医療レセプトデータ REZULTに基づく医原性薬剤の使用過多による頭痛の現状解析

抄録

 Background : Medication Overuse Headache (MOH) occurs when frequent use of analgesics worsens the original headache condition. It is estimated that 2.3％ of the Japanese population may suffer from MOH, with nearly 10％ of cases thought to be iatrogenic, though details are unclear. This study analyzes the current state of iatrogenic MOH using an anonymized claims database (REZULT) containing data from 8.5 million people over a period of up to 12 years.
 Methods : Study 1 : A cross-sectional analysis of claims data from January to December 2020, focusing on the 3-month period with the highest prescription of analgesics or triptans. Study 2 : A longitudinal analysis of data from July 2010 to April 2022, tracking prescription patterns over 2 years from initial diagnosis, investigating the timing and risk factors for overprescription. Overuse was defined as more than 30 triptans/combination analgesics or 45 single analgesics per 90 days.
 Results : Study 1 : Among 4,181,753 claims, 262,623 (6.3％) had a headache diagnosis. Of the 15,524 patients with prescriptions, 91.6％ received only acute treatment, while 8.4％ received preventive treatment. MOH-related overuse was observed in 12.8％ of cases. Study 2 : Out of 7,686,088 cases, 545,021 (7.1％) were tracked for 2 years. 10.1％ experienced overuse at least once during this period, with the highest incidence occurring between months 15-18. Risk factors included male sex, younger age, high initial use of acute treatment, and early use of preventive drugs.
 Conclusion : This big data analysis clarifies the current state of iatrogenic MOH.