1
|
Acton EK, Hennessy S, Gelfand MA, Leonard CE, Bilker WB, Shu D, Willis AW, Kasner SE. Thinking Three-Dimensionally: A Self- and Externally-Controlled Approach to Screening for Drug-Drug-Drug Interactions Among High-Risk Populations. Clin Pharmacol Ther 2024; 116:448-459. [PMID: 38860403 PMCID: PMC11262479 DOI: 10.1002/cpt.3310] [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: 02/05/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024]
Abstract
The global rise in polypharmacy has increased both the necessity and complexity of drug-drug interaction (DDI) assessments, given the growing potential for interactions involving more than two drugs. Leveraging large-scale healthcare claims data, we piloted a semi-automated, high-throughput case-crossover-based approach for drug-drug-drug interaction (3DI) screening. Cases were direct-acting oral anticoagulant (DOAC) users with either a major bleeding event during ongoing dispensings for potentially interacting, enzyme-inhibiting antihypertensive drugs (AHDs) (Study 1), or a thromboembolic event during ongoing dispensings for potentially interacting, enzyme-inducing antiseizure medications (ASMs) (Study 2). 3DI detection was based on screening for additional drug exposures that served as acute outcome triggers. To mitigate direct effects and confounding by concomitant drugs, self-controlled estimates were adjusted using negative cases (external "control" DOAC users with the same outcomes but co-dispensings for non-interacting AHDs or ASMs). Signal thresholds were set based on P-values and false discovery rate q-values to address multiple comparisons. Study 1: 285 drugs were examined among 3,306 episodes. Self-controlled assessments with q-value thresholds yielded 9 3DI signals (cases) and 40 DDI signals (negative cases). External adjustment generated 10 3DI signals from the P-value threshold and no signals from the q-value threshold. Study 2: 126 drugs were examined among 604 episodes. Assessments with P-value thresholds yielded 3 3DI and 26 DDI signals following self-control, as well as 4 3DI signals following adjustment. No 3DI signals met the q-value threshold. The presented self- and externally-controlled approach aimed to advance paradigms for real-world higher order drug interaction screening among high-susceptibility populations with pre-existent DDI risk.
Collapse
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, PA, US
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - 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, PA, US
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, US
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Michael A. Gelfand
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, US
| | - Charles E. Leonard
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, US
| | - Warren B. Bilker
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - Di Shu
- Center for Real-World Effectiveness and Safety of Therapeutics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
| | - 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, PA, US
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, US
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, US
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, US
| | - Scott E. Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, US
| |
Collapse
|
2
|
Hallas J, Maclure M. Use of Point-in-Time or Window Approach in the Case-Crossover Design, Implications for Pharmacoepidemiologic Research Using Registries. Pharmacoepidemiol Drug Saf 2024; 33:e5850. [PMID: 38887901 DOI: 10.1002/pds.5850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
Szilcz M, Wastesson JW, Calderón-Larrañaga A, Prieto-Alhambra D, Blotière PO, Maura G, Johnell K. Cholinesterase inhibitors and non-steroidal anti-inflammatory drugs and the risk of peptic ulcers: A self-controlled study. J Am Geriatr Soc 2024; 72:456-466. [PMID: 37905683 DOI: 10.1111/jgs.18647] [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: 05/26/2023] [Revised: 09/11/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) should be used with caution in adults aged 65 years and older. Their gastrointestinal adverse event risk might be further reinforced when using concomitant cholinesterase inhibitors (ChEIs). We aimed to investigate the association between NSAIDs and ChEI use and the risk of peptic ulcers in adults aged 65 years and older. METHODS Register-based self-controlled case series study including adults ≥65 years with a new prescription of ChEIs and NSAIDs, diagnosed with incident peptic ulcer in Sweden, 2007-2020. We identified persons from the Total Population Register individually linked to several nationwide registers. We estimated the incidence rate ratio (IRR) of peptic ulcer with a conditional Poisson regression model for four mutually exclusive risk periods: use of ChEIs, NSAIDs, and the combination of ChEIs and NSAIDs, compared with the non-treatment in the same individual. Risk periods were identified based on the prescribed daily dose, extracted via a text-parsing algorithm, and a 30-day grace period. RESULTS Of 70,060 individuals initiating both ChEIs and NSAIDs, we identified 1500 persons with peptic ulcer (median age at peptic ulcer 80 years), of whom 58% were females. Compared with the non-treatment periods, the risk of peptic ulcer substantially increased for the combination of ChEIs and NSAIDs (IRR: 9.0, [6.8-11.8]), more than for NSAIDs alone (5.2, [4.4-6.0]). No increased risks were found for the use of ChEIs alone (1.0, [0.9-1.2]). DISCUSSION We found that the risk of peptic ulcer associated with the concomitant use of NSAIDs and ChEIs was over and beyond the risk associated with NSAIDs alone. Our results underscore the importance of carefully considering the risk of peptic ulcers when co-prescribing NSAIDs and ChEIs to adults aged 65 years and older.
Collapse
Affiliation(s)
- Máté Szilcz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas W Wastesson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Centre, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pierre-Olivier Blotière
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Géric Maura
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Sato S, Katsuta T, Kawazoe Y, Takahashi M, Murata F, Maeda M, Fukuda H, Kamidani S. Immune thrombocytopenic purpura and Guillain-Barré syndrome after 23-valent pneumococcal polysaccharide vaccination in Japan: The vaccine effectiveness, networking, and universal safety (VENUS) study. Vaccine 2024; 42:4-7. [PMID: 38044244 DOI: 10.1016/j.vaccine.2023.11.053] [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: 05/05/2023] [Revised: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND To address the lack of an active vaccine safety surveillance system in Japan, the Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study was initiated in 2021 as a pilot system using existing health insurance claims data and vaccination records. METHODS This study evaluated the value of the VENUS study by assessing the incidence of immune thrombocytopenic purpura (ITP) and Guillain-Barré syndrome (GBS) following vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23) using a self-controlled case series (SCCS) design. RESULTS Incidence rate ratios for ITP during 28-day and 42-day risk periods were 0.89 (95% confidence interval [CI], 0.12-6.4), and 0.58 (95% CI, 0.081-4.2), respectively. Neither was statistically significant. Incidence rate ratios could not be estimated for GBS due to the limited sample size. CONCLUSION The VENUS study can provide valuable insights to facilitate the establishment of an advanced vaccine monitoring system in Japan.
Collapse
Affiliation(s)
- Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomohiro Katsuta
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan. katsuta-7-@marianna-u.ac.jp
| | - Yurika Kawazoe
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Masaki Takahashi
- Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Megumi Maeda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan; Center for Cohort Studies, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Satoshi Kamidani
- The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
5
|
Suzuki K, Watanabe A, Kiryu Y, Inoue E, Momo K. Self-controlled Case Series Study for Acute Kidney Injury after Starting Proton Pump Inhibitors or Potassium-Competitive Acid Blocker in Patients with Cancer Using a Large Claims Database. Biol Pharm Bull 2024; 47:518-526. [PMID: 38403662 DOI: 10.1248/bpb.b23-00676] [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: 02/27/2024]
Abstract
To investigate the risk of acute kidney injury (AKI) in patients with cancer following the initiation of proton pump inhibitors (PPIs) and potassium-competitive acid blocker (PCAB), considering sex and anti-cancer drug use. We conducted a self-controlled case-series study using the Japan Medical Data Center claims data from 12422 patients with cancer who were prescribed PPIs or PCAB between January 2017 and December 2019. Considering the timing of PPI or PCAB, control period (days -120 to -1), risk period 1 (days 0 to +30), and risk period 2 (days +31 to +365) were defined. To assess the incidence rate ratio (IRR) and 95% confidence interval (CI) as the risk ratio, we adjusted for anti-cancer drugs to assess the risk of AKI. Additionally, we also examined sex differences to identify the risk of AKI. AKI was observed in risk period 1 [2.05 (1.12-3.72), p = 0.0192], but a slight reduction was noted in risk period 2 [0.60 (0.36-1.00), p = 0.0481]. A sex-specific increase in the risk of AKI was observed only in males during risk period 1 [2.18 (1.10-4.32), p = 0.0260], with a reduction in risk period 2 [0.48 (0.26-0.89), p = 0.0200]. We identified an increased risk of AKI in patients with cancer starting PPIs or PCAB particularly in males within 30 d after PPI or PCAB initiation, emphasizing the need for vigilant monitoring and management of AKI in this patient population.
