1/23/2025

Janusmed kön och genus

Janusmed kön och genus – Rinivent

Janusmed kön och genus är ett kunskapsstöd som tillhandahåller information om köns- och genusaspekter på läkemedelsbehandling. Kunskapsstödet är avsedd främst för hälso- och sjukvårdspersonal. Texterna är generella och ska inte ses som behandlingsriktlinjer. Det är alltid behandlande läkare som ansvarar för patientens medicinering.

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A A
A A

Ipratropium

Ipratropium

Klass : A

Produkter

Atrovent, Atrovent Nasal, Combivent, Ipramol, Ipratropium/Salbutamol O......

Atrovent, Atrovent Nasal, Combivent, Ipramol, Ipratropium/Salbutamol Orion, Ipratropium/Salbutamol Sandoz, Ipratropiumbromid Arrow, Ipravent, Ipraxa, Itrop, Rinivent, Salipra, Sapimol
ATC-koder

R01AX03, R03AL02, R03BB01

R01AX03, R03AL02, R03BB01
Substanser

ipratropium, ipratropiumbromid, ipratropiumbromid (monohydrat)

ipratropium, ipratropiumbromid, ipratropiumbromid (monohydrat)
Sammanfattning

Större kontrollerade studier med analyser avseende könsskillnader i behandlingseffekter saknas. En post-hoc-analys på KOL-patienter visade bättre effekt hos kvinnor. Två mindre studier på astmapatienter visade motsägande resultat vad gäller skillnader i effekt mellan könen. Akut urinretention har rapporterats i högre grad hos män.
Sämre inhalationsteknik har visats hos kvinnor vid användning av vissa inhalatorer, vilket kan ha betydelse för god effekt av läkemedlet, men detta har inte studerats i tillräcklig utsträckning.

Större kontrollerade studier med analyser avseende könsskillnader i behandlingseffekter saknas. En post-hoc-analys på KOL-patienter visade bättre effekt hos kvinnor. Två mindre studier på astmapatienter visade motsägande resultat vad gäller skillnader i effekt mellan könen. Akut urinretention har rapporterats i högre grad hos män. Sämre inhalationsteknik har visats hos kvinnor vid användning av vissa inhalatorer, vilket kan ha betydelse för god effekt av läkemedlet, men detta har inte studerats i tillräcklig utsträckning.
Background

COPD (chronic obstructive pulmonary disease) affects more women than men, and women often get a more serious and rapidly progressive disease [1]. Data from various studies indicate that women have increased dyspnea for a given level of airflow limitation and greater airway hyper-responsiveness, as well as greater frequency of exacerbations [2].
Childhood asthma is more common in boys while adult asthma is more common in women. The reversal of this sex difference in prevalence occurs around puberty which suggests that sex hormones may play a role in the etiology of asthma [3]. However, some studies suggest that there are sex differences in expression and diagnosing of asthma, and whether women are under-treated for respiratory diseases or not has been discussed [4,5].
A systematic review of 32 studies on sex differences in adult asthma and COPD therapy concludes inconsistent evidence concerning sex-related response to treatment [6].

Pharmacokinetics and dosing
No studies with a clinically relevant sex analysis regarding the pharmacokinetics and dosing of ipratropium were found.
# Ef......

COPD (chronic obstructive pulmonary disease) affects more women than men, and women often get a more serious and rapidly progressive disease [1]. Data from various studies indicate that women have increased dyspnea for a given level of airflow limitation and greater airway hyper-responsiveness, as well as greater frequency of exacerbations [2]. Childhood asthma is more common in boys while adult asthma is more common in women. The reversal of this sex difference in prevalence occurs around puberty which suggests that sex hormones may play a role in the etiology of asthma [3]. However, some studies suggest that there are sex differences in expression and diagnosing of asthma, and whether women are under-treated for respiratory diseases or not has been discussed [4,5]. A systematic review of 32 studies on sex differences in adult asthma and COPD therapy concludes inconsistent evidence concerning sex-related response to treatment [6]. # Pharmacokinetics and dosing No studies with a clinically relevant sex analysis regarding the pharmacokinetics and dosing of ipratropium were found. # Effects A post-hoc analysis of data from the Lung Health Study in patients with mild to moderate COPD (1061 men, 683 women) showed greater response to ipratropium in women compared to men after 4 months of treatment (6.0% vs 2.9% increase in FEV1 from baseline). All participants were smokers [11]. In a small short-term (4 days) cross-over RCT including nonsmoking patients (27 men, 17 women) with bronchial asthma, men had a greater response (increase in FEV1) to ipratropium as compared to women [12]. No sex difference in response in asthma were found in an even smaller study (11 men, 10 women) [13]. # Adverse effects A case-control study of the association between inhaled anticholinergic drugs and acute urinary retention in COPD patients (cases 178 men, 31 women; mean age 77 years) found a stronger association in men than in women (1.73 vs 073). However, there were very few women cases  [14]. Similarly, a review of concomitant use of ipratropium and tiotropium showed a higher risk of acute urinary retention in men than women (9432 men, 1806 women) [15]. However, an assumed higher baseline risk for urinary retention in men was not taken into consideration in these studies. # Reproductive health issues Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan). # Other information Women with asthma or COPD were more likely to have incorrect inhalation technique when using either dry-powder inhaler or soft mist inhaler, according to a systematic review and meta-analysis. No sex difference was found for metered-dose inhaler [7]. Several studies show worse prognosis for women with asthma. In an observational registry study (416 men, 498 women), women had more asthmatic symptoms, worse quality of life and require more health care due to their asthma [8]. In a Danish prospective study on hospitalization due to asthma (6104 men of whom 2.5% had asthma, 7436 women of whom 2.2% had asthma), women had a 1.7 higher relative risk to be hospitalized (95%CI 1.2-2.4) [9]. An observational study in Singapore found hospitalization due to asthma to be 1.69 times more common in boys than girls aged 0-4 years. In adults aged 35-64 years, women were more hospitalized (male/female ratio 0.81) [10].
Försäljning på recept

