Implications of off-label use: An example from the final results of an observational cohort study on Intrinsa® (testosterone patch)

Post Reprod Health. 2014 Jun;20(2):48-54. doi: 10.1177/2053369114535762. Epub 2014 May 12.

Abstract

Introduction: Off-label use is where a medicinal product is used for a medical purpose not in accordance with the authorised product information. Intrinsa® is a transdermal testosterone patch, which is indicated for use in hypoactive sexual desire disorder in bilaterally oophorectomised and hysterectomised women receiving concomitant estrogen therapy.

Objectives: To describe the utilization characteristics of patients prescribed testosterone patch (Intrinsa®) and to assess, where possible, if the product is being used according to the authorised product information.

Study design: Patients identified from dispensed prescriptions issued by general practitioners for Intrinsa® between March 2007 and August 2010. Postal questionnaires were sent to general practitioners six months following the date of the first prescription for Intrinsa® for each patient, requesting information including patient demographics and drug utilization.

Main outcome measures: Menopausal status and use of concomitant estrogen therapy.

Results: The final cohort consisted of 3073 patients; the majority were females (3017, 98.2%). The most commonly reported indication was hypoactive sexual desire disorder in 2324 female patients (77.0%). Only 43.5% female patients (n = 1313) were reported to have been hysterectomised and bilaterally oophorectomised. For 1029 (34.1%) female patients there was no evidence that the patient was using concomitant estrogen therapy. Overall, only 643 patients (20.9%) in the cohort were being prescribed Intrinsa® according to the manufacturer's recommendations.

Conclusions: Evidence obtained solely from clinical trials might not be generalisable where off-label prescribing occurs in real-life, so evidence from post-marketing observational studies is important to provide complimentary data on a product's safety and effectiveness.

Keywords: Cohort study; drug utilization; off-label use; testosterone patch.