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Fakih O, Desmarets M, Martin B, Prati C, Monnet E, Verhoeven F, Wendling D. Difficult-to-treat axial spondyloarthritis is associated with psoriasis, peripheral involvement and comorbidities: results of an observational nationwide study. RMD Open 2023; 9:e003461. [PMID: 37996127 PMCID: PMC10668281 DOI: 10.1136/rmdopen-2023-003461] [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: 07/03/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES To determine the cumulative incidence and identify the factors associated with difficult-to-treat axial spondyloarthritis (D2T-axSpA) in French patients newly benefiting from the French 'long-term illness' (LTI) social security scheme for axial spondyloarthritis (axSpA). METHODS This national cohort study was based on the French National Medico-Administrative Database, SNDS, which contains data on hospitalisation, LTI and outpatient care consumption. All French patients newly receiving LTI benefits for ankylosing spondylitis (AS) between 2010 and 2013 were included in the study. In France, LTI is required to access biological/targeted synthetic DMARDs (b/tsDMARDs). The follow-up period ended on 31 December 2018. So-called D2T-axSpA was defined as the failure of three b/tsDMARDs or of two b/tsDMARDs with different modes of action. Comorbidities and extra-musculoskeletal manifestations were identified using previously described algorithms. Characteristics were compared between patients with D2T-axSpA and patients with non-D2T-axSpA who had received at least one b/tsDMARD with bivariate and multivariate analysis using logistic regression. Incidence rates of major cardiovascular event (MACE) and death were compared using competitive risk analysis. RESULTS 22 932 patients were included. 10 798 (47.08%) patients received at least one bDMARD. None received tsDMARD. During follow-up, 2115 patients were classified as having D2T-axSpA, representing 19.59% of patients who received at least one bDMARD. In multivariate analysis, D2T-axSpA was significantly associated with female gender, peripheral involvement, psoriasis, hypertension and depression (p<0.001 for each case). There was no difference in the incidence of MACE (p=0.92) or death (p=0.87). CONCLUSION D2T-axSpA affects one in five patients exposed to bDMARDs in this national cohort. D2T-axSpA is more common in women and patients with peripheral involvement and/or comorbidities.
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Affiliation(s)
- Olivier Fakih
- Service de rhumatologie, CHU de Besançon, Besançon, France
| | - Maxime Desmarets
- Inserm CIC 1431, CHU de Besançon, Besançon, France
- UMR 1098 Right, Université Bourgogne Franche-Comté, Besancon, France
| | | | - Clement Prati
- Service de rhumatologie, CHU de Besançon, Besançon, France
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Fakih O, Desmarets M, Martin B, Prati C, Wendling D, Monnet E, Verhoeven F. Impact of NSAIDs on 8-year cumulative incidence of major cardiovascular events in patients with ankylosing spondylitis: a nationwide study. Rheumatology (Oxford) 2023; 62:3317-3322. [PMID: 36752498 DOI: 10.1093/rheumatology/kead072] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES The objectives of this study were to describe the incidence of major adverse cardiovascular events (MACEs) in French patients newly benefiting from the French Long-term Illness scheme (LTI) for AS and to evaluate the effect of various treatments on the risk of MACE occurrence. METHODS This national cohort study was based on the French national medico-administrative database SNDS containing data on hospitalization, the LTI, and outpatient care consumption. All French patients newly receiving LTI benefits for AS from 2010 to 2013 were included. The final follow-up date was 31 December 2018. The occurrences of MACEs [stroke and myocardial infarction (MI)] and comorbidities were identified from algorithms previously described in the literature. Competitive risk analysis using propensity score and inverse weighting was performed to calculate cumulative incidence functions and to determine subhazard ratios (SHRs) for the various treatments of interest. RESULTS Between 2010 and 2013, 22 929 patients were included [mean age 43.0 (s.d. 13.9) years, 44.9% mal]. The 8-year cumulative incidences of MACE, stroke, and MI were 1.81% (1.61-2.05), 0.97% (0.83-1.14), and 0.85% (0.71-1.04), respectively. NSAIDs [SHR: 0.39 (0.32-0.50), P < 0.001] and anti-TNF [SHR 0.61 (0.46-0.80), P < 0.001], but not anti-IL17 [2.10 (0.79-5.57)] were associated with a lower risk of MACE occurrence. CONCLUSION MACE incidence rates at 8 years are low in patients newly benefiting from LTI for AS. Our results support the hypothesis of a protective role of NSAIDs and anti-TNF in cardiovascular risk in these patients.
