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Santero M, Requeijo C, Quintana MJ, Rodríguez D, Bottaro D, Macias I, Pericay C, Farina N, Blanco JM, Urreta-Barallobre I, Punti L, Nava MA, Bonfill Cosp X. How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study. Clin Transl Oncol 2024; 26:2629-2639. [PMID: 38662169 PMCID: PMC11410856 DOI: 10.1007/s12094-024-03436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
AIM To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals. METHODS Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up. RESULTS We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life. CONCLUSION A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.
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Affiliation(s)
- Marilina Santero
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain.
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain.
- Centro Cochrane Iberoamericano, Barcelona, Spain.
| | - Carolina Requeijo
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Jesus Quintana
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - David Bottaro
- Hospital Universitari Sant Joan de Reus, Reus, Spain
| | | | | | | | | | - Iratxe Urreta-Barallobre
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Clinical Epidemiology, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Laura Punti
- Clinical Epidemiology Unit, Osakidetza Basque Health Service, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Maria Angeles Nava
- Clinical Epidemiology Unit, Osakidetza Basque Health Service, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Xavier Bonfill Cosp
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital de Mataró, Mataró, Spain
- Centro Cochrane Iberoamericano, Barcelona, Spain
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Safari A, Helisaz H, Salmasi S, Adelakun A, De Vera MA, Andrade JG, Deyell MW, Loewen P. Association Between Oral Anticoagulant Adherence and Serious Clinical Outcomes in Patients With Atrial Fibrillation: A Long-Term Retrospective Cohort Study. J Am Heart Assoc 2024; 13:e035639. [PMID: 39248280 DOI: 10.1161/jaha.124.035639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/22/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Patients with atrial fibrillation are frequently nonadherent to oral anticoagulants (OACs) prescribed for stroke and systemic embolism (SSE) prevention. We quantified the relationship between OAC adherence and atrial fibrillation clinical outcomes using methods not previously applied to this problem. METHODS AND RESULTS Retrospective observational cohort study of incident cases of atrial fibrillation from population-based administrative data over 23 years. The exposure of interest was proportion of days covered during 90 days before an event or end of follow-up. Cox proportional hazard models were used to evaluate time to first SSE and the composite of SSE, transient ischemic attack, or death and several secondary outcomes. A total of 44 172 patients were included with median follow-up of 6.7 years. For direct OACs (DOACs), each 10% decrease in adherence was associated with a 14% increased hazard of SSE and 5% increased hazard of SSE, transient ischemic attack, or death. For vitamin K antagonist (VKA) the corresponding increase in SSE hazard was 3%. Receiving DOAC or VKA was associated with primary outcome hazard reduction across most the proportion of days covered spectrum. Differences between VKA and DOAC were statistically significant for all efficacy outcomes and at most adherence levels. CONCLUSIONS Even small reductions in OAC adherence in patients with atrial fibrillation were associated with significant increases in risk of stroke, with greater magnitudes for DOAC than VKA. DOAC recipients may be more vulnerable than VKA recipients to increased risk of stroke and death even with small reductions in adherence. The worsening efficacy outcomes associated with decreasing adherence occurred without the benefit of major bleeding reduction.
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Affiliation(s)
- Abdollah Safari
- School of Mathematics, Statistics, and Computer Science, College of Science University of Tehran Iran
| | - Hamed Helisaz
- Faculty of Applied Science University of British Columbia Vancouver Canada
- GranTAZ Consulting Ltd. Vancouver Canada
| | | | - Adenike Adelakun
- Health Economics and Outcomes Research GlaxoSmithKline Inc. Mississauga Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
| | - Jason G Andrade
- Division of Cardiology, Faculty of Medicine University of British Columbia Vancouver Canada
- Atrial Fibrillation Clinic Vancouver General Hospital Vancouver Canada
- UBC Center for Cardiovascular Innovation Vancouver Canada
- Montreal Heart Institute Université de Montréal Montréal Canada
| | - Marc W Deyell
- Division of Cardiology, Faculty of Medicine University of British Columbia Vancouver Canada
- UBC Center for Cardiovascular Innovation Vancouver Canada
- Centre for Health Evaluation & Outcome Sciences Providence Health Care Research Institute Vancouver Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences University of British Columbia Vancouver Canada
- UBC Center for Cardiovascular Innovation Vancouver Canada
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Faust L, Ranjan A, Jha N, Pai M, Huddart S. Case fatality among people with drug-susceptible TB enrolled in a private health sector TB treatment support program in Bihar, India during the first year of the COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003277. [PMID: 39264895 PMCID: PMC11392330 DOI: 10.1371/journal.pgph.0003277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/26/2024] [Indexed: 09/14/2024]
Abstract
Experiencing 27% of the global tuberculosis (TB) burden, India's TB epidemic is the largest in the world. Due to COVID-19-related disruptions to TB programs, India has also seen the largest drop in TB case notifications of any country globally. We estimated case fatality among people treated for TB in India during the pandemic and compared these to pre-pandemic estimates. A random sample of 4,000 adults enrolled in World Health Partners (WHP), a private sector TB treatment support program (enrolling only people with drug-susceptible TB) in Bihar, India in the first year of COVID-19 (Mar 2020-Mar 2021) were contacted via phone to collect information on TB case fatality and other relevant covariates. Inverse probability of selection (IPS) weighting was used to obtain selection-bias-corrected in-treatment and post-treatment case fatality estimates. Covariates associated with (but not necessarily causal of) case fatality were identified by estimating adjusted hazard ratios (HRs) using the Cox proportional hazards model. WHP enrolled 19,826 adult drug-susceptible TB patients in the first year of COVID-19 (Mar 2020 to Mar 2021). Of our random sample of 4,000 patients, n = 2,962 (74.1%) answered the follow-up call. Unweighted and IPS-weighted in-treatment case fatality in the primary analysis were 6.12% (95%CI: 5.31-6.97%) and 6.07% (95%CI: 5.22-6.93%), respectively. Post-treatment case fatality estimates were 0.97% (95%CI: 0.61-1.33%) (unweighted) and 1.27% (95%CI: 0.79-1.79) (IPS-weighted). Our IPS-weighted estimates for in-treatment and post-treatment case fatality were similar to pre-pandemic IPS-weighted estimates (in-treatment: 7.27%, 95%CI: 5.97%- 8.49% and 12 months post-treatment: 1.23, 95%CI: 0.75-1.73). Although not higher than pre-pandemic estimates, the observed case fatality in this private sector cohort of people treated for drug-susceptible TB during COVID-19 in Bihar, India is above the level needed to reach the 2025 and 2030 End TB Strategy targets for reductions in TB deaths, underlining the extent of pandemic-related setbacks to TB elimination.
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Affiliation(s)
- Lena Faust
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | | | - Nita Jha
- World Health Partners, Patna, India
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Sophie Huddart
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
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Ferreira ES, Requião-Moura L, Nakamura MR, Foresto RD, Medina Pestana J, Tedesco-Silva H. Impact of Dialysis Time on Long-term Outcomes in HLA-identical Living Donor Kidney Transplant Recipients. Transplant Direct 2024; 10:e1703. [PMID: 39188532 PMCID: PMC11346849 DOI: 10.1097/txd.0000000000001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 07/12/2024] [Indexed: 08/28/2024] Open
Abstract
Background Dialysis vintage is associated with worse outcomes after kidney transplantation. The reasons behind this observation include immunological and nonimmunological risk factors. To mitigate the influence of immunological factors, we examined the association between time on dialysis and clinical outcomes in a cohort of HLA-identical kidney transplant recipients. Methods This retrospective study included 13 321 kidney transplant recipients between 1999 and 2016, of whom 589 were HLA identical followed for at least 5 y. Patient and graft survivals were compared according to dialysis time (<12 or >12 mo) using the log-rank test and Cox regression analysis. We compared surgical complications, cytomegalovirus infection, acute rejection, disease recurrence, and the trajectories of estimated glomerular filtration rate (eGFR). Results Median time on dialysis was 15 mo; 9.2% of patients received preemptive transplants, and 55.3% of patients were on dialysis for >12 mo. After a median follow-up time of 154 mo, there were no differences in unadjusted and adjusted patient and graft survivals (1, 5, 10, and 15 y) between the 2 groups. There were no differences in the incidence of surgical complications (6.2% versus 3.1%), acute rejection (6.1% versus 7.7%), cytomegalovirus infection (7.6% versus 4.0%), and disease recurrence (4.2% versus 4.0%), respectively. There were no differences in mean eGFR during 5 y or in the proportion of patients with an eGFR <30 mL/min at 5 y (9.9% versus 9.2%). Conclusions In this low immunological risk cohort of HLA-identical kidney transplant recipients, we did not observe any association between dialysis vintage on patient survival and graft survival.
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Affiliation(s)
- Evelyn S. Ferreira
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucio Requião-Moura
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - Mônica R. Nakamura
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Renato Demarchi Foresto
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - José Medina Pestana
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
| | - Hélio Tedesco-Silva
- Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil
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Shikamura M, Takayama A, Takeuchi M, Kawakami K. Comparative effectiveness of sodium-glucose cotransporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors in improvement of fatty liver index in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: A retrospective nationwide claims database study in Japan. Diabetes Obes Metab 2024; 26:3099-3109. [PMID: 38708591 DOI: 10.1111/dom.15632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
AIM To date, there are limited clinical studies and real-world evidence investigating whether sodium-glucose cotransporter-2 inhibitors (SGLT2i) are associated with improved hepatic steatosis. This study aimed to evaluate the effectiveness of SGLT2i compared with that of dipeptidyl peptidase-4 inhibitors (DPP4i) in improving the fatty liver index (FLI) in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD). MATERIALS AND METHODS This retrospective cohort study included new users of SGLT2i or DPP4i with T2DM and MASLD from a large claims database (JMDC Claims Database). The primary outcome was the incidence of improvement of the FLI. Cox proportional hazard models, weighted using propensity scores for predicting the initiation of treatment, were fitted to estimate hazard ratios with 95% confidence intervals (CIs). Time-course changes in the FLI values were also assessed. RESULTS This study included 9127 SGLT2i and 12 286 DPP4i initiators. SGLT2i showed a higher incidence of improvement in the FLI (≥30%, ≥40% and ≥50% reduction from baseline FLI) compared with DPP4i, and the weighted hazard ratios were 1.27 (95% CI 1.18-1.38), 1.24 (95% CI 1.13-1.37) and 1.19 (95% CI 1.05-1.33), respectively. SGLT2i indicated a greater decreased in FLI values compared with DPP4i at up to 3 years of the follow-up period. CONCLUSION SGLT2is use appeared to be associated with a greater improvement of the FLI than DPP4i use in patients with T2DM and MASLD. In the absence of direct head-to-head comparisons from clinical studies, our study, using real-world data, may support physicians' decision-making in clinical practice.
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Affiliation(s)
- Mitsuhiro Shikamura
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Takeda Development Centre Japan, Takeda Pharmaceutical Company Limited, Osaka, Japan
| | - Atsushi Takayama
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Lund JL, Rivera MP, Su IH, Long JM, Chen X, Pak J, Hudgens MG, Stürmer T, Reuland DS, Henderson LM. Estimating the Effects of Cancer Screening in Clinical Practice Settings: The Role of Selective Uptake and Suboptimal Adherence along the Cancer Screening Continuum. Cancer Epidemiol Biomarkers Prev 2024; 33:984-988. [PMID: 39012954 PMCID: PMC11351907 DOI: 10.1158/1055-9965.epi-23-1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/02/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Randomized controlled trials (RCT) are the gold standard in determining efficacy of cancer screening tests. Yet, systematic differences between RCT and the general populations eligible for screening raise concerns about the generalizability and relevance of RCT findings to guide the development and dissemination of cancer screening programs. Observational studies from clinical practice settings have documented selective uptake in screening-i.e., variation across subgroups regarding who is screened and not screened-as well as suboptimal adherence to screening recommendations, including follow-up of positive findings with subsequent imaging studies and diagnostic invasive procedures. When the effectiveness of a screening intervention varies across subgroups, and there is selective uptake and suboptimal adherence to screening in clinical practice relative to that in the RCT, the effects of screening reported in RCTs are not expected to generalize to clinical practice settings. Understanding the impacts of selective uptake and suboptimal adherence on estimates of the effectiveness of cancer screening in clinical practice will generate evidence that can be used to inform future screening recommendations and enhance shared decision-making tools.
