USING GROUP-BASED TRAJECTORY MODELING TO IDENTIFY HETEROGENEOUS BENZODIAZEPINE USE PATTERNS FOLLOWING LONG-TERM BENZODIAZEPINE THERAPY...
Author(s)
Kitiyaporn Takham, MS1, Weihsuan Jenny Lo-Ciganic, MS, PhD2, Haesuk Park, PhD3, Tae Woo Park, MD, MSc2.
1Carnegie Mellon University, Pittsburgh, PA, USA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 3University of Florida College of Pharmacy, Gainesville, FL, USA.
1Carnegie Mellon University, Pittsburgh, PA, USA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 3University of Florida College of Pharmacy, Gainesville, FL, USA.
OBJECTIVES: Clinical guidelines discourage long-term benzodiazepine therapy (LTBT) and recommend gradual tapering post-LTBT. However, real-world benzodiazepine use patterns following LTBT remain poorly characterized. We applied a data-driven approach to identify post-LTBT benzodiazepine use trajectories and assessed their associations with drug overdose and/or suicide-related outcomes.
METHODS: We conducted a retrospective cohort study using 2014-2024 EHR data from the diverse U.S. All of Us Research Program. We included non-cancer adults (≥18 years) initiating LTBT, defined as ≥3 benzodiazepine orders/fills at least 21 days apart, with ≥84 days supplied. We used group-based trajectory modeling (GBTM) was used to identify 12-month benzodiazepine trajectories post-LTBT. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics across trajectories. IPTW-weighted Weibull accelerated failure time models estimated time to first drug overdose and/or suicide-related emergency department (ED) visits/hospitalizations during the 12-month trajectory period.
RESULTS: Among 9,443 LTBT patients (age≥65=18.8%, female=72.5%, White=73.3% and Black=9.9%), we defined four distinct trajectories: Group (A): persistent use (52.7% of the cohort); (B): discontinuation within 120 days (15.1%); (C): discontinuation between 90-210 days (14.3%); and (D): discontinuation between 210-360 days (18.0%). After IPTW, baseline characteristics were well balanced across trajectories (all standardized mean differences <0.1). A total of 186 patients had drug overdose and/or suicide-related ED visits/hospitalizations (Group A=1.7%; Group B=2.1%; Group C=3.4%; Group D=1.5%) during the trajectory period. Compared to persistent use (Group A), intermediate discontinuation trajectories (Group C) were associated with significantly shorter times to first drug overdose and/or suicide-related outcomes (Group C: TR=0.53, 95%CI=0.36-0.80).
CONCLUSIONS: GBTM identified four distinct benzodiazepine use trajectories post-LTBT. Intermediate discontinuation (90-210 days) was associated with significantly higher short-term risk of drug overdose and/or suicide-related outcomes compared with persistent use; early and later discontinuation were not. These findings suggest that timing of benzodiazepine tapering may influence patient safety, warranting closer clinical monitoring during intermediate-paced discontinuation.
METHODS: We conducted a retrospective cohort study using 2014-2024 EHR data from the diverse U.S. All of Us Research Program. We included non-cancer adults (≥18 years) initiating LTBT, defined as ≥3 benzodiazepine orders/fills at least 21 days apart, with ≥84 days supplied. We used group-based trajectory modeling (GBTM) was used to identify 12-month benzodiazepine trajectories post-LTBT. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics across trajectories. IPTW-weighted Weibull accelerated failure time models estimated time to first drug overdose and/or suicide-related emergency department (ED) visits/hospitalizations during the 12-month trajectory period.
RESULTS: Among 9,443 LTBT patients (age≥65=18.8%, female=72.5%, White=73.3% and Black=9.9%), we defined four distinct trajectories: Group (A): persistent use (52.7% of the cohort); (B): discontinuation within 120 days (15.1%); (C): discontinuation between 90-210 days (14.3%); and (D): discontinuation between 210-360 days (18.0%). After IPTW, baseline characteristics were well balanced across trajectories (all standardized mean differences <0.1). A total of 186 patients had drug overdose and/or suicide-related ED visits/hospitalizations (Group A=1.7%; Group B=2.1%; Group C=3.4%; Group D=1.5%) during the trajectory period. Compared to persistent use (Group A), intermediate discontinuation trajectories (Group C) were associated with significantly shorter times to first drug overdose and/or suicide-related outcomes (Group C: TR=0.53, 95%CI=0.36-0.80).
CONCLUSIONS: GBTM identified four distinct benzodiazepine use trajectories post-LTBT. Intermediate discontinuation (90-210 days) was associated with significantly higher short-term risk of drug overdose and/or suicide-related outcomes compared with persistent use; early and later discontinuation were not. These findings suggest that timing of benzodiazepine tapering may influence patient safety, warranting closer clinical monitoring during intermediate-paced discontinuation.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
MSR9
Topic
Methodological & Statistical Research
Disease
No Additional Disease & Conditions/Specialized Treatment Areas