Collapse
Affiliation(s)
- Kosuke Suzuki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Hospital
| | - Ayako Watanabe
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
- Department of Pharmacy, Showa University Koto Toyosu Hospital
| | - Yoshihiro Kiryu
- Department of Pharmacy, M&B Collaboration Medical corporation Hokuetsu Hospital
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University
| | - Kenji Momo
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University
| |
Collapse
|
6
|
Brothers TD, Lewer D, Jones N, Colledge-Frisby S, Bonn M, Wheeler A, Grebely J, Farrell M, Hickman M, Hayward A, Degenhardt L. Effect of incarceration and opioid agonist treatment transitions on risk of hospitalisation with injection drug use-associated bacterial infections: A self-controlled case series in New South Wales, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104218. [PMID: 37813083 DOI: 10.1016/j.drugpo.2023.104218] [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: 05/18/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Transitional times in opioid use, such as release from prison and discontinuation of opioid agonist treatment (OAT), are associated with health harms due to changing drug consumption practices and limited access to health and social supports. Using a self-controlled (within-person) study design, we aimed to understand if these transitions increase risks of injection drug use-associated bacterial infections. METHODS We performed a self-controlled case series among a cohort of people with opioid use disorder (who had all previously accessed OAT) in New South Wales, Australia, 2001-2018. The outcome was hospitalisation with injecting-related bacterial infections. We divided participants' observed days into time windows related to incarceration and OAT receipt. We compared hospitalization rates during focal (exposure) windows and referent (control) windows (i.e., 5-52 weeks continuously not incarcerated or continuously receiving OAT). We estimated adjusted incidence rate ratios (aIRR) using conditional logistic regression, adjusted for time-varying confounders. RESULTS There were 7590 participants who experienced hospitalisation with injecting-related bacterial infections (35% female; median age 38 years; 78% hospitalised with skin and soft-tissue infections). Risk for injecting-related bacterial infections was elevated for two weeks following release from prison (aIRR 1.45; 95%CI 1.22-1.72). Risk was increased during two weeks before (aIRR 1.89; 95%CI 1.59-2.25) and after (aIRR 1.91; 95%CI 1.54-2.36) discontinuation of OAT, and during two weeks before (aIRR 3.63; 95%CI 3.13-4.22) and after (aIRR 2.52; 95%CI 2.09-3.04) OAT initiation. CONCLUSION Risk of injecting-related bacterial infections varies greatly within-individuals over time. Risk is raised immediately after prison release, and around initiation and discontinuation of OAT. Social contextual factors likely contribute to excess risks at transitions in incarceration and OAT exposure.
Collapse
Affiliation(s)
- Thomas D Brothers
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia; UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom; Division of General Internal Medicine, Department of Medicine, Dalhousie University, Canada.
| | - Dan Lewer
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia; UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom; Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, United Kingdom
| | - Nicola Jones
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
| | | | - Matthew Bonn
- Canadian Association of People who Use Drugs (CAPUD), Canada
| | - Alice Wheeler
- Kirby Institute, University of New South Wales, Australia
| | - Jason Grebely
- Kirby Institute, University of New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, United Kingdom
| | - Andrew Hayward
- UCL Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Australia
| |
Collapse
|
7
|
Tsai TY, Loh CH, Huang HK. Anticholinergic medicines linked to cardiovascular events in older adults. BMJ 2023; 382:2133. [PMID: 37758269 DOI: 10.1136/bmj.p2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Tou-Yuan Tsai
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ching-Hui Loh
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Center for Aging and Health, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Huei-Kai Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97002, Taiwan
| |
Collapse
|
8
|
Huang WC, Yang ASH, Tsai DHT, Shao SC, Lin SJ, Lai ECC. Association between recently raised anticholinergic burden and risk of acute cardiovascular events: nationwide case-case-time-control study. BMJ 2023; 382:e076045. [PMID: 37758279 PMCID: PMC10523277 DOI: 10.1136/bmj-2023-076045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To evaluate the association between recently raised anticholinergic burden and risk of acute cardiovascular events in older adults. DESIGN Case-case-time-control study (ie, incorporating a case crossover design and a control crossover design consisting of future cases). SETTING Taiwan's National Health Insurance Research Database. PARTICIPANTS 317 446 adults aged ≥65 who were admitted to hospital because of an incident acute cardiovascular event between 2011 and 2018. Acute cardiovascular events included myocardial infarction, strokes, arrhythmias, conduction disorders, and cardiovascular death. MAIN OUTCOME MEASURES The anticholinergic burden was measured for each participant by adding up the anticholinergic scores for individual drugs using the Anticholinergic Cognitive Burden Scale. Scores were classified into three levels (0 points, 1-2 points, and ≥3 points). For each participant, anticholinergic burden levels during hazard periods (day -1 to -30 before the cardiovascular event) were compared with randomly selected 30 day reference periods (ie, periods between days -61 and -180). Conditional logistic regression determined odds ratios with 95% confidence intervals to evaluate the association between acute cardiovascular events and recently raised anticholinergic burden. RESULTS The crossover analyses included 248 579 current cases. Participants' average age on the index date was 78.4 years (standard deviation 0.01), and 53.4% were men. The most frequently prescribed drugs with anticholinergic activity were antihistamines (68.9%), gastrointestinal antispasmodics (40.9%), and diuretics (33.8%). Among patients with varying levels of anticholinergic burden in different periods, more patients carried higher levels of anticholinergic burden during hazard periods than during reference periods. For example, 17 603 current cases had 1-2 points of anticholinergic burden in the hazard period with 0 points in the reference period, while 8507 current cases had 0 points in the hazard period and 1-2 points in the reference period. In the comparison of 1-2 points versus 0 points of anticholinergic burden, the odds ratio was 1.86 (95% confidence interval 1.83 to 1.90) in the case crossover analysis and 1.35 (1.33 to 1.38) in the control crossover analysis, which yielded a case-case-time-control odds ratio of 1.38 (1.34 to 1.42). Similar results were found in the comparison of ≥3 versus 0 points (2.03, 1.98 to 2.09) and ≥3 versus 1-2 points (1.48, 1.44 to 1.52). The findings remained consistent throughout a series of sensitivity analyses (eg, cut-off points for anticholinergic burden categories were redefined and different scales were used to measure anticholinergic burden). CONCLUSIONS An association was found between recently raised anticholinergic burden and increased risk of acute cardiovascular events. Furthermore, a greater increase in anticholinergic burden was associated with a higher risk of acute cardiovascular events.