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Affiliation(s)
- Jennifer L. Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - M. Patricia Rivera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY
| | - I-Hsuan Su
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jason M. Long
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Xiaomeng Chen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Joyce Pak
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Michael G. Hudgens
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Daniel S. Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, NC
- Department of Medicine, Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Louise M. Henderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, NC
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D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Bertrand K, Vasiliadis HM. Risk of Mortality Associated with Potentially Inappropriate Medication Use Including Opioids in Older Adults. Drug Saf 2024; 47:799-807. [PMID: 38722482 DOI: 10.1007/s40264-024-01429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION AND OBJECTIVE As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults. METHODS Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0-90 days before death. RESULTS In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69-27.47), after adjusting for potential confounders. CONCLUSIONS Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.
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Affiliation(s)
- Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Carlotta Lunghi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Line Guénette
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, Québec City, QC, Canada
- Faculty of Pharmacy, Laval University, Québec City, QC, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
- Charles-Le Moyne Research Center (CR-CLM), Longueuil, QC, Canada.
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Wohlfeiler MB, Weber RP, Brunet L, Siddiqui J, Harbour M, Phillips AL, Hayward B, Fusco JS, Hsu RK, Fusco GP. Incident HIV-Associated Wasting/Low Weight Is Associated with Nearly Doubled Mortality Risk in the Modern ART Era. AIDS Res Hum Retroviruses 2024; 40:428-434. [PMID: 38481376 DOI: 10.1089/aid.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
HIV-associated wasting (HIVAW) is an underappreciated AIDS-defining illness, despite highly effective antiretroviral therapy (ART). We (a) assessed the association between incident HIVAW/low weight and all-cause mortality and (b) described virologic outcomes after people with HIV (PWH) experienced HIVAW/low weight while on ART. In the Observational Pharmaco-Epidemiology Research & Analysis (OPERA®) cohort, PWH without prior HIVAW/low weight who were active in care in 2016-2020 were followed through the first of the following censoring events: death, loss to follow-up, or study end (October 31, 2021). HIVAW/low weight was a diagnosis of wasting or low body mass index (BMI)/underweight or a BMI measurement <20 kg/m2. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent HIVAW/low weight and mortality were estimated with extended Cox regression models. Over a median follow-up of 45 months (interquartile range: 27, 65), there were 4,755 (8%) cases of HIVAW/low weight and 1,354 (2%) deaths among 62,314 PWH. PWH who experienced HIVAW/low weight had a significantly higher risk of death than those who did not (HR: 1.96; 95% CI: 1.68, 2.27) after adjusting for age, race, ethnicity, and changes in viral load (VL) and Veterans Aging Cohort Study Mortality Index scores over follow-up. Among 4,572 PWH on ART at HIVAW/low weight, 68% were suppressed (VL of <200 copies/mL); subsequent virologic failure was uncommon (7%). Among viremic PWH, 70% and 60% achieved suppression and undetectability (VL of <50 copies/mL), respectively, over follow-up. HIVAW remains a challenge for some PWH. Particular attention needs to be paid to HIVAW/low weight and virologic control to restore health and potentially reduce the risk of death.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ricky K Hsu
- AIDS Healthcare Foundation, New York, New York, USA
- NYU Langone Medical Center, New York, New York, USA
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Iff J, Done N, Tuttle E, Zhong Y, Wei F, Darras BT, McDonald CM, Mercuri E, Muntoni F. Survival among patients receiving eteplirsen for up to 8 years for the treatment of Duchenne muscular dystrophy and contextualization with natural history controls. Muscle Nerve 2024; 70:60-70. [PMID: 38482981 DOI: 10.1002/mus.28075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION/AIMS Eteplirsen, approved in the US for patients with Duchenne muscular dystrophy (DMD) with exon 51 skip-amenable variants, is associated with attenuated ambulatory/pulmonary decline versus DMD natural history (NH). We report overall survival in a US cohort receiving eteplirsen and contextualize these outcomes versus DMD NH. METHODS US patients with DMD receiving eteplirsen were followed through a patient support program, with data collected on ages at eteplirsen initiation and death/end of follow-up. Individual DMD NH data were extracted by digitizing Kaplan-Meier (KM) curves from published systematic and targeted literature reviews. Overall survival age was analyzed using KM curves and contextualized with DMD NH survival curves; subanalyses considered age groups and duration of eteplirsen exposure. Overall survival time from treatment initiation was also evaluated. RESULTS A total of 579 eteplirsen-treated patients were included. During a total follow-up of 2119 person-years, median survival age was 32.8 years. DMD NH survival curves extracted from four publications (follow-up for 1224 DMD NH controls) showed overall pooled median survival age of 27.4 years. Eteplirsen-treated patients had significantly longer survival from treatment initiation versus age-matched controls (age-adjusted hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.44-0.98; p < .05). Longer treatment exposure was associated with improved survival (HR, 0.15; 95% CI, 0.05-0.41; p < .001). Comparisons using different DMD NH cohorts to address common risks of bias yielded consistent findings. DISCUSSION Data suggest eteplirsen may prolong survival in patients with DMD across a wide age range. As more data become available, the impact of eteplirsen on survival will be further elucidated.
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Affiliation(s)
- Joel Iff
- Sarepta Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - Nicolae Done
- Analysis Group, Inc., Boston, Massachusetts, USA
| | | | - Yi Zhong
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Fangzhou Wei
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Basil T Darras
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Craig M McDonald
- University of California Davis Health System, Sacramento, California, USA
| | - Eugenio Mercuri
- Paediatric Neurology and Centro Clinico NeMO, Catholic University and Policlinico Gemelli, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
- Centro Clinico NeMO, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Hospital, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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10
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Kirkegård J, Gaber C, Heide-Jørgensen U, Fristrup CW, Lund JL, Cronin-Fenton D, Mortensen FV. Effect of surgery versus chemotherapy in pancreatic cancer patients: a target trial emulation. J Natl Cancer Inst 2024; 116:1072-1079. [PMID: 38310365 DOI: 10.1093/jnci/djae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/08/2023] [Accepted: 01/28/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND To estimate the causal effect of surgery vs chemotherapy on survival in patients with T1-3NxM0 pancreatic cancer in a rigorous framework addressing selection bias and immortal time bias. METHODS We used population-based Danish health-care registries to conduct a cohort study emulating a hypothetical randomized trial to estimate the absolute difference in survival, comparing surgery with chemotherapy. We included pancreatic cancer patients diagnosed during 2008-2021. Exposure was surgery or chemotherapy initiated within a 16-week grace period after diagnosis. At the time of diagnosis, data of each patient were duplicated; one copy was assigned to the surgery protocol, and one copy to the chemotherapy protocol of the hypothetical trial. Copies were censored when the assigned treatment deviated from the observed treatment. To account for informative censoring, uncensored patients were weighted according to confounders. For comparison, we also applied a more conventional analysis using propensity score-based inverse probability weighting. RESULTS We included 1744 patients with a median age of 68 years: 73.6% underwent surgery, and 18.6% had chemotherapy without surgery; 7.8% received no treatment. The 3-year survival was 39.7% (95% confidence interval [CI] = 36.7% to 42.6%) after surgery and 22.7% (95% CI = 17.7% to 28.4%) after chemotherapy, corresponding to an absolute difference of 17.0% (95% CI = 10.8% to 23.1%). In the conventional survival analysis, this difference was 23.0% (95% CI = 17.0% to 29.0%). CONCLUSION Surgery was superior to chemotherapy in achieving long-term survival for pancreatic cancer. The difference comparing surgery and chemotherapy was substantially smaller when using the clone-censor-weight approach than conventional survival analysis.
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Affiliation(s)
- Jakob Kirkegård
- Department of Surgery, HPB Section, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charles Gaber
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | - Uffe Heide-Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deirdre Cronin-Fenton
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Frank Viborg Mortensen
- Department of Surgery, HPB Section, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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11
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Hurtado I, Robles C, García-Sempere A, Llopis-Cardona F, Sánchez-Sáez F, Rodríguez-Bernal C, Peiró S, Sanfélix-Gimeno G. Long-term use of prescription opioids for non-cancer pain and mortality: a population-based, propensity-weighted cohort study. Public Health 2024; 232:4-13. [PMID: 38718737 DOI: 10.1016/j.puhe.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with long-term opioid use and to assess the association between long-term use and death. STUDY DESIGN Retrospective cohort study combining several population-wide databases and covering a population of five million inhabitants, including all adults who were initiated on opioid treatment from 2014 to 2018 for non-cancer pain. METHODS We used logistic regression models to identify factors associated with chronic opioid use and carried out survival analyses using multivariable Cox regression modelling for all-cause mortality during follow-up using inverse probability of treatment weighting (IPTW) and propensity scores based on the probability of using opioids chronically. RESULTS Among 760,006 patients, 82,423 (10.85%) used opioids for 90 days or more after initiation. Initial therapy characteristics associated with higher risk for long-term use were initiating with long- and short-acting opioids (when compared to tramadol, odds ratio [OR]: 2.63, 95% confidence interval [CI]: 2.57, 2.69 and OR: 1.60, 95%CI: 1.46, 1.76, respectively), using higher daily doses (when compared to 50 morphine milligramme equivalent [MME] or less, prescribing 50 to 89 daily MME, OR: 1.76, 95%CI: 1.65, 1.87; 90 to 119 daily MME, OR: 2.44, 95%CI: 1.99, 3.01; and more than 120 daily MME, OR: 1.77, 95%CI: 1.64, 1.91), and overlapping with gabapentinoids (OR: 2.26, 95%CI: 2.20, 2.32), benzodiazepines (OR: 1.32, 95%CI: 1.30, 1.35), and antipsychotics (OR: 1.21, 95%CI: 1.16, 1.26). After IPTW, chronic opioid use was associated with higher risk of all-cause mortality when compared to short-term use (Hazard Ratio (HR): 1.37, 95%CI: 1.32, 1.42). Sensitivity analyses provided similar results. CONCLUSION These findings may help healthcare managers to identify and address patients at higher risk of long-term use and riskier prescription patterns.
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Affiliation(s)
- I Hurtado
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - C Robles
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - A García-Sempere
- Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain.
| | - F Llopis-Cardona
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - F Sánchez-Sáez
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - C Rodríguez-Bernal
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - S Peiró
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - G Sanfélix-Gimeno
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Fisabio, Spain; Spanish Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
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12
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Park JE, Lee E, Singh D, Kim EK, Park B, Park JH. The effect of inhaler prescription on the development of lung cancer in COPD: a nationwide population-based study. Respir Res 2024; 25:229. [PMID: 38822332 PMCID: PMC11140980 DOI: 10.1186/s12931-024-02838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/04/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND COPD is associated with the development of lung cancer. A protective effect of inhaled corticosteroids (ICS) on lung cancer is still controversial. Hence, this study investigated the development of lung cancer according to inhaler prescription and comorbidties in COPD. METHODS A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded. RESULTS Of the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86-3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01-1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01-1.39), along with older age and male sex, were independently associated with the development of lung cancer. CONCLUSION Our data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.
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Affiliation(s)
- Ji Eun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Worldcup-ro 164, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Eunyoung Lee
- Department of Neurology, McGovern Medical School at UTHealth, Houston, TX, US
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Eun Kyung Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Worldcup-ro 164, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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13
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Müller J, Roos I, Kalincik T, Lorscheider J, Galli E, Benkert P, Schädelin S, Sharmin S, Einsiedler M, Hänni P, Schmid J, Kuhle J, Derfuss T, Granziera C, Ziemssen T, Siepmann T, Yaldizli Ö. Escalating to medium- versus high-efficacy disease modifying therapy after low-efficacy treatment in relapsing remitting multiple sclerosis. Brain Behav 2024; 14:e3498. [PMID: 38688877 PMCID: PMC11061202 DOI: 10.1002/brb3.3498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In patients with relapsing remitting multiple sclerosis (RRMS) on low-efficacy disease modifying therapies (DMT), the optimal strategy on how to escalate treatment once needed, remains unknown. METHODS We studied RRMS patients on low-efficacy DMTs listed in the Swiss National Treatment Registry, who underwent escalation to either medium- or high-efficacy DMTs. Propensity score-based matching was applied using 12 clinically relevant variables. Both groups were also separately matched with control subjects who did not escalate therapy. Time to relapse and to disability worsening were evaluated using Cox proportional hazard models. RESULTS Of 1037 eligible patients, we 1:1 matched 450 MS patients who switched from low-efficacy to medium-efficacy (n = 225; 76.0% females, aged 42.4 ± 9.9 years [mean ± SD], median EDSS 3.0 [IQR 2-4]) or high-efficacy DMTs (n = 225; 72.4% females, aged 42.2 ± 10.6 years, median EDSS 3.0 [IQR 2-4]). Escalation to high-efficacy DMTs was associated with lower hazards of relapses than medium-efficacy DMTs (HR = 0.67, 95% CI 0.47-0.95, p = .027) or control subjects (HR = 0.61, 95% CI 0.44-0.84, p = .003). By contrast, escalation from low to medium-efficacy DMTs did not alter the hazard for relapses when compared to controls (i.e. patients on low-efficacy DMT who did not escalate DMT during follow-up) CONCLUSION: Our nationwide registry analysis suggests that, once escalation from a low-efficacy DMT is indicated, switching directly to a high-efficacy treatment is superior to a stepwise escalation starting with a moderate-efficacy treatment.