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Affiliation(s)
- Olivier Fakih
- Service de Rhumatologie, CHU de Besançon, Besançon, France
| | - Maxime Desmarets
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
- UMR 1098 Right, Inserm, Etablissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
| | - Bérenger Martin
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
| | - Clément Prati
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4266 "EPILAB", UFR Santé, Franche-Comté University, Besançon, France
| | - Elisabeth Monnet
- Centre d'investigation Clinique 1431, CHU de Besançon, Inserm, 2 place Saint Jacques, Besançon, France
| | - Frank Verhoeven
- Service de Rhumatologie, CHU de Besançon, Besançon, France
- EA 4267 "PEPITE", UFR Santé, Franche-Comté University, Besançon, France
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Generating Practice-Based Evidence in the Use of Guideline-Recommended Combination Therapy for Secondary Prevention of Acute Myocardial Infarction. PHARMACY 2022; 10:pharmacy10060147. [PMID: 36412823 PMCID: PMC9680510 DOI: 10.3390/pharmacy10060147] [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: 09/05/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Clinical guidelines recommend beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins for the secondary prevention of acute myocardial infarction (AMI). It is not clear whether variation in real-world practice reflects poor quality-of-care or a balance of outcome tradeoffs across patients. Methods: The study cohort included Medicare fee-for-service beneficiaries hospitalized 2007-2008 for AMI. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes. Outcomes included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Treatment effects were estimated using an Instrumental Variables (IV) approach with instruments based on measures of local-area practice style. Pre-specified data elements were abstracted from hospital medical records for a stratified, random sample to create "unmeasured confounders" (per claims data) and assess model assumptions. Results: Each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. Higher rates of guideline-recommended treatment were associated with both better survival and more adverse events. Unmeasured confounders were not associated with instrumental variable values. Conclusions: The results from this study suggest that providers consider both treatment benefits and harms in patients with AMIs. The investigation of estimator assumptions support the validity of the estimates.
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Martin-Latry K, Latry P, Moysan V, Berges C, Coste P, Douard H, Pucheu Y, Agosti N, Couffinhal T. One-year care pathway after acute myocardial infarction in 2018: Prescription, medical care and medication adherence, using a French health insurance reimbursement database. Arch Cardiovasc Dis 2022; 115:78-86. [PMID: 35115266 DOI: 10.1016/j.acvd.2021.12.003] [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: 06/28/2021] [Revised: 09/17/2021] [Accepted: 12/23/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Myocardial infarction is a major cause of morbidity and mortality. Guidelines have been published to optimize medical care and involve optimization of the care pathway and hospital-city coordination. AIMS To describe the myocardial infarction care pathway during the year following hospital discharge, and the use of and adherence to secondary prevention drugs. METHODS A cohort study was conducted using data from the main French health insurance reimbursement database of the ex-Aquitaine region. Information about the medical and pharmaceutical care of hospitalized patients in 2018 was collected for 12 months. Medication adherence was assessed by using the proportion of days covered by the treatment and persistence. RESULTS A total of 3015 patients were included, and the mean age was 66 years. Almost 76% of the patients had a reimbursement for BAS (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug), BASI (combined prescription of beta-blocker/antiplatelet/lipid-lowering drug/angiotensin-converting enzyme inhibitor) or AS (combined prescription of antiplatelet/lipid-lowering drug) treatment. Medication adherence was around 83% for aspirin and 75% for lipid-lowering drugs for the 1-year persistence. During the same time, the proportion of days covered was suboptimal. Almost 4% of patients died after leaving hospital, 45% went to a cardiac rehabilitation centre and 23% had at least one hospital readmission, whatever the reason. Patients had a mean number of 11 general practitioner consultations during the year. Almost 41% of patients did not have a consultation with a cardiologist, and 38.4% had at least two consultations. Rehabilitation and general practitioner consultations were associated with adherence. CONCLUSIONS These new results provide clear information on the medical care environment of patients, and help us to improve care transition. Close collaboration between healthcare practitioners is very important in the early stages of outpatient follow-up.