Collapse
Affiliation(s)
- Wei-Ching Huang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Avery Shuei-He Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Daniel Hsiang-Te Tsai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Swu-Jane Lin
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
9
|
Huang WC, Lai ECC. Future-case control crossover analysis for adjusting bias in case crossover studies. BMJ 2023; 382:2136. [PMID: 37758283 DOI: 10.1136/bmj.p2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- Wei-Ching Huang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 701 Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 701 Tainan, Taiwan
| |
Collapse
|
10
|
Huang HC, Li WC, Tadrous M, Schumock GT, Touchette D, Awadalla S, Lee TA. Evaluating the use of methods to mitigate bias from non-transient medications in the case-crossover design: A systematic review. Pharmacoepidemiol Drug Saf 2023; 32:939-950. [PMID: 37283212 DOI: 10.1002/pds.5649] [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: 12/09/2022] [Revised: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The case-crossover design is a self-controlled study design used to compare exposure immediately preceding an event occurrence with exposure in earlier control periods. The design is most suitable for transient exposures in order to avoid biases that can be problematic when using the case-crossover design for non-transient (i.e., chronic) exposures. Our goal was to conduct a systematic review of case-crossover studies and its variants (case-time-control and case-case-time-control) in order to compare design and analysis choices by medication type. METHODS We conducted a systematic search to identify recent case-crossover, case-time-control, and case-case-time-control studies focused on medication exposures. Articles indexed in MEDLINE and EMBASE using these study designs that were published between January 2015 and December 2021 in the English language were identified. Reviews, methodological studies, commentaries, articles without medications as the exposure of interest, and articles with no available full text were excluded. Study characteristics including study design, outcome, risk window, control window, reporting of discordant pairs, and inclusion of sensitivity analyses were summarized overall and by medication type. We further evaluated the implementation of recommended methods to account for biases introduced by non-transient exposures among articles that used the case-crossover design on a non-transient exposure. RESULTS Of the 2036 articles initially identified, 114 articles were included. The case-crossover was the most common study design (88%), followed by the case-time-control (17%), and case-case-time-control (3%). Fifty-three percent of the articles included only transient medications, 35% included only non-transient medications, and 12% included both. Across years, the proportion of case-crossover articles evaluating a non-transient medication ranged from 30% in 2018 to 69% in 2017. We found that 41% of the articles that evaluated a non-transient medication did not apply any of the recommended methods to account for biases and more than half of which were conducted by authors with no previous publication history of case-crossover studies. CONCLUSION Using the case-crossover design to evaluate a non-transient medication remains common in pharmacoepidemiology. Researchers should apply appropriate design and analysis choices when opting to use a case-crossover design with non-transient medication exposures.
Collapse
Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Wen-Chin Li
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Daniel Touchette
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Saria Awadalla
- Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, Illinois, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Eiffert SR, Raman SR. Re: "Self-controlled case series design in vaccine safety: a systematic review" - absolute and relative measures. Expert Rev Vaccines 2023; 22:419-420. [PMID: 37144286 DOI: 10.1080/14760584.2023.2211165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Samantha R Eiffert
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
13
|
Holt A, Strange JE, Nouhravesh N, Nielsen SK, Malik ME, Schjerning AM, Køber L, Torp-Pedersen C, Gislason GH, McGettigan P, Schou M, Lamberts M. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol 2023; 81:1459-1470. [PMID: 37045515 DOI: 10.1016/j.jacc.2023.02.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Fluid retention and endothelial dysfunction have been related to use of nonsteroidal anti-inflammatory drugs (NSAIDs), and type 2 diabetes mellitus (T2DM) has been linked to both a decline in kidney function and subclinical cardiomyopathy. OBJECTIVES The authors hypothesized that short-term use of NSAIDs could lead to subsequent development of incident heart failure (HF) in patients with T2DM. METHODS Using nationwide Danish registers, we identified patients diagnosed with T2DM during 1998 to 2021 and included patients without previous HF, rheumatic disease, or use of NSAIDs 120 days before diagnosis. Associations between NSAIDs and first-time HF hospitalization were investigated using a case-crossover design with 28-day exposure windows, and ORs with 95% CIs were reported. RESULTS Included were 331,189 patients with T2DM: 44.2% female, median age of 62 years (IQR: 52-71 years); 23,308 patients were hospitalized with HF during follow-up, and 16% of patients claimed at least 1 NSAID prescription within 1 year. Short-term use of NSAIDs was associated with increased risk of HF hospitalization (OR: 1.43; 95% CI: 1.27-1.63), most notably in subgroups with age ≥80 years (OR: 1.78; 95% CI: 1.39-2.28), elevated hemoglobin (Hb) A1c levels treated with 0 to 1 antidiabetic drug (OR: 1.68; 95% CI: 1.00-2.88), and without previous use of NSAIDs (OR: 2.71; 95% CI: 1.78-4.23). CONCLUSIONS NSAIDs were widely used and were associated with an increased risk of first-time HF hospitalization in patients with T2DM. Patients with advanced age, elevated HbA1c levels, and new users of NSAID seemed more susceptible. These findings could guide physicians prescribing NSAIDs.
Collapse
Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark; Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Grafton, Auckland, New Zealand.
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark; Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. https://twitter.com/JarlStrange
| | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark. https://twitter.com/NinaNouhravesh
| | - Sebastian Kinnberg Nielsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark. https://twitter.com/SebKinnberg
| | - Mariam Elmegaard Malik
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark. https://twitter.com/MariamElmegaard
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; The Danish Heart Foundation, Copenhagen, Denmark. https://twitter.com/AnneSchjerning
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, North Zealand Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/PedersenTorp
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. https://twitter.com/gunngis
| | - Patricia McGettigan
- William Harvey Research Institute, Charterhouse Square Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom. https://twitter.com/P_McGettigan
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/mortschou
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej, Hellerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. https://twitter.com/MortenLamberts
| |
Collapse
|
14
|
Ankarfeldt MZ, von Osmanski BI, Blond K. Kill your darlings: Stop using the terms retrospective and prospective. Pharmacoepidemiol Drug Saf 2023; 32:506-507. [PMID: 36737851 DOI: 10.1002/pds.5598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Mikkel Zöllner Ankarfeldt
- Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Benedikte Irene von Osmanski
- Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- DLI Market Intelligence, Copenhagen Ø, Denmark
| | - Kim Blond
- Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| |
Collapse
|
15
|
Quinn PD, Chang Z, Pujol TA, Bair MJ, Gibbons RD, Kroenke K, D’Onofrio BM. Association between prescribed opioid dose and risk of motor vehicle crashes. Pain 2023; 164:e228-e236. [PMID: 36155384 PMCID: PMC11104685 DOI: 10.1097/j.pain.0000000000002790] [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: 11/23/2021] [Accepted: 09/12/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Opioid-involved motor vehicle traffic fatalities have increased over the past 2 decades. However, the extent to which prescribed opioids increase the risk of motor vehicle crashes remains uncertain. This study used real-world healthcare claims data to examine the association between prescription opioid dose and motor vehicle crash risk. Using nationwide US commercial insurance claims data for 2010 to 2018, we identified 772,404 adults who received incident, noncancer opioid therapy. We examined associations between daily prescription opioid dose, calculated in morphine milligram equivalents (MME) from filled prescription claims, and risk of motor vehicle crashes, assessed as diagnoses of motor vehicle injuries in claims for emergency visits, inpatient hospitalizations, and ambulance transportation. We estimated associations using a within-individual design, which ruled out all time-stable confounding. We complemented the design with time-varying statistical adjustment for other pharmacotherapies and a negative control pain pharmacotherapy analysis (with incident cyclic antidepressant prescriptions). During 2,150,009 person-years of follow-up, there were 12,123 motor vehicle crashes (5.64 crashes per 1000 person-years). In within-individual comparisons, crash risk was greater during opioid prescription periods involving doses ≤60 MME/day (odds ratio [OR], 3.86; 95% confidence interval [CI], 3.54, 4.21), >60 to 120 MME/day (OR, 5.46; 95% CI, 4.44, 6.73), and >120 MME/day (OR, 3.45; 95% CI, 2.31, 5.15) than during off-treatment periods. The negative control analysis supported the specificity of the results to opioids rather than to other processes associated with pharmacologic pain management. These findings suggest that the receipt of prescription opioids, even at doses ≤60 MME/day, is associated with an increased risk of motor vehicle crashes.
