictions were introduced for treatment in children ≥ 12 years.

objectiveThis multinational collaborative study aimed to assess the effectiveness of these risk minimisation measures by evaluating changes in prescribing of codeine and alternative treatments.

methodChildren under 12 and 12-18 years old were followed between 2010 and 2017 to analyse quarterly trends in prescribing of codeine and alternative treatments in electronic health records from France, Germany, Norway, Spain and the United Kingdom using interrupted time series analysis.

resultsOverall prescribing of codeine in children decreased in all five countries, reaching near zero prevalence in children under 12 years of age. This was accompanied by an increase in use of other opioid analgesics in France (from 0.15 to 0.56 prevalence per 100 person-years immediately after the first referral), Norway (from 0.0006 to 0.0013 at the end of the study), the United Kingdom (from 0.018 to 0.05 at the end of the study), and an increase in non-opioid analgesics in Norway (from 0.045 to 0.075 at the end of the study) after the referral on pain relief indication. The referral on cough/cold indication led to a decrease in use of opioid and non-opioid antitussives in children aged < 12 years in France (from 10 to 7 and 20 to 16, respectively) and had no impact in other countries. Overall prescribing trends for codeine and alternatives were similar across both age groups within each country.

conclusionThe decrease in use of codeine shows that healthcare professionals followed the adopted measures and switched prescribing practices for pain management in children aged < 18 years towards opioid or non-opioid analgesics depending on national clinical and reimbursement settings. Whist the magnitude of the first referral on pain differed between countries, the second referral on cough/cold had only a minimal impact on the use of codeine and antitussives.

Indexed as

Analgesics, Non-NarcoticAntitussive AgentsAnalgesics, OpioidChildCodeineCoughEuropeHumansPainAnalgesics, Non-NarcoticAnalgesics, OpioidAntitussive AgentsCodeine

Identifiers

PMID36001288
PMCPMC9492592
OpenAlexW4293213821

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.