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Affiliation(s)
- Jannis Müller
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
| | - Izanne Roos
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Tomas Kalincik
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Johannes Lorscheider
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Edoardo Galli
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Pascal Benkert
- Department of Clinical ResearchClinical Trial UnitUniversity Hospital BaselBaselSwitzerland
| | - Sabine Schädelin
- Department of Clinical ResearchClinical Trial UnitUniversity Hospital BaselBaselSwitzerland
| | - Sifat Sharmin
- CORe, Department of MedicineUniversity of MelbourneMelbourneAustralia
- Neuroimmunology CentreRoyal Melbourne HospitalMelbourneAustralia
| | - Maximilian Einsiedler
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Peter Hänni
- Swiss Federation for Common Tasks of Health Insurances (SVK)SolothurnSwitzerland
| | - Jürg Schmid
- Swiss Federation for Common Tasks of Health Insurances (SVK)SolothurnSwitzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Tobias Derfuss
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Tjalf Ziemssen
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
- Center of Clinical Neuroscience, Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Timo Siepmann
- Division of Health Care SciencesDresden International UniversityDresdenGermany
- Department of Neurology, Medical Faculty and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Özgür Yaldizli
- Neurology Clinic and Policlinic, Departments of Head, Spine and Neuromedicine, MS Center and Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
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14
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Li CP, Tsai RY, Chang HC, Gau SY. Letter: Association between chronic kidney disease, hepatitis B and antiviral treatments. Aliment Pharmacol Ther 2024; 59:587. [PMID: 38247142 DOI: 10.1111/apt.17851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024]
Abstract
LINKED CONTENTThis article is linked to Choi et al papers. To view these articles, visit https://doi.org/10.1111/apt.17819 and https://doi.org/10.1111/apt.17875
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Affiliation(s)
- Chen-Pi Li
- Department of Nursing, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Ru-Yin Tsai
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hui-Chin Chang
- Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medical Education, Chi Mei Medical Center, Tainan, Taiwan
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15
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Wiens MR, French JL, Rogers JA. Confounded exposure metrics. CPT Pharmacometrics Syst Pharmacol 2024; 13:187-191. [PMID: 37984457 PMCID: PMC10864924 DOI: 10.1002/psp4.13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
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16
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Goldman-Mellor S, Qin P. Interpersonal violent injury and subsequent risk of suicide and deliberate self-harm: a register-based national cohort study from Norway, 2010-2018. EClinicalMedicine 2024; 68:102442. [PMID: 38333541 PMCID: PMC10850407 DOI: 10.1016/j.eclinm.2024.102442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024] Open
Abstract
Background Interpersonal violence is a leading cause of morbidity, with potentially severe adverse consequences for the mental health of the injured persons. The extent to which violent injury is associated with subsequent suicidal behavior, however, remains unclear. This study aimed to examine how violent injury was associated with subsequent deliberate self-harm and death by suicide. Methods This retrospective cohort study used nationwide longitudinal registry data from Norway to identify all individuals presenting to emergency services in 2010-2018 with a violence-related injury, along with sex- and age-matched control individuals from the general population. The primary outcomes were any emergency visit for deliberate self-harm (DSH) and suicide death, observed through 31 December 2018. Rates of each outcome were compared between violence-injured patients and comparison individuals using stratified multivariable Cox regression models, controlling for sociodemographic characteristics as well as history of psychiatric treatment and DSH. Secondary analyses tested for moderation by sex, age, and prior psychiatric treatment. Findings Violence-injured patients (n = 28,276) had substantially higher rates of DSH (946.7 per 100,000 person-years) and suicide death (74.5 per 100,000) when compared to controls (n = 282,760; 90.0 and 15.2 per 100,000, respectively). The hazard ratios (HRs) remained significantly higher even after accounting for covariates (HRadj for DSH: 5.11; 95% CI: 4.62, 5.66; HRadj for suicide: 2.40; 95% CI: 1.78, 3.24). Sex differences in this association were negligible, but the association between violence injury and DSH increased with age. Violence-injured patients with prior psychiatric treatment had the highest risk of suicidal behavior. Interpretation Violence-injured patients experience significantly excess rates of suicidal behavior, a finding with potential to inform both clinical intervention and population-level suicide prevention strategies. Funding Fulbright Norway Scholarship.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA, USA
- Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd., Merced, CA, USA
| | - Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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17
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Kirkegård J, Ladekarl M, Lund A, Mortensen F. Impact on Survival of Early Versus Late Initiation of Adjuvant Chemotherapy After Pancreatic Adenocarcinoma Surgery: A Target Trial Emulation. Ann Surg Oncol 2024; 31:1310-1318. [PMID: 37914923 PMCID: PMC10761389 DOI: 10.1245/s10434-023-14497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND We examined the impact of early (0-4 weeks after discharge) versus late (> 4-8 weeks after discharge) initiation of adjuvant chemotherapy on pancreatic adenocarcinoma survival. METHODS We used Danish population-based healthcare registries to emulate a hypothetical target trial using the clone-censor-weight approach. All eligible patients were cloned with one clone assigned to 'early initiation' and one clone assigned to 'late initiation'. Clones were censored when the assigned treatment was no longer compatible with the actual treatment. Informative censoring was addressed using inverse probability of censoring weighting. RESULTS We included 1491 patients in a hypothetical target trial, of whom 32.3% initiated chemotherapy within 0-4 weeks and 38.3% between > 4 and 8 weeks after discharge for pancreatic adenocarcinoma surgery; 206 (13.8%) initiated chemotherapy after > 8 weeks, and 232 (15.6%) did not initiate chemotherapy. Median overall survival was 30.4 and 29.9 months in late and early initiators, respectively. The absolute differences in OS, comparing late with early initiators, were 3.2% (95% confidence interval [CI] - 1.5%, 7.9%), - 0.7% (95% CI - 7.2%, 5.8%), and 3.2% (95% CI - 2.8%, 9.3%) at 1, 3, and 5 years, respectively. Late initiators had a higher increase in albumin levels as well as higher pretreatment albumin values. CONCLUSIONS Postponement of adjuvant chemotherapy up to 8 weeks after discharge from pancreatic adenocarcinoma surgery is safe and may allow more patients to receive adjuvant therapy due to better recovery.
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Affiliation(s)
- Jakob Kirkegård
- HPB Section, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Morten Ladekarl
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Andrea Lund
- HPB Section, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Frank Mortensen
- HPB Section, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Chakraborty A. Biases in dermatology: A primer. Indian J Dermatol Venereol Leprol 2024; 0:1-5. [PMID: 38314974 DOI: 10.25259/ijdvl_126_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/10/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Atreyo Chakraborty
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Veerbhadra Marg, Rishikesh, India
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19
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Sule NO, Suissa S. Statins and Mortality in COPD: A Methodological Review of Observational Studies. COPD 2023; 20:284-291. [PMID: 37555454 DOI: 10.1080/15412555.2023.2242489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023]
Abstract
Randomized controlled trials and observational studies have reported conflicting results on the potential beneficial effects of statins on mortality in patients with chronic obstructive pulmonary disease (COPD). We performed a systematic search of the literature to review all observational studies reporting relative risks of death with statin use in COPD, focusing on potential sources of bias. We identified 15 observational studies, out of 2835, of which 12 were affected by time-related and other biases and the remaining 3 by confounding bias. All 15 studies were also subject to confounding bias due to lack of adjustment for important COPD-related factors. The risk of death associated with statin use was reduced across all 15 studies (pooled relative risk (PRR) 0.66; 95% CI: 0.59-0.74). The reduction was observed in 7 studies with immortal time bias (PRR 0.62; 95%: 0.53-0.72), two with collider-stratification bias (PRR 0.60; 95% CI: 0.45-0.80), one with time-window bias (RR 0.61; 95% CI: 0.38-0.98), one with immeasurable time bias (RR 0.50; 95% CI: 0.40-0.62), and one with exposure misclassification (RR 0.86; 95% CI: 0.72-1.03). The three studies that avoided these biases were, however, affected by confounding bias resulting in a PRR of 0.77 (95% CI: 0.61-0.98). In conclusion, the observational studies investigating statin use and mortality in COPD are affected by major biases, many of which can result in spurious protective effects. Well-designed observational studies that carefully emulate randomized trials are needed to resolve this uncertainty regarding the potential beneficial benefits of statins on mortality in patients with COPD.
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Affiliation(s)
- Naheemot Olaoluwa Sule
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Samy Suissa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
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D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Bertrand K, Vasiliadis HM. Health care system costs related to potentially inappropriate medication use involving opioids in older adults in Canada. BMC Health Serv Res 2023; 23:1295. [PMID: 38001466 PMCID: PMC10668473 DOI: 10.1186/s12913-023-10303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Older adults are at risk of potentially inappropriate medication use given polypharmacy, multimorbidity, and age-related changes, which contribute to the growing burden associated with opioid use. The objective of this study was to estimate the costs of health service utilization attributable to opioid use and potentially inappropriate medication use involving opioids in older adults in a public health care system. METHODS The sample included 1201 older adults consulting in primary care, covered by the public drug plan, without a cancer diagnosis and opioid use in the year before interview. Secondary analyses were conducted using two data sources: health survey and provincial administrative data. Health system costs included inpatient and outpatient visits, physician billing, and medication costs. Unit costs were calculated using annual financial and activity reports from 2013-2014, adjusted to 2022 Canadian dollars. Opioid use and potentially inappropriate medication use involving opioids were identified over 3 years. Generalized linear models with gamma distribution were employed to model 3-year costs associated with opioid use and potentially inappropriate medication use involving opioids. A phase-based approach was implemented to provide descriptive results on the costs associated with each phase: i) no use, ii) opioid use, and iii) potentially inappropriate medication use involving opioids. RESULTS Opioid use and potentially inappropriate medication use involving opioids were associated with adjusted 3-year costs of $2,222 (95% CI: $1,179-$3,264) and $8,987 (95% CI: $7,370-$10,605), respectively, compared to no use. In phase-based analyses, costs were the highest during inappropriate use. CONCLUSIONS Potentially inappropriate medication use involving opioids is associated with higher costs compared to those observed with opioid use and no use. There is a need for more effective use of health care resources to reduce costs for the health care system.
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Affiliation(s)
- Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke (Longueuil campus), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski (Lévis campus), 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, 40126, Bologna, BO, Italy
| | - Line Guénette
- Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, 1050 Chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada
- Faculty of Pharmacy, Laval University, 1050 Av. de La Médecine, Québec City, QC, G1V 0A6, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke (Longueuil campus), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke (Longueuil campus), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
- Charles-Le Moyne Research Center (CR-CLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke (Longueuil campus), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
- Charles-Le Moyne Research Center (CR-CLM), 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada.