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Affiliation(s)
- Karin Martin-Latry
- Inserm UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, 1, avenue de Magellan, 33600 Pessac, France; Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France.
| | - Philippe Latry
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Véronique Moysan
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Camille Berges
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Pierre Coste
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Hervé Douard
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Yann Pucheu
- Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
| | - Nadine Agosti
- Direction Régionale du Service Médical de l'Assurance Maladie de Nouvelle-Aquitaine, CNAM-TS, 33000 Bordeaux, France
| | - Thierry Couffinhal
- Inserm UMR 1034, Biology of Cardiovascular Diseases, Université de Bordeaux, 1, avenue de Magellan, 33600 Pessac, France; Service des Maladies coronaires et Vasculaires, CHU de Bordeaux, 33600 Pessac, France
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Hempenius M, Luijken K, de Boer A, Klungel O, Groenwold R, Gardarsdottir H. Quality of reporting of drug exposure in pharmacoepidemiological studies. Pharmacoepidemiol Drug Saf 2020; 29:1141-1150. [PMID: 32394589 PMCID: PMC7539966 DOI: 10.1002/pds.5020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Abstract
Purpose Exposure definitions vary across pharmacoepidemiological studies. Therefore, transparent reporting of exposure definitions is important for interpretation of published study results. We aimed to assess the quality of reporting of exposure to identify where improvement may be needed. Method We systematically reviewed observational pharmacoepidemiological studies that used routinely collected health data, published in 2017 in six pharmacoepidemiological journals. Reporting of exposure was scored using 11 items of the ISPE‐ISPOR guideline on reporting of pharmacoepidemiological studies. Results Of the 91 studies included, all studies reported the type of exposure (100%), while most reported the exposure risk window (85%) and the exposure assessment window (98%). Operationalization of the exposure window was described infrequently: 16% (14/90) of the studies explicitly reported the presence or absence of an induction period if applicable, 11% (5/47), and 35% (17/49) reported how stockpiling and gaps between exposure episodes were handled, respectively, and 35% (17/49) explicitly mentioned the exposure extension. Switching/add‐on was reported in 62% (50/81). How switching between drugs was dealt with and specific drug codes were reported in 52 (57%) and 24 (26%) studies, respectively. Conclusion Publications of pharmacoepidemiological studies frequently reported the type of exposure, the exposure risk window, and the exposure assessment window. However, more details on exposure assessment are needed, especially when it concerns the operationalization of the exposure risk window (eg, the presence or absence of an induction period or exposure extension, handling of stockpiling and gaps, and specific codes), to allow for correct interpretation, reproducibility, and assessment of validity.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rolf Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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Blin P, Dureau-Pournin C, Bénichou J, Cottin Y, Mismetti P, Abouelfath A, Lassalle R, Droz C, Moore N. Comparative Real-Life Effectiveness and Safety of Dabigatran or Rivaroxaban vs. Vitamin K Antagonists: A High-Dimensional Propensity Score Matched New Users Cohort Study in the French National Healthcare Data System SNDS. Am J Cardiovasc Drugs 2020; 20:81-103. [PMID: 31254174 DOI: 10.1007/s40256-019-00359-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Clinical trials have indicated that the direct-acting oral anticoagulants dabigatran and rivaroxaban have better risk/benefit profiles than do vitamin K antagonists (VKAs) for stroke prevention in non-valvular atrial fibrillation (NVAF). OBJECTIVE Our objective was to compare the 1-year real-life risk of major clinical events with dabigatran or rivaroxaban versus VKAs for NVAF. METHODS This was a high-dimensional propensity score (hdPS)-matched cohort study of new users of dabigatran, rivaroxaban or VKAs for NVAF in the French national healthcare systems database in 2013 followed-up for 1 year [22]. Hazard ratios (HRs) with 95% confidence intervals (CIs) for clinical events and death were determined during exposure. RESULTS In 2013, a total of 103,101 new anticoagulant users had definite NVAF: 44,653 VKA, 27,060 dabigatran, and 31,388 rivaroxaban. In matched populations, HRs were as follows for dabigatran versus VKAs (20,489 per group): stroke and systemic embolism (SSE) 0.75 (95% CI 0.63-0.88), clinically relevant bleeding (CRB) 0.58 (95% CI 0.51-0.66), hemorrhagic stroke (HS) 0.22 (95% CI 0.14-0.36), gastrointestinal bleeding (GIB) 0.98 (95% CI 0.80-1.19), acute coronary syndrome (ACS) 0.79 (95% CI 0.65-0.95), death 0.74 (95% CI 0.67-0.82), composite (any of the above) 0.71 (95% CI 0.66-0.76). For matched rivaroxaban versus VKA (23,053 per group) HRs were as follows: SSE 0.98 (95% CI 0.85-1.14), CRB 0.83 (95% CI 0.75-0.92), HS 0.65 (95% CI 0.49-0.87), GIB 1.08 (95% CI 0.90-1.30), ACS 0.84 (95% CI 0.71-1.00), death 0.77 (95% CI 0.71-0.84), composite 0.84 (95% CI 0.79-0.89). Numbers needed to treat to observe one fewer death were 49 ± 0.05 with dabigatran or rivaroxaban versus VKAs. CONCLUSION Consistent with results from clinical trials and other observational studies, dabigatran and rivaroxaban were at least as effective and safer than VKAs for the prevention of thromboembolic events in NVAF over 1 year in the French population. STUDY REGISTRATION European Medicines Agency EUPAS 13017 (www.encepp.eu) Clinicaltrials.gov id NCT02785354.