Fler kvinnor än män hämtade ut inhalationsspray eller lösning för nebulisator innehållande ipratropium (ATC-kod R03BB01) på recept i Sverige år 2023, totalt 5 223 kvinnor och 3 141 män. Det motsvarar 1,0 respektive 0,6 personer per tusen invånare. Andelen som hämtade ut läkemedel var högst i åldersgruppen 70 år och äldre hos båda könen. Totalt sett var inhalationsspray eller lösning för nebulisator innehållande ipratropium 1,7 gånger vanligare hos kvinnor [16]. Något fler män hämtade ut nässpray innehållande ipratropium (ATC-kod R01AX03) på recept i Sverige år 2023, totalt 3 240 män och 3 072 kvinnor. Det motsvarar 0,6 respektive 0,6 personer per tusen invånare. Andelen som hämtade ut läkemedel var högst i åldersgruppen 70 år och äldre hos båda könen. I åldersgruppen 70 år och äldre var nässpray innehållande ipratropium 1,5 gånger vanligare hos män [16].
Referenser
  1. Nationella riktlinjer för vård vid astma och kroniskt obstruktiv lungsjukdom (KOL). Socialstyrelsen. [updated 2018-01-29, cited 2020-09-14].
  2. Wedzicha JA, Singh D, Tsiligianni I, Jenkins C, Fucile S, Fogel R et al. Treatment response to indacaterol/glycopyrronium versus salmeterol/fluticasone in exacerbating COPD patients by gender: a post-hoc analysis in the FLAME study. Respir Res. 2019;20(1):4.
  3. Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults. Front Pediatr. 2019;7:246.
  4. Dales RE, Mehdizadeh A, Aaron SD, Vandemheen KL, Clinch J. Sex differences in the clinical presentation and management of airflow obstruction. Eur Respir J. 2006;28:319-22.
  5. Tantisira KG, Colvin R, Tonascia J, Strunk RC, Weiss ST, Fuhlbrigge AL et al. Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. Am J Respir Crit Care Med. 2008;178:325-31.
  6. Rogliani P, Cavalli F, Ritondo BL, Cazzola M, Calzetta L. Sex differences in adult asthma and COPD therapy: a systematic review. Respir Res. 2022;23(1):222.
  7. Calzetta L, Aiello M, Frizzelli A, Ritondo BL, Pistocchini E, Rogliani P et al. Impact of Sex on Proper Use of Inhaler Devices in Asthma and COPD: A Systematic Review and Meta-Analysis. Pharmaceutics. 2022;14(8):.
  8. Osborne ML, Vollmer WM, Linton KL, Buist AS. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998;157:123-8.
  9. Prescott E, Lange P, Vestbo J. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population Copenhagen City Heart Study Group. Thorax. 1997;52:287-9.
  10. Ng TP, Niti M, Tan WC. Trends and ethnic differences in asthma hospitalization rates in Singapore, 1991 to 1998. Ann Allergy Asthma Immunol. 2003;90:51-5.
  11. Li X, Obeidat M, Zhou G, Leung JM, Tashkin D, Wise R et al. Responsiveness to Ipratropium Bromide in Male and Female Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease. EBioMedicine. 2017;19:139-145.
  12. Chhabra SK, Pandey KK. Comparison of acute bronchodilator effects of inhaled ipratropium bromide and salbutamol in bronchial asthma. J Asthma. 2002;39:375-81.
  13. Partridge MR, Saunders KB. Site of action of ipratropium bromide and clinical and physiological determinants of response in patients with asthma. Thorax. 1981;36:530-3.
  14. Afonso AS, Verhamme KM, Stricker BH, Sturkenboom MC, Brusselle GG. Inhaled anticholinergic drugs and risk of acute urinary retention. BJU Int. 2011;107:1265-72.
  15. Cole JM, Sheehan AH, Jordan JK. Concomitant use of ipratropium and tiotropium in chronic obstructive pulmonary disease. Ann Pharmacother. 2012;46:1717-21.
  16. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2023 [cited 2024-03-06.]
Uppdaterat

Litteratursökningsdatum: 10/17/2024

Litteratursökningsdatum: 10/17/2024
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