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Park H, Han M, Jang D, Kim D, Huh P, Park H, Park IS, Han Y, Sung JH, Lee K, Lee H, Kim YW. Association of Bypass Surgery and Mortality in Moyamoya Disease. J Am Heart Assoc 2023; 12:e030834. [PMID: 37947101 PMCID: PMC10727291 DOI: 10.1161/jaha.123.030834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Patients with moyamoya disease (MMD) have a high risk of stroke or death. We investigated whether extracranial to intracranial bypass surgery can reduce mortality by preventing strokes in patients with MMD. METHODS AND RESULTS This nationwide retrospective cohort study encompassed patients with MMD registered under the Rare Intractable Diseases program via the Relieved Co-Payment Policy between 2006 and 2019, using the Korean National Health Insurance Service database. Following a 4-year washout period, landmark analyses were employed to assess mortality and stroke occurrence between the bypass surgery group and the nonsurgical control group at specific time points postindex date (1 month and 3, 6, 12, and 36 months). The study included 18 480 patients with MMD (mean age, 40.7 years; male to female ratio, 1:1.86) with a median follow-up of 5.6 years (interquartile range, 2.5-9.3; mean, 6.1 years [SD, 4.0 years]). During 111 775 person-years of follow-up, 265 patients in the bypass surgery group and 1144 patients in the nonsurgical control group died (incidence mortality rate of 618.1 events versus 1660.3 events, respectively, per 105 person-years). The overall adjusted hazard ratio (HR) revealed significantly lower all-cause mortality in the bypass surgery group from the 36-month landmark time point, for any stroke mortality from 3- and 6-month landmark time points, and for hemorrhagic stroke mortality from the 6-month landmark time point. Furthermore, the overall adjusted HRs for hemorrhagic stroke occurrence were beneficially maintained from all 5 landmark time points in the bypass surgery group. CONCLUSIONS Bypass surgery in patients with MMD was associated with a lower risk of all-cause and hemorrhagic stroke mortality and hemorrhagic stroke occurrence compared with nonsurgical control.
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Affiliation(s)
- Hyunjun Park
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonRepublic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems InformaticsYonsei University College of MedicineSeoulRepublic of Korea
| | - Dong‐Kyu Jang
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaIncheonRepublic of Korea
| | - Dal‐Soo Kim
- Department of NeurosurgeryMyong‐Ji St. Mary’s HospitalSeoulRepublic of Korea
| | - Pil‐Woo Huh
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital. College of MedicineThe Catholic University of KoreaGyeonggi‐doRepublic of Korea
| | - Hae‐Kwan Park
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Ik Seong Park
- Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaGyeonggi‐doRepublic of Korea
| | - Young‐Min Han
- Department of NeurosurgeryNaeun HospitalIncheonRepublic of Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent’s Hospital, College of MedicineThe Catholic University of KoreaGyeonggi‐doRepublic of Korea
| | - Kwan‐Sung Lee
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulRepublic of Korea
| | - Hyung‐Jin Lee
- Department of Neurosurgery, Daejeon St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaDaejeonRepublic of Korea
| | - Young Woo Kim
- Department of Neurosurgery, Uijeongbu St. Mary’s Hospital. College of MedicineThe Catholic University of KoreaGyeonggi‐doRepublic of Korea
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Watanabe D, Fujii H, Ohata K, Iihara H, Makiyama A, Kobayashi R, Hirose C, Hishida S, Matsuoka S, Tajima JY, Kiyama S, Takahashi T, Suzuki A, Matsuhashi N. Prognostic impact of severe neutropenia in colorectal cancer patients treated with TAS-102 and bevacizumab, addressing immortal-time bias. BMC Cancer 2023; 23:1078. [PMID: 37940878 PMCID: PMC10634158 DOI: 10.1186/s12885-023-11618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Several studies have reported an association between severe neutropenia and long-term survival in patients treated with trifluridine-tipiracil (TAS-102). Because some of these studies failed to address immortality time bias, however, their findings should be interpreted with caution. Additionally, the association between severe neutropenia and survival in patients receiving TAS-102 in combination with bevacizumab (Bmab) remains unclear. PATIENTS AND METHODS We conducted a single-center retrospective cohort study in patients with colorectal cancer who received Bmab + TAS-102. We compared overall survival (OS) between patients who developed grade ≥ 3 neutropenia during the treatment period and those who did not. To account for immortal time bias, we used two approaches, time-varying Cox regression and landmark analysis. RESULTS Median OS was 15.3 months [95% CI: 14.1-NA] in patients with grade ≥ 3 neutropenia and 10.0 months [95% CI: 8.1-NA] in those without. In time-varying Cox regression, onset grade ≥ 3 neutropenia was significantly related to longer survival after adjustment for age and modified Glasgow Prognostic Score. Additionally, 30-, 60-, 90-, and 120-day landmark analysis showed that grade ≥ 3 neutropenia was associated with longer survival after adjustment for age and modified Glasgow Prognostic Score, with respective HRs of 0.30 [0.10-0.90], 0.65 [0.30-1.42], 0.39 [0.17-0.90], and 0.41 [0.18-0.95]. CONCLUSION We identified an association between long-term survival and the development of severe neutropenia during the early cycle of Bmab + TAS-102 using an approach that addressed immortality time bias.
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Affiliation(s)
- Daichi Watanabe
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Hironori Fujii
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan.
| | - Koichi Ohata
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Hirotoshi Iihara
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | | | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Chiemi Hirose
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Shiori Hishida
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Serika Matsuoka
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
| | - Jesse Yu Tajima
- Department of Gastroenterological Surgery/Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological Surgery/Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery/Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Surgery, Ibi Kousei Hospital, Gifu-Seino Medical Center, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Yanagido 1-1, Gifu, 501-1194, Japan
- Laboratory of Advanced Medical Pharmacy, Gifu Pharmaceutical University, Gifu, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery/Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Sheridan P, Chen C, Thompson CA, Benmarhnia T. Immortal Time Bias With Time-Varying Exposures in Environmental Epidemiology: A Case Study in Lung Cancer Survival. Am J Epidemiol 2023; 192:1754-1762. [PMID: 37400995 PMCID: PMC10558188 DOI: 10.1093/aje/kwad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/19/2023] [Accepted: 06/04/2023] [Indexed: 07/05/2023] Open
Abstract
Immortal time bias is a well-recognized bias in clinical epidemiology but is rarely discussed in environmental epidemiology. Under the target trial framework, this bias is formally conceptualized as a misalignment between the start of study follow-up (time 0) and treatment assignment. This misalignment can occur when attained duration of follow-up is encoded into treatment assignment using minimums, maximums, or averages. The bias can be exacerbated in the presence of time trends commonly found in environmental exposures. Using lung cancer cases from the California Cancer Registry (2000-2010) linked with estimated concentrations of particulate matter less than or equal to 2.5 μm in aerodynamic diameter (PM2.5), we replicated previous studies that averaged PM2.5 exposure over follow-up in a time-to-event model. We compared this approach with one that ensures alignment between time 0 and treatment assignment, a discrete-time approach. In the former approach, the estimated overall hazard ratio for a 5-μg/m3 increase in PM2.5 was 1.38 (95% confidence interval: 1.36, 1.40). Under the discrete-time approach, the estimated pooled odds ratio was 0.99 (95% confidence interval: 0.98, 1.00). We conclude that the strong estimated effect in the former approach was likely driven by immortal time bias, due to misalignment at time 0. Our findings highlight the importance of appropriately conceptualizing a time-varying environmental exposure under the target trial framework to avoid introducing preventable systematic errors.
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Affiliation(s)
- Paige Sheridan
- Correspondence to Dr. Paige Sheridan, Herbert Wertheim School of Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093 (e-mail: )
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Lu SSM, Rutegård M, Ahmed M, Häggström C, Gylfe Å, Harlid S, Van Guelpen B. Prediagnostic Prescription Antibiotics Use and Survival in Patients with Colorectal Cancer: A Swedish National Register-Based Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1391-1401. [PMID: 37490284 PMCID: PMC10543975 DOI: 10.1158/1055-9965.epi-23-0340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Antibiotics use is associated with higher colorectal cancer risk, but little is known regarding any potential effects on survival. METHODS We conducted a nationwide cohort study, using complete-population data from Swedish national registers between 2005 and 2020, to investigate prediagnostic prescription antibiotics use in relation to survival in colorectal cancer patients. RESULTS We identified 36,061 stage I-III and 11,242 stage IV colorectal cancer cases diagnosed between 2010 and 2019. For stage I-III, any antibiotics use (binary yes/no variable) was not associated with overall or cancer-specific survival. Compared with no use, moderate antibiotics use (total 11-60 days) was associated with slightly better cancer-specific survival [adjusted HR (aHR) = 0.93; 95% confidence interval (CI), 0.86-0.99)], whereas very high use (>180 days) was associated with worse survival [overall survival (OS) aHR = 1.42; 95% CI, 1.26-1.60, cancer-specific survival aHR = 1.31; 95% CI, 1.10-1.55]. In analyses by different antibiotic types, although not statistically significant, worse survival outcomes were generally observed across several antibiotics, particularly macrolides and/or lincosamides. In stage IV colorectal cancer, inverse relationships between antibiotics use and survival were noted. CONCLUSIONS Overall, our findings do not support any substantial detrimental effects of prediagnostic prescription antibiotics use on cancer-specific survival after colorectal cancer diagnosis, with the possible exception of very high use in stage I-III colorectal cancer. Further investigation is warranted to confirm and understand these results. IMPACT Although the study findings require confirmation, physicians probably do not need to factor in prediagnostic prescription antibiotics use in prognosticating patients with colorectal cancer.
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Affiliation(s)
- Sai San Moon Lu
- Department of Radiation Sciences, Oncology unit, Umeå University, Umeå, Sweden
| | - Martin Rutegård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Maghfoor Ahmed
- Department of Radiation Sciences, Oncology unit, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Registry Centre North, Umeå University, Umeå, Sweden
| | - Åsa Gylfe
- Department of Clinical Microbiology, Umeå University, Umeå, Sweden
- Umeå Centre for Microbial Research, Umeå University, Umeå, Sweden
- Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology unit, Umeå University, Umeå, Sweden
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology unit, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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25
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Larfors G, Andersson P, Jesson G, Liljebris C, Brisander M, Lennernäs H, Stenke L. Despite warnings, co-medication with proton pump inhibitors and dasatinib is common in chronic myeloid leukemia, but XS004, a novel oral dasatinib formulation, provides reduced pH-dependence, minimizing undesirable drug-drug interactions. Eur J Haematol 2023; 111:644-654. [PMID: 37503797 DOI: 10.1111/ejh.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Dasatinib and other tyrosine kinase inhibitors (TKI) have revolutionized the treatment of chronic myeloid leukemia (CML). However, as a lipophilic weak base, crystalline monohydrate, dasatinib (Sprycel®) is poorly soluble, rendering a pH-dependent absorption and a highly variable bioavailability. Thus, co-medication with proton pump inhibitors (PPI) profoundly impairs dasatinib uptake and is clearly recommended against. XS004 is a novel oral immediate release and amorphous solid dispersion (ASD) formulation of dasatinib and is bioequivalent to the original crystalline dasatinib at 30% lower dosages. XS004 is designed to mitigate gastric pH dependency, thus optimizing absorption and bioavailability. METHODS We investigated the prevalence of dasatinib and PPI co-medication among chronic-phase CML patients in a real-world setting and assessed the plasma pharmacokinetics (PK) of XS004 with and without PPI co-medication (omeprazole) in healthy volunteers. RESULTS Using the Swedish CML and Prescribed Drug Registers, we identified 676 TKI-treated CML patients; 320 (47%) had been prescribed PPI at some point after CML diagnosis. Among dasatinib-treated patients, the 2-year cumulative PPI co-medication was 24%. Interestingly, the 5-year overall survival was significantly lower for TKI-treated CML patients with versus without PPI co-medication (79% vs. 94%; hazard ratio 3.5; 95% confidence interval, 2.1-5.3; p < .0001). When assessing PK of XS004, neither Cmax nor area under the plasma concentration curve levels in plasma were significantly altered by the PPI co-medication. CONCLUSION In conclusion, despite warnings, PPI co-medication is common among dasatinib-treated CML patients in a real-world setting. The new XS004 ASD formulation of dasatinib provided, in contrast to original crystalline dasatinib, superior pH independence with stable bioavailability, thereby minimizing drug-drug interactions. This may improve the long-term efficacy and tolerability of dasatinib in CML.