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Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France
| | - Caroline Dureau-Pournin
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France
| | - Jacques Bénichou
- INSERM U1219, Université de Bordeaux, Bordeaux, France
- CHU de Rouen, Unité de Biostatistique, 1 rue de Germont, 76031, Rouen, France
| | - Yves Cottin
- CHU de Dijon, Service de Cardiologie, 14 rue Gaffarel, 21079, Dijon cedex, France
| | - Patrick Mismetti
- Hôpital Nord, Unité de Recherche Clinique Innovation et Pharmacologie, 120 avenue Albert Raimond, 42055, Saint-Etienne, France
| | - Abdelilah Abouelfath
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France
| | - Regis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC 1401 Université de Bordeaux, CHU de Bordeaux, 146 Rue Leo Saignat, 33076, Bordeaux, France.
- INSERM U1219, Université de Bordeaux, Bordeaux, France.
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Six-year survival study after myocardial infarction: The EOLE prospective cohort study. Long-term survival after MI. Therapie 2019; 74:459-468. [DOI: 10.1016/j.therap.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/08/2018] [Accepted: 02/18/2019] [Indexed: 12/12/2022]
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Araújo C, Laszczyńska O, Viana M, Dias P, Maciel MJ, Moreira I, Azevedo A. Calidad del cuidado y mortalidad a 30 días de mujeres y varones con infarto agudo de miocardio. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bezin J, Moore N, Mansiaux Y, Steg PG, Pariente A. Real-Life Benefits of Statins for Cardiovascular Prevention in Elderly Subjects: A Population-Based Cohort Study. Am J Med 2019; 132:740-748.e7. [PMID: 30660573 DOI: 10.1016/j.amjmed.2018.12.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The benefits of initiating statins in the elderly remains debated. We evaluated the effects of initiating statins in the elderly, according to cardiovascular risk. METHODS This population-based cohort study used data of the representative sample of the French health care system database for the 2008-2015 period. New users of statins, aged 75 years and older, were dynamically included in the cohort and matched 1:1 to statin nonusers on age, sex, numbers of different drugs dispensed and medical consultations, and cardiovascular history. Patients were classified into 3 cardiovascular risk groups: secondary prevention (history of coronary heart disease), primary prevention with modifiable risk factors (diabetes or cardiovascular medications), and primary prevention without modifiable risk factors (none of the above). Effect of cumulative use of statins on occurrence of acute coronary syndrome or all-cause death was analyzed by using multivariable time-dependent Cox models stratified on cardiovascular risk at inclusion. RESULTS Among the 7284 patients included, median follow-up was 4.7 years. Cumulative use of statins was associated with a lower risk of outcomes in the primary prevention with modifiable risk factors group (adjusted hazard ratio 0.93 per year of use; 95% confidence interval, 0.89-0.96; P < .01) and in the secondary prevention group (0.75; 0.63-0.90; P < .01), but not in the primary prevention without modifiable risk factors group (1.01; 0.86-1.18; P = .92). CONCLUSIONS Statin treatment was not associated with a reduction in acute coronary syndrome or all-cause death in elderly without modifiable cardiovascular risk factor treated in primary prevention.
