Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Study Population
2.3. Endpoints and Statistical Methods
3. Results
3.1. Baseline Characteristics
3.2. Nx4 Is Associated with a Significantly Lower Recurrence of Sleep Disorder Diagnosis as Compared to Z-Drugs and BZD
3.3. Physician Preferences Contribute to Prescription Patterns for the Study Therapies: 63% of Practices Prescribe Nx4 to Their Patients with Sleep Disorders
3.4. Results Remained Robust in Secondary Analyses Incorporating Potential Confounders
3.5. Potentially Associated Adverse Events Show Comparable Overall Profiles across Study Therapies
4. Discussion
4.1. Evidence for Lower Incidence of Sleep Disorder Recurrence in Nx4 Cohorts Compared to Z-Drug and BZD Cohorts
4.2. Lower Depression Prevalence in Patients with Nx4 Prescriptions Compared to Patients with Z-Drug and BZD Prescriptions
4.3. No Significant Differences in Potentially Associated Adverse Effects across Study Treatments
4.4. Study Limitations
4.4.1. No Insights Regarding Specific Sleep Disorders and Add-On Therapies
4.4.2. No Insights on the Severity of Sleep Disorders and Depression
4.4.3. Prescription-Based Data
4.4.4. Limitations of Retrospective EMR Database Analyses
4.4.5. Limitations of Statistical Methods
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BZD | Benzodiazepines |
CBT | Cognitive behavioral therapy |
CI | Confidence interval |
COPD | Chronic obstructive pulmonary disease |
DA | Disease analyzer |
EMR | Electronic medical record |
GP | General practitioner |
HR | Hazard ratio |
ICD | International Statistical Classification of Diseases and Related Health Problems |
n | Number of observations |
Nx4 | Neurexan |
OTC | Over-the-counter |
SD | Standard deviation |
SES | Socio-economic status |
SMD | Standardized mean difference |
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Patients with a Prescription of | Nx4 | Z-Drug | p-Value | Nx4 | BZD | p-Value |
---|---|---|---|---|---|---|
n | 8594 | 8594 | 7779 | 7779 | ||
Variables included in matching | ||||||
Age; Mean (SD) | 48.0 (18.5) | 48.0 (18.5) | 1.000 | 50.0 (17.9) | 50.0 (17.9) | 1.000 |
≤30 years; n (%) | 1871 (21.8) | 1871 (21.8) | 1.000 | 1308 (16.8) | 1308 (16.8) | 1.000 |
31–40 years; n (%) | 1338 (15.6) | 1338 (15.6) | 1.000 | 1207 (15.5) | 1207 (15.5) | 1.000 |
41–50 years; n (%) | 1611 (18.8) | 1611 (18.8) | 1.000 | 1545 (19.9) | 1545 (19.9) | 1.000 |
51–60 years; n (%) | 1651 (19.2) | 1651 (19.2) | 1.000 | 1604 (20.6) | 1604 (20.6) | 1.000 |
61–70 years; n (%) | 913 (10.6) | 913 (10.6) | 1.000 | 913 (11.7) | 913 (11.7) | 1.000 |
>70 years; n (%) | 1210 (14.1) | 1210 (14.1) | 1.000 | 1202 (15.5) | 1202 (15.5) | 1.000 |
Sex: female; n (%) | 5372 (62.5) | 5372 (62.5) | 1.000 | 4904 (63.0) | 4904 (63.0) | 1.000 |
Depression; n (%) | 1281 (14.9) | 1281 (14.9) | 1.000 | 1236 (15.9) | 1236 (15.9) | 1.000 |
Anxiety disorder; n (%) | 436 (5.1) | 436 (5.1) | 1.000 | 512 (6.6) | 512 (6.6) | 1.000 |