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Affiliation(s)
- Gunnar Larfors
- Unit of Hematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Hans Lennernäs
- Department of Pharmaceutical Biosciences, Translational Drug Discovery and Development, Uppsala University, Uppsala, Sweden
| | - Leif Stenke
- Karolinska University Hospital and Karolinska Institutet, Department of Hematology, Theme Cancer and Department of Medicine Solna, Stockholm, Sweden
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26
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Winters C, Ford AC. Immortal time bias in a retrospective study examining colorectal cancer mortality according to adherence to colonoscopy. Gut 2023; 72:1799-1800. [PMID: 37549982 DOI: 10.1136/gutjnl-2022-328419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/28/2022] [Indexed: 08/09/2023]
Affiliation(s)
- Conchubhair Winters
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander Charles Ford
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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27
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Beaufils M, Amodru V, Tejeda M, Boher JM, Zemmour C, Chanez B, Chrétien AS, Gorvel L, Gravis G, Bruyat D, Mari R, Madroszyk A, Cuny T, Gonçalves A, Lisberg AE, Olive D, Tassy L, Castinetti F, Rochigneux P. Dysthyroidism during immune checkpoint inhibitors is associated with improved overall survival in adult cancers: data mining of 1385 electronic patient records. J Immunother Cancer 2023; 11:e006786. [PMID: 37536938 PMCID: PMC10401250 DOI: 10.1136/jitc-2023-006786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Dysthyroidism (DT) is a common toxicity of immune checkpoint inhibitors (ICIs) and prior work suggests that dysthyroidism (DT) might be associated with ICI efficacy. PATIENTS AND METHODS ConSoRe, a new generation data mining solution, was used in this retrospective study, to extract data from electronic patient records of adult cancer patients treated with ICI at Institut Paoli-Calmettes (Marseille, France). Every DT was verified and only ICI-induced DT was retained. Survival analyses were performed by Kaplan-Meier method (log-rank test) and Cox model. To account for immortal time bias, a conditional landmark analysis was performed (2 months and 6 months), together with a time-varying Cox model. RESULTS Data extraction identified 1385 patients treated with ICI between 2011 and 2021. DT was associated with improved overall survival (OS) (HR 0.46, (95% CI 0.33 to 0.65), p<0.001), with a median OS of 35.3 months in DT group vs 15.4 months in non-DT group (NDT). Survival impact of DT was consistent using a 6-month landmark analysis with a median OS of 36.7 months (95% CI 29.4 to not reported) in the DT group vs 25.5 months (95% CI 22.8 to 27.8) in the NDT group. In multivariate analysis, DT was independently associated with improved OS (HR 0.49, 95% CI 0.35 to 0.69, p=0.001). After adjustment in time-varying Cox model, this association remained significant (adjusted HR 0.64, 95% CI 0.45 to 0.90, p=0.010). Moreover, patients with DT and additional immune-related adverse event had increased OS compared with patients with isolated DT, with median OS of 38.8 months vs 21.4 months, respectively. CONCLUSION Data mining identified a large number of patients with ICI-induced DT, which was associated with improved OS accounting for immortal time bias.
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Affiliation(s)
- Mathilde Beaufils
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Vincent Amodru
- Department of Endocrinology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Manuel Tejeda
- Department of Informatics, Institut Paoli-Calmettes, Marseille, France
| | - Jean Marie Boher
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
| | - Christophe Zemmour
- Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France
| | - Brice Chanez
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne Sophie Chrétien
- Tumor Immunology, CRCM Marseille, Inserm 1068 - CNRS 7258 - Institut Paoli Calmettes - Aix Marseille University, Marseille, France
| | - Laurent Gorvel
- Tumor Immunology, CRCM Marseille, Inserm 1068 - CNRS 7258 - Institut Paoli Calmettes - Aix Marseille University, Marseille, France
| | | | - Damien Bruyat
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Roxane Mari
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne Madroszyk
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Thomas Cuny
- Department of Endocrinology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Aaron E Lisberg
- Department of Medicine, Division of Hematology/Oncology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Daniel Olive
- Tumor Immunology, CRCM Marseille, Inserm 1068 - CNRS 7258 - Institut Paoli Calmettes - Aix Marseille University, Marseille, France
| | - Louis Tassy
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Frederic Castinetti
- Department of Endocrinology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Philippe Rochigneux
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
- Tumor Immunology, CRCM Marseille, Inserm 1068 - CNRS 7258 - Institut Paoli Calmettes - Aix Marseille University, Marseille, France
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van Ewijk CE, Hahné SJ. Letter to the editor: Bias in the vaccine effectiveness estimates of one-dose post-exposure prophylaxis against mpox. Euro Surveill 2023; 28:2300358. [PMID: 37616116 PMCID: PMC10451009 DOI: 10.2807/1560-7917.es.2023.28.34.2300358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Catharina E van Ewijk
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Susan Jm Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and Environment (RIVM), Bilthoven, the Netherlands
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29
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Li D, Jiang SF, Lei NY, Shah SC, Corley DA. Effect of Helicobacter pylori Eradication Therapy on the Incidence of Noncardia Gastric Adenocarcinoma in a Large Diverse Population in the United States. Gastroenterology 2023; 165:391-401.e2. [PMID: 37142201 DOI: 10.1053/j.gastro.2023.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND & AIMS High-quality data regarding the effect of Helicobacter pylori eradication on the risk of noncardia gastric adenocarcinoma (NCGA) remain limited in the United States. We investigated the incidence of NCGA after H pylori eradication therapy in a large, community-based US population. METHODS We performed a retrospective cohort study of Kaiser Permanente Northern California members who underwent testing and/or treatment for H pylori between 1997 and 2015 and were followed through December 31, 2018. The risk of NCGA was evaluated using the Fine-Gray subdistribution hazard model and standardized incidence ratios. RESULTS Among 716,567 individuals with a history of H pylori testing and/or treatment, the adjusted subdistribution hazard ratios and 95% confidence intervals of NCGA for H pylori-positive/untreated and H pylori-positive/treated individuals were 6.07 (4.20-8.76) and 2.68 (1.86-3.86), respectively, compared with H pylori-negative individuals. When compared directly with H pylori-positive/untreated individuals, subdistribution hazard ratios for NCGA in H pylori-positive/treated were 0.95 (0.47-1.92) at <8 years and 0.37 (0.14-0.97) ≥8 years of follow-up. Compared with the Kaiser Permanente Northern California general population, standardized incidence ratios (95% confidence interval) of NCGA steadily decreased after H pylori treatment: 2.00 (1.79-2.24) ≥1 year, 1.01 (0.85-1.19) ≥4 years, 0.68 (0.54-0.85) ≥7 years, and 0.51 (0.38-0.68) ≥10 years. CONCLUSION In a large, diverse, community-based population, H pylori eradication therapy was associated with a significantly reduced incidence of NCGA after 8 years compared with no treatment. The risk among treated individuals became lower than the general population after 7 to 10 years of follow-up. The findings support the potential for substantial gastric cancer prevention in the United States through H pylori eradication.
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Affiliation(s)
- Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California; Division of Research, Kaiser Permanente Northern California, Oakland, California.
| | - Sheng-Fang Jiang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nan Ye Lei
- Department of Internal Medicine, Kaiser Permanente Northern California, Santa Clara, California
| | - Shailja C Shah
- Division of Gastroenterology, University of California San Diego, San Diego, California; Gastroenterology Section, VA San Diego Healthcare System, San Diego, California
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente Northern California, San Francisco, California
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Winterstein AG, Ehrenstein V, Brown JS, Stürmer T, Smith MY. A Road Map for Peer Review of Real-World Evidence Studies on Safety and Effectiveness of Treatments. Diabetes Care 2023; 46:1448-1454. [PMID: 37471605 PMCID: PMC10369122 DOI: 10.2337/dc22-2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/05/2023] [Indexed: 07/22/2023]
Abstract
The growing acceptance of real-world evidence (RWE) in clinical and regulatory decision-making, coupled with increasing availability of health care data and advances in automated analytic approaches, has contributed to a marked expansion of RWE studies of diabetes and other diseases. However, a recent spate of high-profile retractions highlights the need for improvements in the conduct of RWE research as well as in the associated peer review and editorial processes. We review best pharmacoepidemiologic practices and common pitfalls regarding design, measurement, analysis, data validity, appropriateness, and generalizability of RWE studies. To enhance RWE study assessments, we propose that journal editors require 1) study authors to complete RECORD-PE, a reporting guideline for pharmacoepidemiological studies on routinely collected data, 2) availability of predetermined study protocols and analysis plans, 3) inclusion of pharmacoepidemiologists on the peer review team, and 4) provision of detail on data provenance, characterization, and custodianship to facilitate assessment of the data source. We recognize that none of these steps guarantees a high-quality research study. Collectively, however, they permit an informed assessment of whether the study was adequately designed and conducted and whether the data source used was fit for purpose.
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Affiliation(s)
- Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, Department of Epidemiology, and Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL
- International Network for Epidemiology in Policy, American College of Epidemiology, Washington Avenue Extension, Albany, NY
- International Society for Pharmacoepidemiology, Bethesda, MD
| | - Vera Ehrenstein
- International Network for Epidemiology in Policy, American College of Epidemiology, Washington Avenue Extension, Albany, NY
- International Society for Pharmacoepidemiology, Bethesda, MD
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Jeffrey S. Brown
- International Network for Epidemiology in Policy, American College of Epidemiology, Washington Avenue Extension, Albany, NY
- International Society for Pharmacoepidemiology, Bethesda, MD
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Cambridge, MA
- TriNetX, LLC, Cambridge, MA
| | - Til Stürmer
- International Network for Epidemiology in Policy, American College of Epidemiology, Washington Avenue Extension, Albany, NY
- International Society for Pharmacoepidemiology, Bethesda, MD
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meredith Y. Smith
- International Network for Epidemiology in Policy, American College of Epidemiology, Washington Avenue Extension, Albany, NY
- International Society for Pharmacoepidemiology, Bethesda, MD
- Evidera, Inc., PPD, Boston, MA
- School of Pharmacy, University of Southern California, Los Angeles, CA
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Montero Morales L, Barbas Del Buey JF, Alonso García M, Iñigo Martínez J, Cenamor Largo N, Jiménez Bueno S, Arce Arnáez A. Authors' response: Bias in the vaccine effectiveness estimates of one-dose post-exposure prophylaxis against mpox. Euro Surveill 2023; 28:2300442. [PMID: 37616117 PMCID: PMC10451012 DOI: 10.2807/1560-7917.es.2023.28.34.2300442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Laura Montero Morales
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | | | - Marcos Alonso García
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Jesús Iñigo Martínez
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Noelia Cenamor Largo
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Susana Jiménez Bueno
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
| | - Araceli Arce Arnáez
- Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, Spain
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Bergami M, Manfrini O, Nava S, Caramori G, Yoon J, Badimon L, Cenko E, David A, Demiri I, Dorobantu M, Fabin N, Gheorghe‐Fronea O, Jankovic R, Kedev S, Ladjevic N, Lasica R, Loncar G, Mancuso G, Mendieta G, Miličić D, Mjehović P, Pašalić M, Petrović M, Poposka L, Scarpone M, Stefanovic M, van der Schaar M, Vasiljevic Z, Vavlukis M, Vega Pittao ML, Vukomanovic V, Zdravkovic M, Bugiardini R. Relationship Between Azithromycin and Cardiovascular Outcomes in Unvaccinated Patients With COVID-19 and Preexisting Cardiovascular Disease. J Am Heart Assoc 2023; 12:e028939. [PMID: 37449568 PMCID: PMC10382084 DOI: 10.1161/jaha.122.028939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/05/2023] [Indexed: 07/18/2023]
Abstract
Background Empiric antimicrobial therapy with azithromycin is highly used in patients admitted to the hospital with COVID-19, despite prior research suggesting that azithromycin may be associated with increased risk of cardiovascular events. Methods and Results This study was conducted using data from the ISACS-COVID-19 (International Survey of Acute Coronavirus Syndromes-COVID-19) registry. Patients with a confirmed diagnosis of SARS-CoV-2 infection were eligible for inclusion. The study included 793 patients exposed to azithromycin within 24 hours from hospital admission and 2141 patients who received only standard care. The primary exposure was cardiovascular disease (CVD). Main outcome measures were 30-day mortality and acute heart failure (AHF). Among 2934 patients, 1066 (36.4%) had preexisting CVD. A total of 617 (21.0%) died, and 253 (8.6%) had AHF. Azithromycin therapy was consistently associated with an increased risk of AHF in patients with preexisting CVD (risk ratio [RR], 1.48 [95% CI, 1.06-2.06]). Receiving azithromycin versus standard care was not significantly associated with death (RR, 0.94 [95% CI, 0.69-1.28]). By contrast, we found significantly reduced odds of death (RR, 0.57 [95% CI, 0.42-0.79]) and no significant increase in AHF (RR, 1.23 [95% CI, 0.75-2.04]) in patients without prior CVD. The relative risks of death from the 2 subgroups were significantly different from each other (Pinteraction=0.01). Statistically significant association was observed between AHF and death (odds ratio, 2.28 [95% CI, 1.34-3.90]). Conclusions These findings suggest that azithromycin use in patients with COVID-19 and prior history of CVD is significantly associated with an increased risk of AHF and all-cause 30-day mortality. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT05188612.