Collapse
Affiliation(s)
- Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Matthew J. Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Robert D. Gibbons
- Center for Health Statistics, University of Chicago, Chicago, Illinois
- Department of Medicine, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Kurt Kroenke
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
- Regenstrief Institute, Indianapolis, Indiana
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| |
Collapse
|
16
|
Qin LY. A Comparison of the Effect of Facemasks on Perceived Breathability and Air Quality during Daily Activities and Indoor Exercises. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4144. [PMID: 36901156 PMCID: PMC10002446 DOI: 10.3390/ijerph20054144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Transmission of COVID-19 occurs predominantly through respired droplets and aerosols containing the SARS-CoV-2 virus. As a solution, face masks have been used to protect against infection. Wearing face masks during indoor exercises is essential to prevent the spread of virus-containing respiratory droplets and aerosols. However, previous studies have not investigated all elements, including the users' perceived breathability (PB) and perceived air quality (PAQ) when wearing a face mask during indoor exercises. The current study aimed to assess users' perceived comfort (PC) of face masks based on assessment criteria of PB and PAQ during moderate to vigorous exercises, and compare them with those during normal daily activities. Data on PC, PB, and PAQ were collected from an online questionnaire survey from 104 participants doing regular moderate to vigorous exercises. Within-subjects comparison with self-controlled case series design was performed to compare PC, PB, and PAQ between wearing face masks during exercises and daily activities. Results showed that the degree of dissatisfaction with PC, PB, and PAQ while wearing face masks and performing indoor exercises is higher than when performing daily activities (p < 0.05). The significance of the study implies that masks comfortable for daily activities may not remain the same during moderate to vigorous exercises, especially during indoor exercises.
Collapse
Affiliation(s)
- Lai-Yin Qin
- Academy of Visual Arts, School of Creative Arts, Hong Kong Baptist University, Hong Kong, China
| |
Collapse
|
17
|
Nicolajsen CW, Nielsen PB, Jensen M, Eldrup N, Larsen TB, Lip GYH, Goldhaber SZ, Søgaard M. Stroke and Myocardial Infarction in Patients with Abdominal Aortic Aneurysm and New-Onset Atrial Fibrillation. Thromb Haemost 2023; 123:555-564. [PMID: 36626930 DOI: 10.1055/a-2009-8954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We investigated the association between new-onset atrial fibrillation (AF) and risk of stroke and myocardial infarction (MI) in patients with abdominal aortic aneurysmal (AAA) disease. METHODS Observational crossover study using Danish nationwide data, including patients with AAA and incident AF between 1997 and 2018. We estimated the 1-year risk of stroke and MI and the within-individual odds ratios (ORs) of ischemic events before and after an AF diagnosis, stratified by year of AF diagnosis (1997-2010 and 2011-2018), and supplemented with analyses on changes in use of antithrombotic therapy. RESULTS A total of 3,035 AAA patients were included: 1,040 diagnosed during 1997 to 2010, and 1,995 during 2011 to 2018 (22.2% females, median age 78 years; median CHA2DS2-VASc score 4; interquartile range: 3-5). One-year risk of ischemic events after AF was 5.9% (confidence interval [CI] 95%: 4.6-7.5%) and 4.5% (CI 95%: 3.7-5.5%) for stroke and 5.4% (CI 95%: 4.2-6.9%) and 4.0% (CI 95%: 3.2-4.9%) for MI during 1997 to 2010 and 2011 to 2018, respectively. The OR of ischemic stroke before and after incident AF was 2.8 (CI 95%: 1.6-5.2) during 1997 to 2010; and 2.4 (CI 95%: 1.5 to 3.9) during 2011 to 2018, and 3.5 (CI 95%: 1.7-7.5) and 1.5 (CI 95%: 0.9-2.4) for MI. One-year proportion of prescription claims for oral anticoagulants after AF changed from 66.1% in 1997 to 2010 to 82.6% in 2011 to 2018, while antiplatelet prescription claims changed from 80.8 to 60.9%. CONCLUSION Cardiovascular prognosis has improved in patients with prevalent AAA disease and new-onset AF in concordance with optimization of antithrombotic therapy over time. A diagnosis of AF conferred residual risk of stroke and MI.
Collapse
Affiliation(s)
- Chalotte W Nicolajsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Peter B Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Jensen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Nikolaj Eldrup
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Copenhagen University, Copenhagen, Denmark
| | - Torben B Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Samuel Z Goldhaber
- Division of Cardiovascular Medicine, Thrombosis Research Group, Brigham and Women's Hospital, Boston, Massachusetts, United States.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
18
|
Reilev M, Jensen PB, Ranch LS, Egeberg A, Furu K, Gembert K, Hagg D, Haug U, Karlstad Ø, Reutfors J, Schäfer W, Schwartz S, Smits E, Holthius E, Herings R, Trifirò G, Kirchmayer U, Rosa AC, Belleudi V, Gini R, Støvring H, Hallas J. Methodology of the brodalumab assessment of hazards: a multicentre observational safety (BRAHMS) study. BMJ Open 2023; 13:e066057. [PMID: 36725094 PMCID: PMC9896233 DOI: 10.1136/bmjopen-2022-066057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Safe and effective pharmacological treatment is of paramount importance for treating severe psoriasis. Brodalumab, a monoclonal antibody against interleukin (IL) 17 receptor A, was granted marketing authorisation in the EU in 2017. The European Medicines Agency requested a postauthorisation safety study of brodalumab to address potential safety issues raised during drug development regarding major adverse cardiovascular events, suicidal conduct, cancer and serious infections. METHODS AND ANALYSIS BRodalumab Assessment of Hazards: A Multinational Safety is a multicentre observational safety study of brodalumab running from 2017 to 2029 using population-based healthcare databases from Denmark, Sweden, Norway, Netherlands, Germany and three different centres in Italy. A distributed database network approach is used, such that only aggregate data are exchanged between sites.Two types of designs are used: a case-time-control design to study acute effects of transient treatment and a variation of the new user active comparator design to study the effects of transient or chronic treatment. As comparators, inhibitors of TNF-α, inhibitors of IL-12 and IL-23, and other inhibitors of cytokine IL-17A are included.In the self-controlled case-time-control design, the risk of developing the outcome of interest during periods of brodalumab use is compared within individuals to the risk in periods without use.In the active comparator cohort design, new users of brodalumab are identified and matched to new users of active comparators. Potential baseline confounders are adjusted for by using propensity score modelling. For outcomes that potentially require large cumulative exposure, an adapted active comparator design has been developed. ETHICS AND DISSEMINATION The study is approved by relevant authorities in Denmark, Norway, Sweden, the Netherlands, Germany and Italy in line with the relevant legislation at each site. Data confidentiality is secured by the distributed network approach. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER EUPAS30280.
Collapse
Affiliation(s)
- Mette Reilev
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Peter Bjødstrup Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Lise Skov Ranch
- Biostatistics and Pharmacoepidemiology, LEO Pharma A/S, Ballerup, Denmark
| | - Alexander Egeberg
- Department of dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Helath, Oslo, Norway
| | - Karin Gembert
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - David Hagg
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - Ulrike Haug
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Human and Health Science, University of Bremen, Bremen, Germany
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Helath, Oslo, Norway
| | - Johan Reutfors
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - Wiebke Schäfer
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Sarina Schwartz
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Emily Holthius
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosa Gini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Henrik Støvring
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
Reilev M, Olesen M, Kildegaard H, Støvring H, Andersen JH, Hallas J, Lund LC, Ladebo L, Ernst MT, Damkier P, Jensen PB, Pottegård A, Rasmussen L. Changing characteristics over time of individuals receiving COVID-19 vaccines in Denmark: A population-based descriptive study of vaccine uptake. Scand J Public Health 2022; 50:686-692. [PMID: 35799465 DOI: 10.1177/14034948221108246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS The Danish authorities implemented a differential rollout of the COVID-19 vaccines where individuals at high risk of COVID-19 were prioritized. We describe the temporal uptake and characteristics of COVID-19 vaccine recipients in Denmark. METHODS Using nationwide healthcare registries, we identified all Danish residents ⩾5 years of age who received at least one dose of a COVID-19 vaccine from 27 December 2020-29 January 2022. We charted the daily number of newly vaccinated individuals and the cumulative vaccine coverage over time, stratified by vaccine type, age groups and vaccination priority groups, and described characteristics of vaccine recipients during two-month-intervals and in vaccination priority groups. RESULTS By 29 January 2022, 88%, 86% and 64% of Danish residents ⩾5 years (n=5,562,008) had received a first, second and third dose, respectively, of a COVID-19 vaccine, most commonly the BNT162b2 vaccine (84%). Uptake ranged from 48% in 5-11-year-olds to 98% in 65-74-year-olds. Individuals vaccinated before June 2021 were older (median age 61-70 years vs 10-35 years in later periods) and had more comorbidities such as hypertension (22-28% vs 0.77-2.8% in later periods), chronic lung disease (9.4-15% vs 3.7-4.6% in later periods) and diabetes (9.3-12% vs 0.91-2.4% in later periods). CONCLUSIONS We document substantial changes over time in, for example, age, sex and medical history of COVID-19 vaccine recipients. Though these results are related to the differential vaccine rollout in Denmark, similar findings are probable in other countries and should be considered when designing and interpreting studies on the effectiveness and safety of COVID-19 vaccines.