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Affiliation(s)
- Julien Bezin
- University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France.
| | - Nicholas Moore
- University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France; Bordeaux PharmacoEpi, INSERM CIC 1401, Bordeaux, France
| | - Yohann Mansiaux
- University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France
| | - Philippe Gabriel Steg
- FACT (French Alliance for Cardiovascular Clinical Trials), Département Hospitalo-Universitaire (DHU) Fibrose Inflammation Remodelage (FIRE), University Paris Diderot, Assistance Publique - Hôpitaux de Paris (AP-HP), INSERM U-1148, Paris, France; National Heart and Lung Institute (NHLI), Institute of Cardiovascular Medicine and Science (ICMS), Royal Brompton Hospital, Imperial College, London, United Kingdom
| | - Antoine Pariente
- University Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Team Pharmacoepidemiology, Unité Mixte de Recherche (UMR) 1219, Bordeaux, France; Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
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Blin P, Dureau‐Pournin C, Cottin Y, Bénichou J, Mismetti P, Abouelfath A, Lassalle R, Droz C, Moore N. Comparative Effectiveness and Safety of Standard or Reduced Dose Dabigatran vs. Rivaroxaban in Nonvalvular Atrial Fibrillation. Clin Pharmacol Ther 2019; 105:1439-1455. [DOI: 10.1002/cpt.1318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/30/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | | | - Yves Cottin
- Service de CardiologieCHU de Dijon Dijon France
| | - Jacques Bénichou
- INSERM U1219Université de Bordeaux Bordeaux France
- CHU de RouenUnité de Biostatistique Rouen France
| | - Patrick Mismetti
- Unité de Recherche Clinique Innovation et PharmacologieHôpital Nord Saint‐Etienne France
| | - Abdelilah Abouelfath
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Regis Lassalle
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Cécile Droz
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
| | - Nicholas Moore
- Bordeaux PharmacoEpiINSERM CIC1401Université de BordeauxCHU de Bordeaux Bordeaux France
- INSERM U1219Université de Bordeaux Bordeaux France
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Ma TT, Wong ICK, Man KKC, Chen Y, Crake T, Ozkor MA, Ding LQ, Wang ZX, Zhang L, Wei L. Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis. PLoS One 2019; 14:e0210988. [PMID: 30657781 PMCID: PMC6338367 DOI: 10.1371/journal.pone.0210988] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/05/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The combination pharmacotherapy of antiplatelet agents, lipid-modifiers, ACE inhibitors/ARBs and beta-blockers are recommended by international guidelines. However, data on effectiveness of the evidence-based combination pharmacotherapy (EBCP) is limited. OBJECTIVES To determine the effect of EBCP on mortality and Cardiovascular events in patients with Coronary Heart Disease (CHD) or cerebrovascular disease. METHODS Publications in EMBASE and Medline up to October 2018 were searched for cohort and case-control studies on EBCP for the secondary prevention of cardiovascular disease. The main outcomes were all-cause mortality and major cardiovascular events. Meta-analyses were performed based on random effects models. RESULTS 21 studies were included. Comparing EBCP to either monotherapy or no therapy, the pooled risk ratios were 0.60 (95% confidence interval 0.55 to 0.66) for all-cause mortality, 0.70 (0.62 to 0.79) for vascular mortality, 0.73 (0.64 to 0.83) for myocardial infarction and 0.79 (0.68 to 0.91) for cerebrovascular events. Optimal EBCP (all 4 classes of drug prescribed) had a risk ratio for all-cause mortality of 0.50 (0.40 to 0.64). This benefit became more dilute as the number of different classes of drug comprising EBCP was decreased-for 3 classes of drug prescribed the risk ratio was 0.58 (0.49 to 0.69) and for 2 classes, the risk ratio was 0.67 (0.60 to 0.76). CONCLUSIONS EBCP reduces the risk of all-cause mortality and cardiovascular events in patients with CHD or cerebrovascular disease. The different classes of drugs comprising EBCP work in an additive manner, with optimal EBCP conferring the greatest benefit.