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Affiliation(s)
- Maria Bergami
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Olivia Manfrini
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Sant’Orsola HospitalBolognaItaly
| | - Stefano Nava
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaRespiratory and Critical Care UnitBolognaItaly
| | - Gaetano Caramori
- Pneumologia, Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali (BIOMORF)University of MessinaMessinaItaly
| | | | - Lina Badimon
- Cardiovascular Research Program ICCCIR‐IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV‐Institute Carlos IIIBarcelonaSpain
| | - Edina Cenko
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Antonio David
- Department of Human Pathology of the Adult and Evolutive Age “Gaetano Barresi”, Division of Anesthesia and Critical CareUniversity of MessinaMessinaItaly
| | - Ilir Demiri
- University Clinic of Infectious DiseasesUniversity "Ss. Cyril and Methodius"SkopjeNorth Macedonia
| | - Maria Dorobantu
- "Carol Davila" University of Medicine and PharmacyBucharestRomania
| | - Natalia Fabin
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | | | | | - Sasko Kedev
- University Clinic for CardiologySkopjeRepublic of North Macedonia
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
| | - Nebojsa Ladjevic
- Faculty of MedicineUniversity of Belgrade, University Clinical centre of SerbiaBelgradeSerbia
| | - Ratko Lasica
- Clinical Center of SerbiaUniversity of BelgradeBelgradeSerbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases DedinjeBelgradeSerbia
| | - Giuseppe Mancuso
- Medical Microbiology, Department of Human PathologyUniversity of MessinaMessinaItaly
| | - Guiomar Mendieta
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC)MadridSpain
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic de BarcelonaBarcelonaSpain
- Department for Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of ZagrebZagrebCroatia
| | - Davor Miličić
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine Novi SadUniversity of Novi SadNovi SadSerbia
| | - Petra Mjehović
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine Novi SadUniversity of Novi SadNovi SadSerbia
| | - Marijan Pašalić
- Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Faculty of Medicine Novi SadUniversity of Novi SadNovi SadSerbia
| | - Milovan Petrović
- Department of Electrical and Computer EngineeringUniversity of CaliforniaCALos AngelesUSA
| | - Lidija Poposka
- University Clinic for CardiologySkopjeRepublic of North Macedonia
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
| | - Marialuisa Scarpone
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Milena Stefanovic
- University Clinic of Infectious DiseasesUniversity "Ss. Cyril and Methodius"SkopjeNorth Macedonia
| | - Mihaela van der Schaar
- Cambridge Centre for Artificial Intelligence in Medicine, Department of Applied Mathematics and Theoretical Physics and Department of Population HealthUniversity of CambridgeCambridgeUnited Kingdom
- Medical FacultyUniversity of BelgradeBelgradeSerbia
| | | | - Marija Vavlukis
- University Clinic for CardiologySkopjeRepublic of North Macedonia
- Faculty of MedicineSs. Cyril and Methodius University in SkopjeSkopjeRepublic of North Macedonia
| | - Maria Laura Vega Pittao
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaRespiratory and Critical Care UnitBolognaItaly
| | - Vladan Vukomanovic
- Faculty of MedicineUniversity of Belgrade, Clinical Hospital Center Bezanijska kosaBelgradeSerbia
| | - Marija Zdravkovic
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Raffaele Bugiardini
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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Su IH, Lund JL, Gaber CE, Sanoff HK, Strassle PD, Duchesneau ED. Regarding "Neoadjuvant Versus Adjuvant Chemotherapy for Resectable Metastatic Colon Cancer in Non-academic and Academic Programs". Oncologist 2023; 28:e588-e589. [PMID: 37210593 PMCID: PMC10322127 DOI: 10.1093/oncolo/oyad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/18/2023] [Indexed: 05/22/2023] Open
Abstract
This letter to the editor expresses concerns related to immortal time bias that may partially account for recently published study results.
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Affiliation(s)
- I-Hsuan Su
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles E Gaber
- Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois-Chicago, Chicago, IL, USA
| | - Hanna K Sanoff
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Emilie D Duchesneau
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Hernandez-Con P, Shults J, Willis AW, Yang YX. Dopamine agonists and risk of lung cancer in patients with restless legs syndrome. Pharmacoepidemiol Drug Saf 2023; 32:726-734. [PMID: 36760024 PMCID: PMC10766437 DOI: 10.1002/pds.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE To examine the association between long-term use of dopamine agonists (DAs) and the risk of lung cancer in patients with restless legs syndrome (RLS). METHODS We conducted a retrospective cohort study using Optum Clinformatics® database. We included adults ≥40 years diagnosed with RLS during the study period (1/2006-12/2016). Follow-up started with the first RLS diagnosis and ended on the earliest of: incident diagnosis of lung cancer, end of enrollment in the database or end of the study period. The exposure of interest was cumulative duration of DAs use, measured in a time-varying manner. We constructed a multivariable Cox regression model to estimate HRs and 95% CIs for the association between lung cancer and cumulative durations of DA use, adjusting for potential confounding variables. RESULTS We identified 295 042 patients with a diagnosis of RLS. The mean age of the cohort was 62.9; 66.6% were women and 82.3% were white. The prevalence of any DA exposure was 40.3%. Compared to the reference group (no use and ≤1 year), the crude HRs for lung cancer were 1.16 (95% CI 0.99-1.36) and 1.14 (95% CI 0.86-1.51) for 1-3 years and >3 years of cumulative DA use, respectively. The adjusted HR for lung cancer was 1.05 (95% CI 0.88-1.25) for 1-3 years and 1.02 (95% CI 0.76-1.37) for >3 years of cumulative DA use, respectively. CONCLUSIONS At typical doses for the clinical management of RLS, long-term DA use was not associated with risk of lung cancer.
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Affiliation(s)
- Pilar Hernandez-Con
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Justine Shults
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Allison W Willis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Sun Y, Iwagami M, Komiyama J, Sugiyama T, Inokuchi R, Sakata N, Ito T, Yoshie S, Matsui H, Kume K, Sanuki M, Kato G, Mori Y, Ueshima H, Tamiya N. The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan. J Gen Intern Med 2023; 38:2156-2163. [PMID: 36650335 PMCID: PMC10361922 DOI: 10.1007/s11606-023-08030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Heart failure is common and is associated with high rates of hospitalization. Home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in Japan in 2006 and 2012, respectively. OBJECTIVE This study aimed to examine the effect of post-discharge care by conventional or enhanced HCSCs on readmission, compared with general clinics. DESIGN Retrospective cohort study using the Japanese nationwide health insurance claims database. PARTICIPANTS Participants were ≥65 years of age, admitted for heart failure and discharged between July 2014 and August 2015 and received a home visit within a month following the discharge (n=12,393). MAIN MEASURES The exposure was the type of medical facility that provides post-discharge home healthcare: general clinics, conventional HCSCs, and enhanced HCSCs. The primary outcome was all-cause readmission for 6 months after the first visit; the incidence of emergency house calls was a secondary outcome. We used a competing risk regression using the Fine and Gray method, in which death was regarded as a competing event. KEY RESULTS At 6 months, readmissions were lower in conventional (38%) or enhanced HCSCs (38%) than general clinics (43%). The adjusted subdistribution hazard ratio (sHR) of readmission was 0.87 (95% CI: 0.78-0.96) for conventional and 0.86 (0.78-0.96) for enhanced HCSCs. Emergency house calls increased with conventional (sHR: 1.77, 95% CI:1.57-2.00) and enhanced HCSCs (sHR: 1.93, 95% CI: 1.71-2.17). CONCLUSIONS Older Japanese patients with heart failure receiving post-discharge home healthcare by conventional or enhanced HCSCs had lower readmission rates, possibly due to compensation with more emergency house calls. Conventional and enhanced HCSCs may be effective in reducing the risk of rehospitalization. Further studies are necessary to confirm the medical functions performed by HCSCs.
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Affiliation(s)
- Yu Sun
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
| | - Jun Komiyama
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takehiro Sugiyama
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ryota Inokuchi
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Nobuo Sakata
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
- Heisei Medical Welfare Group Research Institute, Tokyo, Japan
| | - Tomoko Ito
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Satoru Yoshie
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Keitaro Kume
- Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masaru Sanuki
- Department of Clinical Medicine, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Genta Kato
- Solutions Center for Health Insurance Claims, Kyoto University Hospital, Kyoto, Japan
| | - Yukiko Mori
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Ueshima
- Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
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Montastruc F, de Canecaude C. Tixagevimab-Cilgavimab Treatment and Cardiovascular Events: Immortal Time Bias. Clin Infect Dis 2023; 76:2044-2045. [PMID: 36799347 DOI: 10.1093/cid/ciad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- François Montastruc
- Department of Medical and Clinical Pharmacology, Faculty of Medicine, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
| | - Claire de Canecaude
- Department of Medical and Clinical Pharmacology, Faculty of Medicine, Centre of PharmacoVigilance and Pharmacoepidemiology, Toulouse University Hospital (CHU), Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS (Pharmacologie En Population cohorteS et biobanqueS), Toulouse University Hospital, Toulouse, France
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Lai SW, Hwang BF, Kuo YH, Liu CS, Liao KF. Sodium-glucose cotransporter-2 inhibitors use and the risk of gout: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1158153. [PMID: 37288295 PMCID: PMC10242385 DOI: 10.3389/fendo.2023.1158153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Objective To assess the relationship between use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the risk of gout among patients with type 2 diabetes mellitus (T2DM). Methods A systemic review and meta-analysis were designed by reviewing articles published between 2000 January 1 and 2022 December 31 using PubMed system and Web of Science system based on the PRISMA 2020 guidelines. The end point of interest was gout (including gout flares, gout events, starting uric-acid lowering therapy and starting anti-gout drugs use) among patients with T2DM using SGLT2i versus not using SGLT2i. A random-effects model was utilized to measure the pooled hazard ratio (HR) with 95% confidence interval (CI) for the risk of gout associated with SGLT2i use. Results Two prospective post-hoc analyses of randomized controlled trials and 5 retrospective electronic medical record-linkage cohort studies met the inclusion criteria. The meta-analysis demonstrated that there was a decreased risk of developing gout for SGLT2i use as comparing with non-use of SGLT2i among patients with T2DM (pooled HR=0.66 and 95%CI=0.57-0.76). Conclusions This meta-analysis demonstrates that SGLT2i use is associated with a 34% decreased risk of developing gout among patients with T2DM. SGLT2i may be the treatment options for patients with T2DM who are at high risk of gout. More randomized controlled trials and real-world data are needed to confirm whether there is a class effect of SGLT2i for the risk reduction of gout among patients with T2DM.