Collapse
Affiliation(s)
- Mette Reilev
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Morten Olesen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Helene Kildegaard
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Henrik Støvring
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Jacob H Andersen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Louise Ladebo
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Martin T Ernst
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Per Damkier
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark.,Department of Clinical Research, University of Southern Denmark, Denmark
| | - Peter B Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| | - Lotte Rasmussen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern, Denmark
| |
Collapse
|
20
|
Vouri SM, Morris EJ, Jiang X, Hofer AK, Schmidt S, Pepine C, Winterstein AG, Smith SM. Evaluation of a Beta-Blocker-Edema-Loop Diuretic Prescribing Cascade: A Prescription Sequence Symmetry Analysis. Am J Hypertens 2022; 35:601-609. [PMID: 35106529 DOI: 10.1093/ajh/hpac013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/12/2021] [Accepted: 01/29/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Drug-related adverse events associated with antihypertensive therapy may result in subsequent prescribing of other potentially harmful medications, known as prescribing cascades. The aim of this study was to assess the magnitude and characteristics of a beta-blocker-edema-loop diuretic prescribing cascade. METHODS A prescription sequence symmetry analysis was used to assess loop diuretic initiation before and after initiation of beta-blockers among patients 20 years or older without heart failure, atrial fibrillation, other arrythmias, or use of calcium channel blocker within a U.S. private insurance claims database (2005-2018). The temporality of loop diuretic initiation relative to a beta-blocker or negative control (renin-angiotensin system blocker) initiation was tabulated. Secular trend-adjusted sequence ratios (aSRs) with 95% confidence intervals (CIs) compared the initiation of loop diuretic 90 days before and after initiation of beta-blockers. RESULTS Among 988,675 beta-blocker initiators, 9,489 patients initiated a new loop diuretic prescription 90 days after and 5,245 patients before beta-blocker initiation, resulting in an aSR of 1.78 (95% CI, 1.72-1.84). An estimated 1.72 beta-blocker initiators per 100 patient-years experienced the prescribing cascade in the first 90 days. The aSR was disproportionately higher among older adults (aSR 1.97), men (aSR 2.25), and patients who initiated metoprolol tartrate (aSR 2.48), labetalol (aSR 2.18), or metoprolol succinate (aSR 2.11). Negative control results (aSR 1.09, 95% CI, 1.05-1.13) generally corroborated our findings, but suggested modest within-person time-varying confounding. CONCLUSIONS We observed excess use of loop diuretics following beta-blocker initiation that was only partially explained by secular trends or hypertension progression.
Collapse
Affiliation(s)
- Scott Martin Vouri
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA
| | - Earl J Morris
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Ann-Kathrin Hofer
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, University of Florida College of Pharmacy, Gainesville, Florida, USA.,Center for Pharmacometrics and Systems Pharmacology, University of Florida, Lake Nona, Florida, USA
| | - Carl Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, University of Florida College of Medicine, Gainesville, Florida, USA.,University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA.,Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, Florida, USA.,Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, USA
| |
Collapse
|
21
|
Lewellyan CM, Spoutz P, Schaefer M, Patterson ME. Risk of volume depletion events with concomitant use of sodium glucose co-transporter 2 inhibitors and loop diuretics: A self-controlled case series study. Pharmacoepidemiol Drug Saf 2022; 31:1102-1109. [PMID: 35713292 DOI: 10.1002/pds.5496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sodium glucose co-transporter 2 inhibitors (SGLT2is) are used to prevent cardiovascular complications in type 2 diabetes mellitus (T2DM) and newly indicated to treat heart failure (HF). Loop diuretics are commonly prescribed to manage volume overload in HF and may increase the risk of volume depletion in real-world practice. This study evaluated the risk of volume depletion following concomitant use of SGLT2is and loop diuretics in veterans. METHODS Veterans with T2DM were included if they received concomitant loop diuretics and SGLT2is and experienced at least one volume depletion event between December 2012 and December 2019, utilizing a self-controlled case series design. Concomitant prescribing periods were divided into focal windows of 1 to 14 days, 14 to 28 days, and greater than 28 days. Incidence rate ratios (IRR) were estimated using multivariable Poisson regressions adjusted for age and renal function. RESULTS 3352 patients experienced at least one volume depletion event and were concomitantly prescribed SGLT2is and loop diuretics at least once. The risk of volume depletion increased in the treatment versus control windows during the 1 to 14-day window (IRR = 1.82, 95% CI 1.63-2.02) the 15-to-28-day window (IRR = 1.46, 95% CI 1.28-1.67), and the greater than 28-day window (IRR = 1.22, 95% CI 1.21-1.34). CONCLUSIONS Concomitant prescribing of SGLT2is and loop diuretics is associated with an increased risk of volume depletion, an effect that attenuates with longer therapy durations. Prescribers need to closely monitor fluid status in patients receiving concomitant therapy, especially those with advancing age or with eGFR below 60.
Collapse
Affiliation(s)
| | - Patrick Spoutz
- Department of Veterans Affairs VISN #20, VA Northwest Health Network, Vancouver, Washington, USA
| | - Monica Schaefer
- Department of Veterans Affairs VISN #15, VA Heartland Network, Kansas City, Missouri, USA
| | - Mark E Patterson
- University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, USA
| |
Collapse
|
22
|
Holt A, Blanche P, Jensen AKG, Nouhravesh N, Rajan D, Jensen MH, El-Sheikh M, Schjerning AM, Schou M, Gislason G, Torp-Pedersen C, McGettigan P, Lamberts M. Adverse Events Associated With Coprescription of Phosphodiesterase Type 5 Inhibitors and Oral Organic Nitrates in Male Patients With Ischemic Heart Disease : A Case-Crossover Study. Ann Intern Med 2022; 175:774-782. [PMID: 35436155 DOI: 10.7326/m21-3445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concomitant use of oral organic nitrates (nitrates) and phosphodiesterase type 5 (PDE5) inhibitors is contraindicated. OBJECTIVE To measure temporal trends in the coprescription of nitrates and PDE5 inhibitors and to measure the association between cardiovascular outcomes and the coprescription of nitrates with PDE5 inhibitors. DESIGN Case-crossover design. SETTING Nationwide study of Danish patients from 2000 to 2018. PATIENTS Male patients with International Classification of Diseases, 10th Revision (ICD-10) codes for ischemic heart disease (IHD), including those who had a continuing prescription for nitrates and a new, filled prescription for PDE5 inhibitors. MEASUREMENTS Two composite outcomes were measured: 1) cardiac arrest, shock, myocardial infarction, ischemic stroke, or acute coronary arteriography and 2) syncope, angina pectoris, or drug-related adverse event. RESULTS From 2000 to 2018, 249 541 male patients with IHD were identified. Of these, 42 073 patients had continuing prescriptions for nitrates. During this period, the prescription rate for PDE5 inhibitors in patients with IHD who were taking nitrates increased from an average of 0.9 prescriptions (95% CI, 0.5 to 1.2 prescriptions) per 100 persons per year in 2000 to 19.5 prescriptions (CI, 18.0 to 21.1 prescriptions) in 2018. No statistically significant association was found between the coprescription of nitrates with PDE5 inhibitors and the risk for either composite outcome (odds ratio [OR], 0.58 [CI, 0.28 to 1.13] for the first outcome and OR, 0.73 [CI, 0.40 to 1.32] for the second outcome). LIMITATION An assumption was made that concurrently filled prescriptions for nitrates and PDE5 inhibitors equaled concomitant use. CONCLUSION From 2000 to 2018, the use of PDE5 inhibitors increased 20-fold among Danish patients with IHD who were taking nitrates. A statistically significant association between concomitant use of these medications and cardiovascular adverse events could not be identified. PRIMARY FUNDING SOURCE Ib Mogens Kristiansens Almene Fond and Helsefonden.
