OBJECTIVES: Opioid analgesics are reported to be overprescribed in various parts of the world. Since data for South Africa in its entirety is not available, studies on available electronic dispensing databases can add a valuable insight into opioid prescribing patterns in the country. The primary aim of the study was to determine which opioids are prescribed in a medical insurance scheme setting in South Africa. METHODS: A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup N02A (opioids) were extracted and analysed. RESULTS: A total of 102 255 opioids were dispensed to 33 249 patients (72.47% male patients). The average age of patients was 40.80 (SD¼12.26) years. Patients received on average 3.08 (SD¼5.57) opioid prescriptions over the year. Most opioids were dispensed by private hospitals (46.45%), followed by general medical practices (43.38%) and pharmacies (9.74%). Dihydrocodeine and paracetamol (N02AJ06, 45.09%) were dispensed the most, followed by tramadol (N02AX02, 28.99%), and tramadol and paracetamol combined (N02AJ13, 9.67%). These three agents together accounted for 83.75% of all opioid analgesics dispensed. Pethidine (N02AB02) accounted for 4.74% and morphine (not in combination) (N02AA01) for 4.48%. A total amount of R2 560 040.07 was claimed by patients, of which R2 004 941.77 was reimbursed. Generic substitution is compulsory in South Africa. The average amount claimed per opioid was only R25.04 (SD¼R56.72).

A547 intensity was, on average, moderate. The majority of respondents suffered pain in the head (e.g. headache and migraine) and back (e.g. lower back pain). Thirtyfour respondents (17.6%) were migraine sufferers. A third (37.3%) of respondents indicated that other family members also use CAM. The CAM classifications indicated for treating pain were cross-cultural (e.g. yoga), external (e.g. chiropractors, massage and heat therapy), internal (e.g. herbal supplements) and mind-body healing therapies (e.g. prayer therapy, sleep and meditation). The CAM modality reported to be most effective in treating pain was cross-cultural therapies with an average effectiveness of 3.6 out of a maximum score of 4.0. The most popular therapies were external body healing therapies (reported by 33.6% of respondents). Nearly half of the therapies were used in conjunction with conventional analgesics, with 43.0% indicating that they obtain their treatment for pain from pharmacies. ConClusions: CAM was used either on its own or in combination with conventional medication for the treatment of pain. Therapies seemed to be effective. The choice of CAM therapy was highly individualised.

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The discontinuation rates were high for patients who started with opioids (58%) or antidepressants/anticonvulsants/topicals (54%). ConClusions: In both the US and UK's real-world settings, the management of PDN was in accordance with the recommended treatment guidelines. However, the management of PHN was in-line with recommended guidelines in UK, but not in the US (opioids were used as 1st line treatment).

baseline to months 1 and 3. RESULTS: All patients treated with AVXS-101 survived event-free to 24 months. A rapid increase in mean CHOP-INTEND scores of 9.8 (n¼12; SD¼3.91) points as early as 1 month and 15.4 (n¼12, SD¼6.36) points at 3 months post-dose were observed. CONCLUSIONS: AVXS-101 appears to induce a rapid and significant improvement in motor function as measured by CHOP-INTEND score relative to nusinersen, consistent with its pharmacological mechanism of action designed to promptly restore SMN expression in motor neurons with a single dose administration. Advances in the understanding of SMA, currently available and investigational pharmacologic treatments, and the gene replacement therapy, AVXS-101, underscore the importance of early diagnosis and treatments with a near-immediate onset of action to maximize clinical improvements.