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Affiliation(s)
- Tian-Tian Ma
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C. K. Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yang Chen
- UCL Institute of Cardiovascular Science, Univeristy College London, London, United Kingdom
| | - Thomas Crake
- Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Muhiddin A. Ozkor
- Barts Heart Centre, St. Bartholomew’s Hospital, West Smithfield, London, United Kingdom
| | - Ling-Qing Ding
- Department of Pharmacy, The Affiliated Cardiovascular Hospital of Xiamen University, Xiamen, China
| | - Zi-Xuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Lin Zhang
- Intensive Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
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12
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Blin P, Dureau-Pournin C, Cottin Y, Bénichou J, Mismetti P, Abouelfath A, Lassalle R, Droz C, Moore N. Effectiveness and safety of 110 or 150 mg dabigatran vs. vitamin K antagonists in nonvalvular atrial fibrillation. Br J Clin Pharmacol 2018; 85:432-441. [PMID: 30423205 DOI: 10.1111/bcp.13815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS We compared the 1-year safety and effectiveness of dabigatran 110 mg (D110) or 150 mg (D150) twice daily to vitamin K antagonists (VKA) in patients with nonvalvular atrial fibrillation. METHODS New user cohort study of patients dispensed D110 or D150 vs. VKA in 2013 for nonvalvular atrial fibrillation, followed 1 year in the French Système National des Données de Santé (66 million persons). D110 and D150 users were matched 1:1 with VKA users on sex, age, date of first drug dispensing and high-dimensional propensity score. Hazard ratios [HR (95% confidence intervals)] for stroke and systemic embolism (SSE), major bleeding (MB) and death were computed using Cox proportional hazards or Fine and Gray models during exposure. RESULTS In 14 442 matched D110 and VKA patients, mean age 79, 49% male, 91% with CHA2 DS2 -VASc ≥2 and 8% with HAS-BLED score >3, incidence rates of SSE were 1.9% and 2.6% person-years [HR 0.69 (0.56-0.84)], MB 1.8% and 2.9% [0.62 (0.51-0.76)], death 7.2% and 8.6% [0.84 (0.76-0.94)]. In 8389 matched D150 and VKA patients, mean age 67, 67% male, 65% with CHA2 DS2 -VASC ≥2; < 5% HAS-BLED >3, incidence rates were for SSE 1.4% and 1.9% [0.76 (0.56-1.04)], MB 0.6% and 1.9% [0.30 (0.20-0.46)], death 1.6% and 3.6% [0.46 (0.35-0.59)]. Numbers needed to treat to observe one fewer death were 78 for D110, 88 for D150. CONCLUSION In real life D110 and D150 were at least as effective, and safer than VKA.
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Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Caroline Dureau-Pournin
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Yves Cottin
- CHU de Dijon, Service de Cardiologie, 21079, Dijon, France
| | - Jacques Bénichou
- INSERM U1219, Université de Bordeaux, 33076, Bordeaux, France.,CHU de Rouen, Unité de Biostatistique, 76031, Rouen, France
| | - Patrick Mismetti
- Hôpital Nord, Unité de Recherche Clinique Innovation et Pharmacologie, 42055, Saint-Etienne, France
| | - Abdelilah Abouelfath
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Regis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, 33076, Bordeaux, France.,INSERM U1219, Université de Bordeaux, 33076, Bordeaux, France
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13
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Blin P, Dureau-Pournin C, Benichou J, Bonello L, Dallongeville J, Danchin N, Falissard B, Thomas-Delecourt F, Jové J, Lassalle R, Droz C, Moore N. Secondary prevention of acute coronary events with antiplatelet agents (SPACE-AA): One-year real-world effectiveness and safety cohort study in the French nationwide claims database. Atherosclerosis 2018; 281:98-106. [PMID: 30658197 DOI: 10.1016/j.atherosclerosis.2018.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/16/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS We aimed to compare the effectiveness of ticagrelor vs. clopidogrel or prasugrel on recurrence of acute coronary syndromes (ACS) in real-life conditions, as requested by regulatory authorities at the time of marketing. METHODS We performed a cohort study in SNDS, the French national healthcare database. All patients with a hospital admission for ACS in 2013 were followed one year. Patients on ticagrelor, clopidogrel or prasugrel were matched 1:1 using age, gender, index ACS type, and high-dimensional propensity scores (hdPS). Outcomes were ACS, stroke, all-cause death, and major bleeding, compared within matched groups using Cox proportional hazards models analysis during treatment. RESULTS 54,048 ACS were hospitalized in 2013. At discharge, 19,796 were dispensed clopidogrel, 8242 prasugrel, and 13,916 ticagrelor. Per group, 9224 ticagrelor vs. clopidogrel, 6752 ticagrelor vs. prasugrel, and 4676 prasugrel vs. clopidogrel patients were matched. Compared to clopidogrel, ticagrelor was associated with a lower hazard ratio of death 0.73 [0.59-0.90] and composite criterion (0.88, 95% CI [0.79-0.99] but not ACS 0.92 [0.80-1.06], stroke (0.96 [017-5.53]) or major bleeding (1.02 [0.82-1.26]). Prasugrel was not different from ticagrelor or clopidogrel for any outcome, in matched patients. CONCLUSIONS Ticagrelor in real-life conditions in matched populations was associated with a lower risk of all-cause death than clopidogrel, and a lower risk of composite outcome, as in the main pivotal clinical trial. Ticagrelor and prasugrel were not different, nor were prasugrel and clopidogrel.