Collapse
Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Paul Blanche
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark (P.B., A.K.G.J.)
| | | | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Deepthi Rajan
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Mads Hashiba Jensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Mohammed El-Sheikh
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Anne-Marie Schjerning
- Department of Cardiology, Zealand University Hospital, Roskilde, and The Danish Heart Foundation, Copenhagen, Denmark (A.S.)
| | - Morten Schou
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, and The Danish Heart Foundation, Copenhagen, Denmark (G.G.)
| | - Christian Torp-Pedersen
- Department of Clinical Research, North Zealand Hospital, Hillerød, and Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark (C.T.)
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom (P.M.)
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark (A.H., N.N., D.R., M.H.J., M.E., M.S., M.L.)
| |
Collapse
|
23
|
Wensink MJ, Lu Y, Tian L, Shaw GM, Rizzi S, Jensen TK, Mathiesen ER, Skakkebæk NE, Lindahl-Jacobsen R, Eisenberg ML. Preconception Antidiabetic Drugs in Men and Birth Defects in Offspring : A Nationwide Cohort Study. Ann Intern Med 2022; 175:665-673. [PMID: 35344380 PMCID: PMC9844982 DOI: 10.7326/m21-4389] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diabetes reduces semen quality and increasingly occurs during reproductive years. Diabetes medications, such as metformin, have glucose-independent effects on the male reproductive system. Associations with birth defects in offspring are unknown. OBJECTIVE To evaluate whether the risk for birth defects in offspring varies with preconceptional pharmacologic treatment of fathers with diabetes. DESIGN Nationwide prospective registry-based cohort study. SETTING Denmark from 1997 to 2016. PARTICIPANTS All liveborn singletons from mothers without histories of diabetes or essential hypertension. MEASUREMENTS Offspring were considered exposed if their father filled 1 or more prescriptions for a diabetes drug during the development of fertilizing sperm. Sex and frequencies of major birth defects were compared across drugs, times of exposure, and siblings. RESULTS Of 1 116 779 offspring included, 3.3% had 1 or more major birth defects (reference). Insulin-exposed offspring (n = 5298) had the reference birth defect frequency (adjusted odds ratio [aOR], 0.98 [95% CI, 0.85 to 1.14]). Metformin-exposed offspring (n = 1451) had an elevated birth defect frequency (aOR, 1.40 [CI, 1.08 to 1.82]). For sulfonylurea-exposed offspring (n = 647), the aOR was 1.34 (CI, 0.94 to 1.92). Offspring whose fathers filled a metformin prescription in the year before (n = 1751) or after (n = 2484) sperm development had reference birth defect frequencies (aORs, 0.88 [CI, 0.59 to 1.31] and 0.92 [CI, 0.68 to 1.26], respectively), as did unexposed siblings of exposed offspring (3.2%; exposed vs. unexposed OR, 1.54 [CI, 0.94 to 2.53]). Among metformin-exposed offspring, genital birth defects, all in boys, were more common (aOR, 3.39 [CI, 1.82 to 6.30]), while the proportion of male offspring was lower (49.4% vs. 51.4%, P = 0.073). LIMITATION Information on underlying disease status was limited. CONCLUSION Preconception paternal metformin treatment is associated with major birth defects, particularly genital birth defects in boys. Further research should replicate these findings and clarify the causation. PRIMARY FUNDING SOURCE National Institutes of Health.
Collapse
Affiliation(s)
- Maarten J Wensink
- Department of Epidemiology, Biostatistics and Biodemography, and Interdisciplinary Center on Population Dynamics, University of Southern Denmark, Odense C, Denmark (M.J.W., R.L.)
| | - Ying Lu
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California (Y.L., L.T.)
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California (Y.L., L.T.)
| | - Gary M Shaw
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California (G.M.S.)
| | - Silvia Rizzi
- Interdisciplinary Center on Population Dynamics and Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense M, Denmark (S.R.)
| | - Tina Kold Jensen
- Department of Environmental Medicine, University of Southern Denmark, Odense C, Denmark (T.K.J.)
| | - Elisabeth R Mathiesen
- Centre for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen University, Copenhagen, Denmark (E.R.M.)
| | - Niels E Skakkebæk
- Juliane Marie Centre, Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark (N.E.S.)
| | - Rune Lindahl-Jacobsen
- Department of Epidemiology, Biostatistics and Biodemography, and Interdisciplinary Center on Population Dynamics, University of Southern Denmark, Odense C, Denmark (M.J.W., R.L.)
| | - Michael L Eisenberg
- Male Reproductive Medicine and Surgery, Department of Urology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California (M.L.E.)
| |
Collapse
|
24
|
Holt A, Strange JE, Rasmussen PV, Blanche P, Nouhravesh N, Jensen MH, Schjerning AM, Schou M, Torp-Pedersen C, Gislason GH, Hansen ML, McGettigan P, Lamberts M. Bleeding Risk Following Systemic Fluconazole or Topical Azoles in Patients with Atrial Fibrillation on Apixaban, Rivaroxaban, or Dabigatran. Am J Med 2022; 135:595-602.e5. [PMID: 34861201 DOI: 10.1016/j.amjmed.2021.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bleeding safety in relation to use of systemic fluconazole and topical azoles among patients with atrial fibrillation treated with apixaban, rivaroxaban, or dabigatran is insufficiently explored, despite clinical relevance and several reports suggesting associations. METHODS Using nationwide Danish registers, we identified patients with atrial fibrillation initiated on apixaban, rivaroxaban, or dabigatran from 2012-2018. We investigated associations between bleeding incidents and systemic fluconazole or topical azole treatment using a case-crossover design with 30-day exposure windows and reported odds ratios (OR) with 95% confidence intervals (CI). RESULTS We included 32,340 (36%), 32,409 (36%), and 24,940 (28%) patients initiated on apixaban, rivaroxaban, and dabigatran, respectively. Patients on apixaban were older (median age: 77 years; interquartile range [IQR] 70-84) compared with rivaroxaban users (median age: 75 years; IQR 68-82) and patients on dabigatran (median age: 73 years; IQR 66-80). Apixaban users had a significantly increased risk of bleeding following exposure to systemic fluconazole: odds ratio (OR) 3.5; 95% confidence interval (CI), 1.4-10.6. No increased risk was found among rivaroxaban and dabigatran users: ORs of 0.9 (95% CI, 0.2-3.0) and 1.7 (95% CI, 0.5-5.6), respectively. As to bleeding risk pertaining to topical azole exposure among apixaban, rivaroxaban, and dabigatran users, no association was found, with corresponding ORs of 0.8 (95% CI, 0.5-1.3); 1.3 (95% CI, 0.9-2.1); and 1.2 (95% CI 0.8-1.8), respectively. CONCLUSION In patients with atrial fibrillation on either apixaban, rivaroxaban, or dabigatran, an association between an elevated bleeding risk and use of systemic fluconazole was found among patients on apixaban. We found no increased risk of bleeding following co-exposure to topical azoles.
Collapse
Affiliation(s)
- Anders Holt
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark.
