Abstract
ObjectiveTo examine the effect of the COVID‐19 pandemic on gonadorelin analogue prescription for community patients in England.Materials and methodsWe included data from all primary‐care patients who had relevant prescriptions dispensed in the community in England. Descriptive statistics and interrupted time series analysis over 22 months (15 months before and 7 months after lockdown) was evaluated.ResultsA total of 22 months’ worth of data were analyzed (or 1 041 638 total items, monthly average 47 347 items). Goserelin; leuprorelin, and triptorelin are the medicines most used by total quantity in the study period. Simple descriptive statistics show that mean values have declined during the pandemic. The Interrupted Time Series (ARIMA Modeling) shows declining trends.After the pandemic's onset, we observe a statistically significant downward trend for goserelin (P = .017) and leuprorelin (P = .014). As these are the major constituents of the model, we interpret this overall data as showing a significant downward category trend. Aside from linearity, a significant step change was noted for leuprorelin (P = .029) showing an increase in prescription items with a similar effect that is close to being statistically significant for goserelin (P = .051).The actual cost of medicines shows minimal variation suggesting that prices of individual medicines have remained stable. The regional data showed variation but this was not statistically significant. In all cases, the Oct‐20 figures are lower “year on year.” This novel work reports the impact of a global pandemic on prescription volumes of prostate cancer (PCa) medicines.ConclusionsA worrying decrease in prescription medicines raises concerns for the care of PCa patients. We encourage diagnosed patients to discuss their planned care with their doctor.
Highlights
Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.1 Prostate cancer (PCa) is the second most common cancer affecting men worldwide.[2,3] Risks include advanced age, ethnicity, obesity, and family history.[4]
The data exclude prescriptions issued outside England (Wales, Scotland, Guernsey, Alderney, Jersey, and the Isle of Man—this difference is solely to do with where prescriptions were issued as opposed to where dispensed); items not dispensed, disallowed, and those returned for further clarification; prescriptions prescribed and dispensed in prisons, hospitals, and private prescriptions; items prescribed but not presented for dispensing or not submitted to NHS prescription services by the dispenser
Goserelin acetate; Leuprorelin acetate; Triptorelin (Acetate) and Triptorelin embonate are the medicines most used by total quantity in the study period
Summary
Cancer is a leading cause of death worldwide, accounting for an estimated 9.6 million deaths in 2018.1 Prostate cancer (PCa) is the second most common cancer affecting men worldwide.[2,3] Risks include advanced age, ethnicity, obesity, and family history.[4]. There is down-regulation of GnRH receptors, thereby reducing the release of gonadotrophins (follicle stimulating hormone and luteinizing hormone) which in turn leads to inhibition of androgen production in men This effect is reversible on GnRH analogue discontinuation. GnRH analogues have been used in hormone-dependent advanced breast cancer, uterine fibroids,[12] endometriosis,[13] and suppression of follicular development within the ovary, where they cause endometrial thinning and amenorrhea[14] In children they may be used to address growth and maturation deficiencies.[15,16] As a result, these medications have a wide spectrum of use,[17,18] though clinically they are overwhelmingly used for the treatment of PCa.[19]. There should be minimal variation in prescription volumes
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