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Affiliation(s)
- Patrick Blin
- Bordeaux PharmacoEpi, University of Bordeaux, INSERM CIC1401, Bordeaux, France
| | | | - Jacques Benichou
- INSERM U1219, 33076, Bordeaux, France; CHU de Rouen, 76031, Rouen, France
| | | | | | | | - Bruno Falissard
- CESP/INSERM U1018, Maison de Solenn, 75679, Paris 14, France
| | | | - Jérémy Jové
- Bordeaux PharmacoEpi, University of Bordeaux, INSERM CIC1401, Bordeaux, France
| | - Regis Lassalle
- Bordeaux PharmacoEpi, University of Bordeaux, INSERM CIC1401, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, University of Bordeaux, INSERM CIC1401, Bordeaux, France
| | - Nicholas Moore
- Bordeaux PharmacoEpi, University of Bordeaux, INSERM CIC1401, Bordeaux, France; INSERM U1219, 33076, Bordeaux, France.
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14
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Quality of Care and 30-day Mortality of Women and Men With Acute Myocardial Infarction. ACTA ACUST UNITED AC 2018; 72:543-552. [PMID: 29980406 DOI: 10.1016/j.rec.2018.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/04/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite increased awareness of sex disparities in care and outcomes of acute myocardial infarction (AMI), there appears to have been no consistent attenuation of these differences over the last decade. We investigated differences by sex in management and 30-day mortality using the European Society of Cardiology Acute Cardiovascular Care Association quality indicators (QIs) for AMI. METHODS Proportions and standard errors of the 20 Acute Cardiovascular Care Association QIs were calculated for 771 patients with AMI who were admitted to the cardiology departments of 2 tertiary hospitals in Portugal between August 2013 and December 2014. The association between the composite QI and 30-day mortality was derived from logistic regression. RESULTS Significantly fewer eligible women than men received timely reperfusion, were discharged on dual antiplatelet therapy and high-intensity statins, and were referred to cardiac rehabilitation. Women were less likely to receive recommended interventions (59.6% vs 65.2%; P <.001) and also had higher mean GRACE 2.0 risk score-adjusted 30-day mortality (3.0% vs 1.7%; P <.001). An inverse association between the composite QI and crude 30-day mortality was observed for both sexes (OR, 0.08; 95%CI, 0.01-0.64 for the highest performance tertile vs the lowest). CONCLUSIONS Performance in AMI management is worse for women than men and is associated with higher 30-day mortality, which is also worse for women. Evidence-based QIs have the potential to improve health care delivery and patient prognosis in the overall AMI population and may also bridge the disparity gap between women and men.