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Vibe Rasmussen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Paul Blanche
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark; Section of Biostatistics, University of Copenhagen, Denmark
| | - Nina Nouhravesh
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Mads Hashiba Jensen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Morten Schou
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Departments of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | - Morten Lock Hansen
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| | - Patricia McGettigan
- William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Morten Lamberts
- Department of Cardiology, Copenhagen University Hosptial - Herlev and Gentofte, Copenhagen, Denmark
| |
Collapse
|
25
|
Madsen JEH, Hallas J, Delvin T, Scheike T, Pipper C. Sampling in the case-time-control design among drug users when outcome prevents further treatment. Pharmacoepidemiol Drug Saf 2022; 31:404-410. [PMID: 35088482 DOI: 10.1002/pds.5410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/09/2021] [Accepted: 01/20/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The objective of this paper is to advocate a new way of sampling controls in the case-time-control design in a cohort of drug users when the studied outcome prevents further treatment. METHODS Mathematically we demonstrate how a standard sampling of controls, where controls are sampled among all subjects without an event at end-of-study, leads to a biased effect estimate. We propose to add the requirement that controls initiate treatment before the calendar time of event of their matched case to circumvent this. The standard and proposed sampling methods are compared in a simulation study and in an empirical data example examining the effect of nonsteroidal anti-inflammatory drug usage on the risk of upper gastrointestinal bleeding. RESULTS When the controls are sampled the standard way, the case-time-control design confers a bias because cases and controls have a different time-trend of exposure. The bias has been upwards in all the scenarios we have investigated. The requirement we add to be a potential control ensures that cases and controls have the same time-trend of exposure when treatment and outcome are independent. The simulation study confirms that the proposed sampling method removes the bias between treatment and outcome. The proposed sampling method lowered the odds-ratio estimate from 3.72 to 3.26 in the data example. CONCLUSION The proposed sampling method makes it possible to use the case-time-control design in a cohort of subjects with registered use of a drug when outcome prevents further treatment.
Collapse
Affiliation(s)
- Jeppe Ekstrand Halkjaer Madsen
- Leo Pharma A/S, Industriparken 55, 2750, Ballerup, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, Denmark
| | - Jesper Hallas
- Department of Clinical Pharmacology, University of Southern Denmark, J. B. Winsløws Vej 19, Odense, Denmark
| | - Thomas Delvin
- Leo Pharma A/S, Industriparken 55, 2750, Ballerup, Denmark
| | - Thomas Scheike
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, Denmark
| | | |
Collapse
|
26
|
Vouri SM, Morris EJ, Usmani SA, Reise R, Jiang X, Pepine CJ, Manini TM, Malone DC, Winterstein AG. Evaluation of the key prescription sequence symmetry analysis assumption using the calcium channel blocker: Loop diuretic prescribing cascade. Pharmacoepidemiol Drug Saf 2022; 31:72-81. [PMID: 34553438 PMCID: PMC8688319 DOI: 10.1002/pds.5362] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the prescription sequence symmetry analysis assumption regarding balance between marker drug (i.e., medication used to treat a drug-induced adverse event) initiation rates before and after initiation of an index drug (i.e., medication that is potentially associated with the drug-induced adverse event) in the absence of prescribing cascades, we used a well-described example of loop diuretic initiation to treat dihydropyridine calcium channel blockers (DH CCB)-induced edema. STUDY DESIGN AND SETTING The University of Florida Health Integrated Data Repository from June 2011 and July 2018 was used to assess temporal prescribing of DH CCB and loop diuretics within the prescription sequence symmetry analysis framework. Validation of the prescribing cascade was performed via clinical expert chart review. RESULTS Among patients without heart failure who were initiated on DH CCB, 26 and 64 loop diuretics initiators started within 360 days before versus after DH CCB initiation, respectively, resulting in an adjusted sequence ratio (aSR) of 2.27 (95% CI, 1.44-3.58). Overall, 35 (54.7%) patients were determined to have a prescribing cascade. Removing patients who experienced a prescribing cascade resulted in an aSR of 1.05, 95% CI 0.62-1.78). CONCLUSION Loop diuretic initiation rates before and after DH CCB initiation for reasons other a prescribing cascade were similar, thus confirming the prescription sequence symmetry analysis assumption.
Collapse
Affiliation(s)
- Scott M. Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL,Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Earl J. Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Silken A. Usmani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Rachel Reise
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,University of Florida Health Physicians, Gainesville, FL
| | - Xinyi Jiang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Carl J. Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL
| | - Daniel C. Malone
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL,Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL,Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL
| |
Collapse
|
27
|
Lewer D, Petersen I, Maclure M. The case-crossover design for studying sudden events. BMJ MEDICINE 2022; 1:e000214. [PMID: 36936574 PMCID: PMC9978680 DOI: 10.1136/bmjmed-2022-000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Dan Lewer
- Epidemiology and Public Health, UCL, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
| | - Malcolm Maclure
- Department of Anaesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
Ahmed H, Whitaker H, Farewell D, Hippisley-Cox J, Noble S. Respiratory tract infection and risk of bleeding in oral anticoagulant users: self-controlled case series. BMJ 2021; 375:e068037. [PMID: 34933893 PMCID: PMC8689396 DOI: 10.1136/bmj-2021-068037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the association between untreated, community acquired, respiratory tract infections and bleeding in oral anticoagulant users. DESIGN Self-controlled case series. SETTING General practices in England contributing data to the Clinical Practice Research Datalink GOLD. PARTICIPANTS 1208 adult users of warfarin or direct oral anticoagulants with a general practice or hospital admission record of a bleeding event between January 2010 and December 2019, and a general practice record of a consultation for a community acquired respiratory tract infection for which immediate antibiotics were not prescribed (that is, untreated). MAIN OUTCOME MEASURES Relative incidence of major bleeding and clinically relevant non-major bleeding in the 0-14 days after an untreated respiratory tract infection, compared to unexposed time periods. RESULTS Of 1208 study participants, 58% (n=701) were male, median age at time of first bleed was 79 years (interquartile range 72-85), with a median observation period of 2.4 years (interquartile range 1.3-3.8). 292 major bleeds occurred during unexposed time periods and 41 in the 0-14 days after consultation for a respiratory tract infection. 1003 clinically relevant non-major bleeds occurred during unexposed time periods and 81 in the 0-14 days after consultation for a respiratory tract infection. After adjustment for age, season, and calendar year, the relative incidence of major bleeding (incidence rate ratio 2.68, 95% confidence interval 1.83 to 3.93) and clinically relevant non-major bleeding (2.32, 1.82 to 2.94) increased in the 0-14 days after an untreated respiratory tract infection. Findings were robust to several sensitivity analyses and did not differ by sex or type of oral anticoagulant. CONCLUSIONS This study observed a greater than twofold increase in the risk of bleeding during the 0-14 days after an untreated respiratory tract infection. These findings have potential implications for how patients and clinicians manage oral anticoagulant use during an acute intercurrent illness and warrant further investigation into the potential risks and how they might be mitigated.
Collapse
Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | | | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Noble
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
29
|
Ramachandran S, Rong Y, Bhattacharya K, Salkar M, McGwin G, Yang Y, Bentley JP. Does Transient Opioid Use Increase Risk of Short-Term Respiratory Exacerbation among Older Adults with Chronic Obstructive Pulmonary Disease? COPD 2021; 18:650-656. [PMID: 34879750 DOI: 10.1080/15412555.2021.2013460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of this study was to examine the association between transient opioid use and acute respiratory exacerbations among older Medicare beneficiaries with COPD. This study was conducted using national Medicare 5% sample administrative claims data between 2012 and 2016 and employed a case-crossover design. The date of eligible COPD exacerbation events was defined as the index date and the presence of opioid prescriptions during a 7-day exposure window prior to index date was compared to a set of 10 control periods, each 7-days long. The association between opioid exposure and COPD exacerbation was estimated using a conditional logistic regression with robust sandwich estimators, after accounting for known time-varying confounders. Among 16,290 eligible COPD exacerbations included in the study sample, the average patient age was 77.08 years, and 64.2% of events occurred in women. Transient exposure to opioids was associated with a 76% increase in the odds of an acute COPD exacerbation (OR: 1.76, 95%CI: 1.67-1.84), and each 25 mg increase in morphine milligram equivalent dose was associated with a 18% increase in the odds of exacerbation (OR: 1.18, 95% CI: 1.15-1.21). Effect estimates were consistent across subgroup analyses conducted among events identified in the emergency department versus hospital, and among individuals with a single exacerbation event versus those with multiple exacerbations. Transient exposure to opioids was associated with an increased short-term risk of respiratory exacerbation among older adults with COPD. Treatment decisions for breathlessness among individuals with COPD need to account for the benefit-risk profile of opioids.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2013460 .
