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MALAYSIAN STATISTICS ON MEDICINES 2007

CHAPTER 14 | USE OF DRUGS FOR ENDOCRINE DISORDERSJanet Y.H. Hong 1, Tan A.T.B.2, Lim P.C.3, Loh Y.F.3, Nor Azizah3

1. Putrajaya Hospital, 2. University Malaya Medical Centre, 3. Pulau Pinang Hospital

In Malaysia, the total consumption for endocrine-related drugs for 2007 increased only by 0.8% when compared to 2006 (2.113 to 2.130

DDD/1000 populations/day).1 The most utilised endocrine drugs were thyroid-related drugs (94.4%), followed by pituitary-hypothalamic hormones

and analogues (4.9%), and drugs for calcium homeostasis (0.6%). In comparison, there was much higher utilisation of endocrine-related drugs

in Australia for 2007 at a level of 18.9 DDD/1000 population/day, with thyroid-related drugs (94.2%) being most commonly used, followed by

pituitary-hypothalamic hormones and analogues (5.8%) and drugs for calcium homeostasis (0.001%).2

Thyroid therapy consisted of drugs utilised for hypothyroidism and hyperthyroidism. Treatment of hypothyroidism was almost entirely with

levothyroxine (T4) sodium (99.99%) at 0.97 DDD/1000 population/day. This was markedly lower compared to Australia (16.94 DDD/1000

population/day).2 Liothyronine (T3) sodium was hardly used in Malaysia. Similarly, its use in Australia was minimal (0.05 DDD/1000 population/

day). Thyroid hormone consumption with levothyroxine sodium was more than 10-fold higher in Australia compared to Malaysia, suggesting a

higher prevalence of hypothyroidism, possibly related to better screening, diagnosis and treatment among the elderly population, as well as higher

utilisation of radioactive iodine treatment.2

In 2007, the consumption of antithyroid preparations for hyperthyroidism was higher in Malaysia (1.05 DDD/1000 population/day) as compared

to Australia (0.83 DDD/1000 population/day).2 The most utilised antithyroid preparation in Malaysia was carbimazole (82.8%), followed by

propylthiouracil (17.2%), which may reflect the preference for the more convenient once-daily dosing of carbimazole. The higher antithyroid drug

utilisation in Malaysia is probably related to a preference for drugs as the first-line therapy in hyperthyroidism, often continued over the long-term

as radioactive iodine facilities for treatment of hyperthyroidism are currently still limited and usually placed as second-line therapy.

Drug utilisation of pituitary-hypothalamic hormones and analogues were generally low in Malaysia at 0.11 DDD/1000 population/day and similarly

in Australia at 0.32 DDD/1000 population/day.2 This may be due to the low prevalence or low detection rate of neuro-endocrine disorders. This

may also reflect under-reporting of drug utilisation of pituitary-hypothalamic hormones and analogues in view of increasing number of patients

over the years.

Consumption of drugs for calcium homeostasis was low in Malaysia at 0.014 DDD/1000 population/day, compared to Australia at 0.001 DDD/1000

population/day.2 The Malaysian 2007 figure, however, was more than double of that in 2006 (0.006 DDD/1000 population/day).1 This is mainly

due to an almost 5-fold increase in the use of teriparatide (0.0028 versus 0.0006 DDD/1000 population/day)1 by the private sectors since the

launching of the drug in Malaysia in 2006. There was no data on teriparatide use in Australia.

There was a 40% increase in the use of calcitonin preparations (0.0081 DDD/1000 population/day) in 2007 versus 0.0058 DDD/1000 population/

day in 2006.1 This increase occurred predominantly in the public hospitals in Malaysia. The use of calcitonin in Australia was much lower (0.001

DDD/1000 population/day).2

In conclusion, although the overall consumption of endocrine related drugs has increased, these figures may still not accurately reflect the actual

usage of drugs as these data rely heavily on public and private sectors purchasing reports. Furthermore, the common practice of purchasing

medicines at the end of the year may affect the statistics of drug utilisation in the following year.

