Use of benzodiazepines non -compliant with guidelines in patients with psychiatric and non -psychiatric chronic disorders

Objective: To quantify benzodiazepine use non-compliant with guidelines in patients with psychiatric and non- psychiatric chronic diseases and assess the risk of non-recommended use associated with these diseases. Method: A cohort study was conducted in the French health insurance databases, including 254,488 new ben- zodiazepine users between 2007 and 2014. Psychiatric, cardiovascular, cancer, diabetes and in flammatory diseases were identi fied. Patients were followed for 2 years. Non-recommended use was de fined as excessive treatment duration, use of long half-life drugs in older patients and concomitant use of several benzodiazepines. Cox models identi fied the factors associated with non-recommended use. Results: Non-recommended use was frequent, ranging from 44.9% to 68.1%. It was independently associated with each chronic disease, with a slight increase in patients with chronic in flammatory disease (HR = 1.07; 95%CI 1.03-1.13) or diabetes (HR = 1.09; 1.06-1.12), a higher risk in those with chronic cardiovascular disease (HR = 1.34; 1.31-1.37) or cancer (HR = 1.30; 1.25-1.35) and the highest risk in those with psychiatric disease (HR = 2.04; 2.00-2.09). Conclusion: Patients with chronic disease have a high risk of benzodiazepine use leading to a higher exposure than recommended. Prescribers should be aware of the need to comply with the recommendations, especially in these patients who are the most frail and vulnerable to adverse events.