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Affiliation(s)
- Shih-Wei Lai
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Bing-Fang Hwang
- Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yu-Hung Kuo
- Department of Research, Taichung Tzu Chi Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan
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Gosselin L, Vilcu AM, Souty C, Steichen O, Launay T, Conte C, Saint-Salvi B, Turbelin C, Sarazin M, Blanchon T, Hanslik T, Lapeyre-Mestre M, Rossignol L. Prevalence and bleeding risk associated with the concomitant use of direct oral anticoagulants and antiarrhythmic drugs in patients with atrial fibrillation, based on the French healthcare insurance database. Eur J Clin Pharmacol 2023:10.1007/s00228-023-03501-8. [PMID: 37184597 DOI: 10.1007/s00228-023-03501-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Pharmacokinetic interactions exist between apixaban or rivaroxaban, and CYP3A4 and P-glycoprotein inhibitors such as amiodarone, verapamil and diltiazem. We aimed to estimate the prevalence of exposure to this drug-drug association (DDA) and to assess the bleeding risk associated in patients with atrial fibrillation (AF). METHODS We conducted a cohort study using a representative 1/97th sample of the French healthcare insurance database between 2014 and 2019. Patients with AF receiving apixaban or rivaroxaban were included and followed-up until hospitalization for bleeding, death, discontinuation of apixaban or rivaroxaban, exposure to strong CYP3A4 inhibitor, or until December 31st 2019, whichever came first. Primary outcome was hospitalization for bleeding registered as primary diagnosis. The association between the exposure to the DDA and hospitalization for bleeding was evaluated as a time-dependent variable in Cox model. RESULTS Between 2014 and 2019, the AF population under apixaban or rivaroxaban represented 10,392 patients. During the study period, the annual average prevalence of DDA exposure in this population was 38.9%. Among the 10,392 patients, 223 (2.1%) were hospitalized for bleeding, of which 75 (33.6%) received the association and 148 (66.4%) received apixaban or rivaroxaban alone. There was no association between DDA exposure and risk of hospitalization for bleeding (aHR = 1.19, [95% CI: 0.90, 1.58]). Age (HR 1.03 [1.02, 1.05]) and male gender (HR 1.72 [1.28, 2.30]) were associated with an increased risk of hospitalization for bleeding. CONCLUSION Exposure to antiarrhythmic drugs was not associated with an increased risk of hospitalization for bleeding in patients with AF under rivaroxaban or apixaban.
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Affiliation(s)
- Laëtitia Gosselin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France.
- Département de Médecine Générale, Université Paris Cité, Paris, France.
| | - Ana-Maria Vilcu
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Olivier Steichen
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
- Assistance Publique - Hôpitaux de Paris (APHP), hôpital Tenon, Service de Médecine Interne, Paris, France
| | - Titouan Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Cécile Conte
- INSERM, Université de Toulouse, Service de Pharmacologie médicale et clinique, CIC 1436, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Béatrice Saint-Salvi
- Agence National de Sécurité du Médicaments et des produits de santé, Saint-Denis, 93200, France
| | - Clément Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Marianne Sarazin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines, UVSQ, UFR de Médecine, Versailles, France
- Assistance Publique - Hôpitaux de Paris (APHP), hôpital Ambroise Paré, Service de Médecine Interne, Boulogne Billancourt, France
| | - Maryse Lapeyre-Mestre
- INSERM, Université de Toulouse, Service de Pharmacologie médicale et clinique, CIC 1436, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), Toulouse, France
| | - Louise Rossignol
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé publique (IPLESP), Paris, France
- Département de Médecine Générale, Université Paris Cité, Paris, France
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Tong WH, Mertens BJ. More Updates to Come of Tisagenlecleucel in Pediatric and Young Adult Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia in the ELIANA Trial: Could the Statistical Methodology Be Further Improved? J Clin Oncol 2023; 41:2450-2451. [PMID: 36898080 DOI: 10.1200/jco.22.02839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/19/2022] [Accepted: 02/01/2023] [Indexed: 03/12/2023] Open
Affiliation(s)
- Wing H Tong
- Wing H. Tong, MD, PhD, MSc, Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands, Argos Zorggroep "DrieMaasStede," Center for Specialized Geriatric Care, Schiedam, the Netherlands; and Bart J. Mertens, PhD, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart J Mertens
- Wing H. Tong, MD, PhD, MSc, Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands, Argos Zorggroep "DrieMaasStede," Center for Specialized Geriatric Care, Schiedam, the Netherlands; and Bart J. Mertens, PhD, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Nead KT, Haas A, Joo L, Wehner MR. Letter to the Editor. Challenges of immortal time biases in observational research. J Neurosurg 2023; 138:1482-1484. [PMID: 36461819 DOI: 10.3171/2022.10.jns222203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Yu OHY, Suissa S. Metformin and Cancer: Solutions to a Real-World Evidence Failure. Diabetes Care 2023; 46:904-912. [PMID: 37185680 DOI: 10.2337/dci22-0047] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/09/2023] [Indexed: 05/17/2023]
Abstract
The quest to repurpose metformin, an antidiabetes drug, as an agent for cancer prevention and treatment, which began in 2005 with an observational study that reported a reduction in cancer incidence among metformin users, generated extensive experimental, observational, and clinical research. Experimental studies revealed that metformin has anticancer effects via various pathways, potentially inhibiting cancer cell proliferation. Concurrently, multiple nonrandomized observational studies reported remarkable reductions in cancer incidence and outcomes with metformin use. However, these studies were shown, in 2012, to be affected by time-related biases, such as immortal time bias, which tend to greatly exaggerate the benefit of a drug. The observational studies that avoided these biases did not find an association. Subsequently, the randomized trials of metformin for the treatment of type 2 diabetes and as adjuvant therapy for the treatment of various cancers, advanced or metastatic, did not find reductions in cancer incidence or outcomes. Most recently, the largest phase 3 randomized trial of metformin as adjuvant therapy for breast cancer, which enrolled 3,649 women with a 5-year follow-up, found no benefit for disease-free survival or overall survival with metformin. This major failure of observational real-world evidence studies in correctly assessing the effects of metformin on cancer incidence and outcomes was caused by preventable biases which, surprisingly, are still prominent in 2022. Rigorous approaches for observational studies that emulate randomized trials, such as the incident and prevalent new-user designs along with propensity scores, avoid these biases and can provide more accurate real-world evidence for the repurposing of drugs such as metformin.
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Affiliation(s)
- Oriana Hoi Yun Yu
- 1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
- 2Division of Endocrinology, Jewish General Hospital, Montreal, Canada
- 3Department of Medicine, McGill University, Montreal, Canada
| | - Samy Suissa
- 1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
- 3Department of Medicine, McGill University, Montreal, Canada
- 4Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Nowicka Z, Matyjek A, Płoszka K, Łaszczych M, Fendler W. Metanalyses on metformin's role in pancreatic cancer suffer from severe bias and low data quality - An umbrella review. Pancreatology 2023; 23:192-200. [PMID: 36697348 DOI: 10.1016/j.pan.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
AIMS Discrepancies in the preclinical evidence, retrospective studies, and randomized trials evaluating metformin's role in pancreatic cancer are difficult to disentangle. We aimed to critically and systematically examine the quality and sources of heterogeneity between meta-analyses investigating the association between metformin intake and the prognosis of patients with pancreatic cancer. MATERIALS AND METHODS We performed a literature search on PubMed, MEDLINE, Embase, and Scopus on October 31, 2021 to identify meta-analyses investigating the impact of metformin treatment on the prognosis of patients with pancreatic cancer. Meta-analyses quality was assessed using according to the AMSTAR 2 criteria. We assessed bias in individual studies included in the meta-analyses, with particular attention to immortal time bias and quality of reporting. RESULTS Eleven meta-analyses describing 24 individual studies were included. All meta-analyses were rated low (n = 5) or critically low (n = 6) quality. Only 4 followed PRISMA reporting guidelines and only in 5 presented data were sufficient to replicate the analyses. Most meta-analyses combined results from clinical trials and retrospective studies (n = 6); patients with different cancer stages (resectable vs advanced) and from studies with different control group definitions. Immortal time bias was present and not accounted for in most (65.2%) of the individual retrospective studies; almost all (n = 9) meta-analyses failed to identify and correct for this source of bias. CONCLUSIONS Meta-analyses describing the association of metformin use in patients with pancreatic cancer are plagued by various types of bias inherent in retrospective studies. The quality of evidence linking metformin to decreased pancreatic cancer mortality is generally low.
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Affiliation(s)
- Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215, Lodz, Poland
| | - Anna Matyjek
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215, Lodz, Poland; Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, 04-141, Warsaw, Poland
| | - Katarzyna Płoszka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215, Lodz, Poland
| | - Mateusz Łaszczych
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215, Lodz, Poland
| | - Wojciech Fendler
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, 92-215, Lodz, Poland; Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
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Eimer J, Fréchet-Jachym M, Le Dû D, Caumes E, El-Helali N, Marigot-Outtandy D, Mechai F, Peytavin G, Pourcher V, Rioux C, Yazdanpanah Y, Robert J, Guglielmetti L. Association Between Increased Linezolid Plasma Concentrations and the Development of Severe Toxicity in Multidrug-Resistant Tuberculosis Treatment. Clin Infect Dis 2023; 76:e947-e956. [PMID: 35717636 DOI: 10.1093/cid/ciac485] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment of multidrug-resistant (MDR) tuberculosis with linezolid is characterized by high rates of adverse events. Evidence on therapeutic drug monitoring to predict drug toxicity is scarce. This study aimed to evaluate the association of linezolid trough concentrations with severe toxicity. METHODS We retrospectively assessed consecutive patients started on linezolid for MDR tuberculosis between 2011 and 2017. The primary outcome was severe mitochondrial toxicity (SMT) due to linezolid, defined as neurotoxicity or myelotoxicity leading to drug discontinuation. The impact of plasma linezolid trough concentrations >2 mg/L was assessed in multivariate Cox proportional hazards models including time-varying covariates. RESULTS SMT occurred in 57 of 146 included patients (39%) at an incidence rate of 0.38 per person-year (95% confidence interval, .30-.49). A maximum linezolid trough concentration >2 mg/L was detected in 52 patients (35.6%), while the mean trough concentration was >2 mg/L in 22 (15%). The adjusted hazard ratio for SMT was 2.35 (95% confidence interval, 1.26-4.38; P = .01) in patients with a mean trough concentration >2 mg/L and 2.63 (1.55-4.47; P < .01) for SMT after the first detection of a trough concentration >2 mg/L. In an exploratory analysis, higher maximum trough concentrations were dose-dependently associated with toxicity, while lowering elevated trough concentrations did not restore baseline risk. CONCLUSIONS Linezolid trough concentrations >2 mg/L are strongly associated with the development of severe treatment-emergent toxicity in patients treated for MDR tuberculosis. Pending further prospective evidence, an individual risk-benefit assessment on the continuation of linezolid treatment is warranted in any patient with trough concentrations >2 mg/L.
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Affiliation(s)
- Johannes Eimer
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France
| | | | - Damien Le Dû
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France
| | - Najoua El-Helali
- Plateforme de Dosage des Anti-infectieux, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Dhiba Marigot-Outtandy
- Sanatorium, Centre Hospitalier de Bligny, Briis-sous-Forges, France.,AP-HP, Service de Maladies Infectieuses, Hôpital Raymond Poincaré, Université de Saint-Quentin en Yvelines, Garches, France
| | - Frédéric Mechai
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Avicenne, Paris, France.,IAME INSERM UMR-S 1137, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Gilles Peytavin
- Laboratoire de Pharmacologie-Toxicologie, DMU Biologie et Génomique Médicale (BioGeM), IAME INSERM UMR-S 1137, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Valérie Pourcher
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié-Salpêtrière, AP-HP.Sorbonne Université, Paris, France
| | - Christophe Rioux
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France
| | - Yazdan Yazdanpanah
- AP-HP, Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Paris, France
| | - Jérôme Robert
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France.,Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, AP-HP.Sorbonne Université, Paris, France
| | - Lorenzo Guglielmetti
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Équipe 2, Sorbonne Université, Paris, France.,Hôpital Pitié-Salpêtrière, Laboratoire de Bactériologie-Hygiène, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, AP-HP.Sorbonne Université, Paris, France
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Fairhurst C, Martin F, Watt I, Bland M, Doran T, Brackenbury WJ. Sodium channel-inhibiting drugs and cancer-specific survival: a population-based study of electronic primary care data. BMJ Open 2023; 13:e064376. [PMID: 36737094 PMCID: PMC9900071 DOI: 10.1136/bmjopen-2022-064376] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Antiepileptic and antiarrhythmic drugs inhibit voltage-gated sodium (Na+) channels (VGSCs), and preclinical studies show that these medications reduce tumour growth, invasion and metastasis. We investigated the association between VGSC inhibitor use and survival in patients with breast, bowel and prostate cancer. DESIGN Retrospective cohort study. SETTING Individual electronic primary healthcare records extracted from the Clinical Practice Research Datalink. PARTICIPANTS Records for 132 996 patients with a diagnosis of breast, bowel or prostate cancer. OUTCOME MEASURES Adjusted Cox proportional hazards regression was used to analyse cancer-specific survival associated with exposure to VGSC inhibitors. Exposure to non-VGSC-inhibiting antiepileptic medication and other non-VGSC blockers were also considered. Drug exposure was treated as a time-varying covariate to account for immortal time bias. RESULTS During 1 002 225 person-years of follow-up, there were 42 037 cancer-specific deaths. 53 724 (40.4%) patients with cancer had at least one prescription for a VGSC inhibitor of interest. Increased risk of cancer-specific mortality was associated with exposure to this group of drugs (HR 1.59, 95% CI 1.56 to 1.63, p<0.001). This applied to VGSC-inhibiting tricyclic antidepressants (HR 1.61, 95% CI 1.50 to 1.65, p<0.001), local anaesthetics (HR 1.49, 95% CI 1.43 to 1.55, p<0.001) and anticonvulsants (HR 1.40, 95% CI 1.34 to 1.48, p<0.001) and persisted in sensitivity analyses. In contrast, exposure to VGSC-inhibiting class 1c and 1d antiarrhythmics was associated with significantly improved cancer-specific survival (HR 0.75, 95% CI 0.64 to 0.88, p<0.001 and HR 0.54, 95% CI 0.33 to 0.88, p=0.01, respectively). CONCLUSIONS Association between VGSC inhibitor use and mortality in patients with cancer varies according to indication. Exposure to VGSC-inhibiting antiarrhythmics, but not anticonvulsants, supports findings from preclinical data, with improved survival. However, additional confounding factors may underlie these associations, highlighting the need for further study.