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15
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Duong M, Abouelfath A, Lassalle R, Droz C, Blin P, Moore N. Coronary Events After Dispensing of Ibuprofen: A Propensity Score-Matched Cohort Study Versus Paracetamol in the French Nationwide Claims Database Sample. Drug Saf 2018; 41:1049-1058. [DOI: 10.1007/s40264-018-0686-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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Bezin J, Klungel OH, Lassalle R, Dureau‐Pournin C, Moore N, Pariente A. Medications Recommended for Secondary Prevention After First Acute Coronary Syndrome: Effectiveness of Treatment Combinations in a Real‐Life Setting. Clin Pharmacol Ther 2017; 103:1038-1046. [DOI: 10.1002/cpt.864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/10/2017] [Accepted: 08/26/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Julien Bezin
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team PharmacoepidemiologyBordeaux France
- University Hospital of BordeauxBordeauxFrance
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrecht The Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | - Nicholas Moore
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team PharmacoepidemiologyBordeaux France
- University Hospital of BordeauxBordeauxFrance
- Bordeaux PharmacoEpiINSERM CIC1401Bordeaux France
| | - Antoine Pariente
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team PharmacoepidemiologyBordeaux France
- University Hospital of BordeauxBordeauxFrance
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17
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Singh Y, Gupta G, Shrivastava B, Dahiya R, Tiwari J, Ashwathanarayana M, Sharma RK, Agrawal M, Mishra A, Dua K. Calcitonin gene-related peptide (CGRP): A novel target for Alzheimer's disease. CNS Neurosci Ther 2017; 23:457-461. [PMID: 28417590 PMCID: PMC6492742 DOI: 10.1111/cns.12696] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/11/2017] [Accepted: 03/17/2017] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease (AD) is leading cause of death among older characterized by neurofibrillary tangles, oxidative stress, progressive neuronal deficits, and increased levels of amyloid-β (Aβ) peptides. Cholinergic treatment could be the best suitable physiological therapy for AD. Calcitonin gene-related peptide (CGRP) is a thirty-seven-amino acid regulatory neuropeptide resulting from different merging of the CGRP gene, which also includes adrenomedullin, amylin, calcitonin, intermedin, and calcitonin receptor-stimulating peptide. It is a proof for a CGRP receptor within nucleus accumbens of brain that is different from either the CGRP1 or CGRP2 receptor in which it demonstrates similar high-affinity binding for salmon calcitonin, CGRP, and amylin, a possession which is not shared by any extra CGRP receptors. Binding of CGRP to its receptor increases activated cAMP-dependent pkA and PI3 kinase, resulting in N-terminal fragments that are shown to exert complex inhibitory as well facilitator actions on nAChRs. Fragments such as CGRP1-4, CGRP1-5, and CGRP1-6 rapidly as well as reversibly improve agonist sensitivity of nAChRs without straight stimulating those receptors and produce the Ca2+ -induced intracellular Ca2+ mobilization. Renin-angiotensin-aldosterone system (RAAS)-activated angiotensin-type (AT4) receptor is also beneficial in AD. It has been suggested that exogenous administration of CGRP inhibits infiltration of macrophages and expression of various inflammatory mediators such as NFkB, IL-1b, TNF-α, iNOS, matrix metalloproteinase (MMP)-9, and cell adhesion molecules like intercellular adhesion molecule (ICAM)-1 which attenuates consequence of inflammation in AD. Donepezil, a ChEI, inhibits acetylcholinesterase and produces angiogenesis and neurogenesis, in the dentate gyrus of the hippocampus of WT mice after donepezil administration. However, none of the results discovered in CGRP-knockout mice and WT mice exposed to practical denervation. Therefore, selective agonists of CGRP receptors may become the potential candidates for treatment of AD.
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Affiliation(s)
- Yogendra Singh
- School of PharmacyJaipur National UniversityJagatpuraJaipurIndia
| | - Gaurav Gupta
- School of PharmacyJaipur National UniversityJagatpuraJaipurIndia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNSWAustralia
| | | | - Rajiv Dahiya
- Laboratory of Peptide Research and DevelopmentSchool of Pharmacy, The University of the West IndiesSt. Augustine, Trinidad & TobagoWest Indies
| | - Juhi Tiwari
- School of PharmacyJaipur National UniversityJagatpuraJaipurIndia
| | | | | | - Mohit Agrawal
- School of pharmacySuresh Gyan Vihar UniversityJaipurIndia
| | - Anurag Mishra
- School of pharmacySuresh Gyan Vihar UniversityJaipurIndia
| | - Kamal Dua
- Discipline of PharmacyGraduate School of HealthUniversity of Technology SydneySydneyNSWAustralia
- School of Biomedical Sciences and PharmacyUniversity of NewcastleNewcastleNSWAustralia
- School of Pharmaceutical SciencesShoolini UniversitySolanHimachal PradeshIndia
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18
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Bezin J, Duong M, Lassalle R, Droz C, Pariente A, Blin P, Moore N. The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2017; 26:954-962. [PMID: 28544284 DOI: 10.1002/pds.4233] [Citation(s) in RCA: 365] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/30/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Julien Bezin
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Mai Duong
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Régis Lassalle
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Cécile Droz
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Antoine Pariente
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
| | - Patrick Blin
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
| | - Nicholas Moore
- Department of Medical Pharmacology, CHU de Bordeaux; Université de Bordeaux; 33076 Bordeaux France
- INSERM U1219; 33076 Bordeaux France
- Bordeaux PharmacoEpi; INSERM CIC1401; 33076 Bordeaux France
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