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MALAYSIAN STATISTICS ON MEDICINES 2007

77

Table 14.1 : Use of Drug for Endocrine Disorders, in DDD/1000 population/day 2006-2007

ATC Drug Class 2006 2007

H01 Pituitary and hypothalamic hormones and analogues 0.1131 0.1051

H03 Thyroid therapy 1.9934 2.0112

H04 Pancreatic hormones <0.0001 0.0001

H05 Calcium homeostasis 0.0064 0.0136

Table 14.2 : Use of Pituitary and Hypothalamic Hormones and Analogues by Drug Class, in DDD/1000 population/day 2006-2007

ATC Drug Class 2006 2007

H01A Anterior pituitary lobe hormones and analogues 0.0090 0.0018

H01A A Adrenocorticotropic hormone (ACTH) 0.0045 0.0001

H01A B Thyrotropin <0.0001 -

H01A C Somatropin and somatropin agonists 0.0045 0.0017

H01B Posterior pituitary lobe hormones 0.1028 0.1022

H01B A Vasopressin and analogues 0.0191 0.0234

H01B B Oxytocin and analogues 0.0837 0.0788

H01C Hypothalamic hormones 0.0012 0.0011

H01C A Gonadotropin-releasing hormones - -

H01C B Antigrowth hormone 0.0012 0.0010

H01C C Antigonadotropin-releasing hormones <0.0001 <0.0001

Table 14.3.1 : Use of Thyroid Therapy by Drug Class, in DDD/1000 population/day 2006-2007

ATC Drug Class 2006 2007

H03A Thyroid preparations 0.9338 0.9656

H03A A Thyroid hormones 0.9338 0.9656

H03B Antithyroid preparations 1.0596 1.0454

H03B A Thiouracils 0.1661 0.1798

H03B B Sulfur-containing imidazole derivatives 0.8935 0.8656

H03C Iodine therapy - 0.0002

H03C A Iodine therapy - 0.0002 Table 14.3.2 : Use of Thyroid Therapy by Drug Class and Agents, in DDD/1000 population/day 2006-2007

ATC Drug Class and Agents Sector 2006 2007

H03A A Thyroid hormones

H03A A01 Levothyroxine sodium

Public 0.7504 0.7675

Private 0.1834 0.1981

Total 0.9338 0.9656

H03A A02 Liothyronine sodium

Public <0.0001 -

Private <0.0001 <0.0001

Total <0.0001 <0.0001

H03B A Thiouracils

H03B A01 Methylthiouracil

Public - -

Private - -

Total - -

H03B A02 Propylthiouracil

Public 0.0877 0.1145

Private 0.0784 0.0653Total 0.1661 0.1798

CHAPTER 14 | USE OF DRUGS FOR ENDOCRINE DISORDERS

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MALAYSIAN STATISTICS ON MEDICINES 2007

ATC Drug Class and Agents Sector 2006 2007

H03B B Sulfur-containing imidazole derivatives

H03B B01 Carbimazole

Public 0.6110 0.6010

Private 0.2825 0.2645

Total 0.8935 0.8655

H03B B02 Thiamazole

Public - -

Private - <0.0001

Total - <0.0001

H03C A Iodine therapy

H03C AXX Iodine therapy

Public - -

Private - 0.0002

Total - 0.0002

Table 14.4.1 : Use of Pancreatic Hormones by Drug Class, in DDD/1000 population/day 2006-2007

ATC Drug Class 2006 2007

H05A Parathyroid hormones and analogues 0.0006 0.0028

H05A A Parathyroid hormones and analogues 0.0006 0.0028

H05B Antiparathyroid agents 0.0058 0.0108

H05B A Calcitonin preparations 0.0058 0.0081

H05B X Other antiparathyroid agents - 0.0027

Table 14.4.2 : Use of Pancreatic Hormones by Drug Class and Agents, in DDD/1000 population/day 2006-2007

ATC Drug Class and Agents Sector 2006 2007

H05A A Parathyroid hormones and analogues

H05A A02 Teriparatide

Public <0.0001 -

Private 0.0005 0.0028

Total 0.0006 0.0028

H05A A03 Parathyroid hormone

Public - -

Private - -

Total - -

H05B A Calcitonin preparations

H05B A01 Calcitonin (salmon synthetic)

Public 0.0044 0.0056

Private 0.0013 0.0025

Total 0.0058 0.0081

H05B X Other antiparathyroid agents

H05B X01 Cinacalcet

Public - -

Private - -

Total - -

H05B X02 Paricalcitol

Public - 0.0012

Private - 0.0015

Total - 0.0027

References:

1. Pharmaceutical Services Division & Clinical Research Centre. Malaysian Statistics on Medicines 2006. Ministry of Health Malaysia 2009

2. Australian Government Department of Health and Ageing. Australian Statistics on Medicines. 2007 13th Edition. Commonwealth of Australia 2009

CHAPTER 14 | USE OF DRUGS FOR ENDOCRINE DISORDERS