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Affiliation(s)
| | - Fabiola Martin
- University of Queensland, Brisbane, Queensland, Australia
| | - Ian Watt
- Health Sciences, University of York, York, UK
| | | | - Tim Doran
- Health Sciences, University of York, York, UK
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Zhao H, Zhuo L, Sun Y, Shen P, Lin H, Zhan S. Thiazolidinedione use is associated with reduced risk of dementia in patients with type 2 diabetes mellitus: A retrospective cohort study. J Diabetes 2023; 15:97-109. [PMID: 36660897 PMCID: PMC9934955 DOI: 10.1111/1753-0407.13352] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/27/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and dementia cause heavy health burden in mainland China, where few studies have investigated the association between glucose-lowering agents and dementia risk. We aimed to assess the association between use of thiazolidinediones (TZDs) and dementia incidence in a mainland Chinese population with T2DM. METHODS A retrospective cohort of T2DM patients who were new users of TZDs or alpha glucosidase inhibitors (AGIs) was assembled using the Yinzhou Regional Health Care Database. A Cox model with inverse probability of treatment weighting (IPTW) for controlling potential founding was applied to estimate the hazard ratio (HR) of the association between use of TZDs and dementia risk. RESULTS A total of 49 823 new users of AGIs and 12 752 new users of TZDs were included in the final cohort. In the primary analysis, the incidence of dementia was 195.7 and 78.2 per 100 000 person-years in users of AGIs and TZDs respectively. TZD use was associated with a reduced risk of incident dementia after adjusting for potential confounding using IPTW, with a HR of 0.51 (95% CI, 0.38-0.67). The results in various subgroup analyses and sensitivity analyses were consistent with the findings of the primary analysis. CONCLUSIONS Use of TZDs is associated with a decreased risk of dementia incidence in a mainland Chinese population with T2DM.
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Affiliation(s)
- Houyu Zhao
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
| | - Lin Zhuo
- Research Center of Clinical EpidemiologyPeking University Third HospitalBeijingChina
| | - Yexiang Sun
- Yinzhou District Center for Disease Control and PreventionNingboChina
| | - Peng Shen
- Yinzhou District Center for Disease Control and PreventionNingboChina
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and PreventionNingboChina
| | - Siyan Zhan
- Department of Epidemiology and Biostatistics, School of Public HealthPeking UniversityBeijingChina
- Research Center of Clinical EpidemiologyPeking University Third HospitalBeijingChina
- Center for Intelligent Public Health, Institute for Artificial IntelligencePeking UniversityBeijingChina
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Crisafulli S, Khan Z, Karatas Y, Tuccori M, Trifirò G. An overview of methodological flaws of real-world studies investigating drug safety in the post-marketing setting. Expert Opin Drug Saf 2023; 22:373-380. [PMID: 37243676 DOI: 10.1080/14740338.2023.2219892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The evaluation of the post-marketing safety profile of drugs is a continuous monitoring process for approved and marketed medicines and it is crucial for detecting new adverse drug reactions. As such, real-world studies are essential to complement pre-marketing evidence with information concerning drug risk-benefit profile and use in wider patient populations and they have a great potential to support post-marketing drug safety evaluations. AREAS COVERED A detailed description of the main limitations of real-world data sources (i.e. claims databases, electronic healthcare records, drug/disease registers and spontaneous reporting system databases) and of the main methodological challenges of real-world studies in generating real-world evidence is provided. EXPERT OPINION Real-world evidence biases can be ascribed to both the methodological approach and the specific limitations of the different real-world data sources used to carry out the study. As such, it is crucial to characterize the quality of real-world data, by establishing guidelines and best practices for the assessment of data fitness for purpose. On the other hand, it is important that real-world studies are conducted using a rigorous methodology, aimed at minimizing the risk of bias.
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Affiliation(s)
| | - Zakir Khan
- Faculty of Medicines, Department of Medical Pharmacology Çukurova University, Sarıçam, Adana, Türkiye
| | - Yusuf Karatas
- Faculty of Medicines, Department of Medical Pharmacology Çukurova University, Sarıçam, Adana, Türkiye
- Pharmacovigilance Specialist, Faculty of Medicines, Balcali Hospital, Sarıçam, Adana, Türkiye
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Unit of Adverse Drug Reaction Monitoring, University Hospital of Pisa, Pisa, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Wang SV, Pottegård A, Crown W, Arlett P, Ashcroft DM, Benchimol EI, Berger ML, Crane G, Goettsch W, Hua W, Kabadi S, Kern DM, Kurz X, Langan S, Nonaka T, Orsini L, Perez-Gutthann S, Pinheiro S, Pratt N, Schneeweiss S, Toussi M, Williams RJ. HARmonized Protocol Template to Enhance Reproducibility of hypothesis evaluating real-world evidence studies on treatment effects: A good practices report of a joint ISPE/ISPOR task force. Pharmacoepidemiol Drug Saf 2023; 32:44-55. [PMID: 36215113 PMCID: PMC9771861 DOI: 10.1002/pds.5507] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023]
Abstract
PROBLEM Ambiguity in communication of key study parameters limits the utility of real-world evidence (RWE) studies in healthcare decision-making. Clear communication about data provenance, design, analysis, and implementation is needed. This would facilitate reproducibility, replication in independent data, and assessment of potential sources of bias. WHAT WE DID The International Society for Pharmacoepidemiology (ISPE) and ISPOR-The Professional Society for Health Economics and Outcomes Research (ISPOR) convened a joint task force, including representation from key international stakeholders, to create a harmonized protocol template for RWE studies that evaluate a treatment effect and are intended to inform decision-making. The template builds on existing efforts to improve transparency and incorporates recent insights regarding the level of detail needed to enable RWE study reproducibility. The overarching principle was to reach for sufficient clarity regarding data, design, analysis, and implementation to achieve 3 main goals. One, to help investigators thoroughly consider, then document their choices and rationale for key study parameters that define the causal question (e.g., target estimand), two, to facilitate decision-making by enabling reviewers to readily assess potential for biases related to these choices, and three, to facilitate reproducibility. STRATEGIES TO DISSEMINATE AND FACILITATE USE Recognizing that the impact of this harmonized template relies on uptake, we have outlined a plan to introduce and pilot the template with key international stakeholders over the next 2 years. CONCLUSION The HARmonized Protocol Template to Enhance Reproducibility (HARPER) helps to create a shared understanding of intended scientific decisions through a common text, tabular and visual structure. The template provides a set of core recommendations for clear and reproducible RWE study protocols and is intended to be used as a backbone throughout the research process from developing a valid study protocol, to registration, through implementation and reporting on those implementation decisions.
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Affiliation(s)
| | | | | | | | | | - Eric I Benchimol
- 1. Department of Paediatrics and Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto, Canada,2. Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada,3. ICES, Toronto, Canada
| | | | | | - Wim Goettsch
- The National Health Care Institute, Diemen, and Utrecht University, Utrecht, the Netherlands
| | - Wei Hua
- US Food and Drug Administration
| | | | | | | | | | | | | | | | | | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia
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Suissa S, Suissa K. Antifibrotics and Reduced Mortality in Idiopathic Pulmonary Fibrosis: Immortal Time Bias. Am J Respir Crit Care Med 2023; 207:105-109. [PMID: 35950929 PMCID: PMC9952857 DOI: 10.1164/rccm.202207-1301le] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Samy Suissa
- Jewish General HospitalMontréal, Canada,McGill UniversityMontréal, Canada,Corresponding author (e-mail: )
| | - Karine Suissa
- Brigham and Women’s HospitalBoston, Massachusetts,Harvard Medical SchoolBoston, Massachusetts
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Acton EK, Willis AW, Hennessy S. Core concepts in pharmacoepidemiology: Key biases arising in pharmacoepidemiologic studies. Pharmacoepidemiol Drug Saf 2023; 32:9-18. [PMID: 36216785 DOI: 10.1002/pds.5547] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 02/06/2023]
Abstract
Pharmacoepidemiology has an increasingly important role in informing and improving clinical practice, drug regulation, and health policy. Therefore, unrecognized biases in pharmacoepidemiologic studies can have major implications when study findings are translated to the real world. We propose a simple taxonomy for researchers to use as a starting point when thinking through some of the most pervasive biases in pharmacoepidemiology. We organize this discussion according to biases best assessed with respect to the study population (including confounding by indication, channeling bias, healthy user bias, and protopathic bias), the study design (including prevalent user bias and immortal time bias), and the data source (including misclassification bias and missing data/loss to follow up). This tutorial defines, provides a curated list of recommended references, and illustrates through relevant case examples these key biases to consider when planning, conducting, or evaluating pharmacoepidemiologic studies.
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Affiliation(s)
- Emily K Acton
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Allison W Willis
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean Hennessy
- Center for Real-world Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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50
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Zheng Q, Otahal P, Cox IA, de Graaff B, Campbell JA, Ahmad H, Walters EH, Palmer AJ. The influence of immortal time bias in observational studies examining associations of antifibrotic therapy with survival in idiopathic pulmonary fibrosis: A simulation study. Front Med (Lausanne) 2023; 10:1157706. [PMID: 37113607 PMCID: PMC10126672 DOI: 10.3389/fmed.2023.1157706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Immortal time bias (ITB) has been overlooked in idiopathic pulmonary fibrosis (IPF). We aimed to identify the presence of ITB in observational studies examining associations between antifibrotic therapy and survival in patients with IPF and illustrate how ITB may affect effect size estimates of those associations. Methods Immortal time bias was identified in observational studies using the ITB Study Assessment Checklist. We used a simulation study to illustrate how ITB may affect effect size estimates of antifibrotic therapy on survival in patients with IPF based on four statistical techniques including time-fixed, exclusion, time-dependent and landmark methods. Results Of the 16 included IPF studies, ITB was detected in 14 studies, while there were insufficient data for assessment in two others. Our simulation study showed that use of time-fixed [hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.47-0.64] and exclusion methods (HR 0.79, 95% CI 0.67-0.92) overestimated the effectiveness of antifibrotic therapy on survival in simulated subjects with IPF, in comparison of the time-dependent method (HR 0.93, 95% CI 0.79-1.09). The influence of ITB was mitigated using the 1 year landmark method (HR 0.69, 95% CI 0.58-0.81), compared to the time-fixed method. Conclusion The effectiveness of antifibrotic therapy on survival in IPF can be overestimated in observational studies, if ITB is mishandled. This study adds to the evidence for addressing the influence of ITB in IPF and provides several recommendations to minimize ITB. Identifying the presence of ITB should be routinely considered in future IPF studies, with the time-dependent method being an optimal approach to minimize ITB.
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Affiliation(s)
- Qiang Zheng
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- Department of Anaesthesiology (High–Tech Branch), First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid A. Cox
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
| | - Julie A. Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Australian Government Department of Health and Aged Care, Tasmania (TAS) Office, Hobart, TAS, Australia
| | - E. Haydn Walters
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- NHMRC Centre of Research Excellence for Pulmonary Fibrosis, Camperdown, NSW, Australia
- *Correspondence: Andrew J. Palmer,
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