Collapse
Affiliation(s)
- Sujith Ramachandran
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Yiran Rong
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Monika Salkar
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yi Yang
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| |
Collapse
|
30
|
Horton DB, Blum MD, Burcu M. Real-World Evidence for Assessing Treatment Effectiveness and Safety in Pediatric Populations. J Pediatr 2021; 238:312-316. [PMID: 34217767 PMCID: PMC8249672 DOI: 10.1016/j.jpeds.2021.06.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Daniel B. Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ,Reprint requests: Daniel B. Horton, MD, MSCE, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, 112 Paterson St, New Brunswick, NJ 08901
| | - Michael D. Blum
- Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD
| | - Mehmet Burcu
- Department of Epidemiology, Merck & Co., Inc., Kenilworth, NJ
| |
Collapse
|
31
|
Morris EJ, Hollmann J, Hofer AK, Bhagwandass H, Oueini R, Adkins LE, Hallas J, Vouri SM. Evaluating the use of prescription sequence symmetry analysis as a pharmacovigilance tool: A scoping review. Res Social Adm Pharm 2021; 18:3079-3093. [PMID: 34376366 DOI: 10.1016/j.sapharm.2021.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/25/2021] [Accepted: 08/03/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The (prescription) sequence symmetry analysis (PSSA) design has been used to identify potential prescribing cascade signals by assessing the prescribing sequence of an index drug relative to a marker drug presumed to treat an adverse drug event provoked by the index drug. OBJECTIVES This review aimed to explore the use of the PSSA design as a pharmacovigilance tool with a particular focus on the breadth of identified signals and advances in PSSA methodology. METHODS We searched Embase, PubMed/Medline, Google Scholar, Web of Science and grey literature to identify studies that used the PSSA methodology. Two reviewers independently extracted relevant data for each included article. Study characteristics including signals identified, exposure time window, stratified analyses, and use of controls were extracted. RESULTS We identified 53 studies which reported original results obtained using PSSA methodology or quantified the validity of components of the PSSA design. Of those, nine studies provided validation metrics showing reasonable sensitivity and high specificity of PSSA to identify prescribing cascade signals. We identified 340 unique index drug - marker drug signals published in the PSSA literature, representing 281 unique index - marker pharmacological class dyads (i.e., unique fourth-level Anatomical Therapeutic Chemical [ATC] classification dyads). Commonly observed signals were identified for index drugs acting upon the nervous system (34%), cardiovascular system (21%), and blood and blood-forming organs (15%), and many marker drugs were related to the nervous system (25%), alimentary tract and metabolism (23%), cardiovascular system (17%), and genitourinary system and sex hormones (14%). Negative controls and positive controls were utilized in 21% and 13% of studies, respectively. CONCLUSIONS The PSSA methodology has been used in 53 studies worldwide to detect and evaluate over 300 unique prescribing cascades signals. Researchers should consider sensitivity analyses incorporating negative and/or positive controls and additional time windows to evaluate time-varying biases when designing PSSA studies.
Collapse
Affiliation(s)
- Earl J Morris
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Josef Hollmann
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Ann-Kathrin Hofer
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Hemita Bhagwandass
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Razanne Oueini
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Lauren E Adkins
- Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark; Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
32
|
Jeong HE, Lee H, Lai ECC, Liao TC, Man KKC, Wong ICK, Coghill D, Chi MH, Hsieh CY, Shin JY. Association between methylphenidate and risk of myocardial infarction: A multinational self-controlled case series study. Pharmacoepidemiol Drug Saf 2021; 30:1458-1467. [PMID: 34216049 DOI: 10.1002/pds.5322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the association between use of methylphenidate and risk of myocardial infarction among Asians. METHODS We conducted a multinational self-controlled case series study using nationwide healthcare databases of South Korea (2002-2018), Taiwan (2004-2015), and Hong Kong (2001-2016). Of patients with myocardial infarction who were also prescribed methylphenidate within the observation period, methylphenidate use was classified into four mutually exclusive periods by each person-day: exposed (exposed to methylphenidate), pre-exposure (prior to the first methylphenidate prescription), washout (after the end of methylphenidate treatment), and baseline (unexposed to methylphenidate). Risk of myocardial infarction among the three periods of methylphenidate use was compared to the baseline period using conditional Poisson regression analysis to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs). RESULTS We identified 2104, 484, and 30 patients from South Korea, Taiwan, and Hong Kong, respectively. Risk of myocardial infarction was the highest during the pre-exposure period in all three populations: South Korea, pre-exposure (IRR 3.17, 95% CI 3.04-3.32), exposed (1.05, 1.00-1.11), washout (1.92, 1.80-2.04); Taiwan, pre-exposure (1.97, 1.78-2.17), exposed (0.72, 0.65-0.80), washout (0.56, 0.46-0.68); Hong Kong, pre-exposure (18.09, 8.19-39.96), exposed (9.32, 3.44-25.28), washout (7.69, 1.72-34.41). Following stratification for age and sex, the trends remained analogous to the main findings across all three populations. CONCLUSIONS Although a positive association between initiating methylphenidate and the onset of myocardial infarction was observed, the risk was the highest in the period before its initiation. Thus, this multinational study suggests there was no causal relationship between methylphenidate and myocardial infarction among Asians.
Collapse
Affiliation(s)
- Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon-si, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon-si, South Korea
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kenneth K C Man
- Centre for Medicines Optimisation Research and Education, Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong
| | - Ian C K Wong
- Centre for Medicines Optimisation Research and Education, Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong
| | - David Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mei-Hung Chi
- Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Yang Hsieh
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon-si, South Korea.,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
33
|
Cadarette SM, Maclure M, Delaney JAC, Whitaker HJ, Hayes KN, Wang SV, Tadrous M, Gagne JJ, Consiglio GP, Hallas J. Control yourself: ISPE-endorsed guidance in the application of self-controlled study designs in pharmacoepidemiology. Pharmacoepidemiol Drug Saf 2021; 30:671-684. [PMID: 33715267 PMCID: PMC8251635 DOI: 10.1002/pds.5227] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Consensus is needed on conceptual foundations, terminology and relationships among the various self-controlled "trigger" study designs that control for time-invariant confounding factors and target the association between transient exposures (potential triggers) and abrupt outcomes. The International Society for Pharmacoepidemiology (ISPE) funded a working group of ISPE members to develop guidance material for the application and reporting of self-controlled study designs, similar to Standards of Reporting Observational Epidemiology (STROBE). This first paper focuses on navigation between the types of self-controlled designs to permit a foundational understanding with guiding principles. METHODS We leveraged a systematic review of applications of these designs, that we term Self-controlled Crossover Observational PharmacoEpidemiologic (SCOPE) studies. Starting from first principles and using case examples, we reviewed outcome-anchored (case-crossover [CCO], case-time control [CTC], case-case-time control [CCTC]) and exposure-anchored (self-controlled case-series [SCCS]) study designs. RESULTS Key methodological features related to exposure, outcome and time-related concerns were clarified, and a common language and worksheet to facilitate the design of SCOPE studies is introduced. CONCLUSIONS Consensus on conceptual foundations, terminology and relationships among SCOPE designs will facilitate understanding and critical appraisal of published studies, as well as help in the design, analysis and review of new SCOPE studies. This manuscript is endorsed by ISPE.
Collapse
Affiliation(s)
- Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.,WHO Collaborating Centre for Governance, Accountability and Transparency in the Pharmaceutical Sector, Toronto, Ontario, Canada
| | - Malcolm Maclure
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - J A Chris Delaney
- College of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Whitaker
- Department of Mathematic and Statistics, The Open University, Milton Keynes, UK.,Department of Statistics, Modelling and Economics, Public Health England, London, UK
| | - Kaleen N Hayes
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shirley V Wang
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Joshua J Gagne
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Giulia P Consiglio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, IST, University of Southern Denmark, Odense, Denmark.,Department of Clinical Pharmacology and Biochemistry, Odense University Hospital, Odense, Denmark
| |
Collapse
|