Severe stress and adjustment disorders; n (%) | 1360 (15.8) | 1360 (15.8) | 1.000 | 1098 (14.1) | 1098 (14.1) | 1.000 |
Number of consultations during the 12 months of follow-up; mean (SD) | 4.9 (5.0) | 4.9 (5.0) | 0.642 | 4.9 (5.0) | 4.9 (5.0) | 0.563 |
Further variables | ||||||
Back pain; n (%) | 1956 (22.8) | 1766 (20.6) | <0.001 | 1812 (23.3) | 1637 (21.0) | <0.001 |
Heart disease; n (%) | 942 (11.0) | 906 (10.5) | 0.375 | 906 (11.7) | 934 (12.0) | 0.487 |
Diabetes; n (%) | 460 (5.4) | 589 (6.9) | <0.001 | 453 (5.8) | 565 (7.3) | <0.001 |
Chronic bronchitis/COPD; n (%) | 326 (3.8) | 326 (3.8) | 1.000 | 310 (4.0) | 391 (5.0) | 0.002 |
Cancer; n (%) | 232 (2.7) | 409 (4.8) | <0.001 | 228 (2.9) | 417 (5.4) | <0.001 |
Nx4 versus Z-Drugs | Nx4 versus BZD | |||
---|---|---|---|---|
Subgroup | Hazard Ratio (95%CI) | p-Value | Hazard Ratio (95%CI) | p-Value |
Total | 0.65 (0.60–0.70) | <0.001 | 0.85 (0.79–0.93) | <0.001 |
≤30 years | 0.70 (0.58–0.85) | <0.001 | 0.85 (0.66–1.09) | 0.194 |
31–40 years | 0.63 (0.50–0.79) | <0.001 | 0.63 (0.50–0.80) | <0.001 |
41–50 years | 0.71 (0.59–0.85) | <0.001 | 0.99 (0.81–1.20) | 0.910 |
51–60 years | 0.57 (0.48–0.68) | <0.001 | 0.78 (0.65–0.94) | 0.010 |
61–70 years | 0.64 (0.54–0.74) | <0.001 | 0.98 (0.73–1.11) | 0.316 |
>70 years | 0.64 (0.52–0.77) | <0.001 | 0.88 (0.75–1.04) | 0.135 |
Men | 0.74 (0.66–0.84) | <0.001 | 0.84 (0.74–0.96) | 0.010 |
Women | 0.60 (0.55–0.66) | <0.001 | 0.86 (0.76–0.95) | 0.004 |
Nx4 versus Z-Drugs | Nx4 versus BZD | |||
---|---|---|---|---|
Subgroup | Hazard Ratio (95%CI) | p-Value | Hazard Ratio (95%CI) | p-Value |
Total | 0.90 (0.83–0.98) | 0.020 | 0.89 (0.82–0.97) | 0.009 |
≤30 years | 0.78 (0.64–0.96) | 0.019 | 0.98 (0.77–1.23) | 0.831 |
31–40 years | 0.92 (0.74–1.15) | 0.460 | 0.85 (0.68–1.08) | 0.181 |
41–50 years | 0.86 (0.71–1.05) | 0.148 | 0.75 (0.62–0.92) | 0.005 |
51–60 years | 0.92 (0.77–1.11) | 0.384 | 0.82 (0.69–0.98) | 0.032 |
61–70 years | 0.97 (0.75–1.26) | 0.833 | 0.90 (0.69–1.16) | 0.395 |
>70 years | 1.01 (0.82–1.24) | 0.931 | 1.16 (0.93–1.44) | 0.195 |
Men | 0.88 (0.76–1.02) | 0.095 | 0.91 (0.78–1.07) | 0.258 |
Women | 0.91 (0.82–1.01) | 0.084 | 0.88 (0.79–0.98) | 0.016 |
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Hajak, G.; Vetter, C.; Wehling, M. Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany. Healthcare 2024, 12, 1413. https://doi.org/10.3390/healthcare12141413
Hajak G, Vetter C, Wehling M. Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany. Healthcare. 2024; 12(14):1413. https://doi.org/10.3390/healthcare12141413
Chicago/Turabian StyleHajak, Göran, Céline Vetter, and Martin Wehling. 2024. "Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany" Healthcare 12, no. 14: 1413. https://doi.org/10.3390/healthcare12141413
APA StyleHajak, G., Vetter, C., & Wehling, M. (2024). Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany. Healthcare, 12(14), 1413. https://doi.org/10.3390/healthcare12141413