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Ock M, Lee S, Kim H. Osteoporosis or fracture risk associated with thiazolidinedione and proton pump inhibitor co-administration in patients with type 2 diabetes mellitus. J Clin Pharm Ther 2022; 47:1028-1035. [PMID: 35257383 DOI: 10.1111/jcpt.13640] [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: 01/08/2022] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Thiazolidinedione (TZD) and proton pump inhibitor (PPI) belong to classes of drugs that affect bone metabolism; however, few studies have investigated the effects of these drugs on bone metabolism. The aim of this study was to assess the risk of osteoporosis or fracture in patients with type 2 diabetes mellitus (T2DM) co-administered TZD and PPIs. METHODS This retrospective cohort study was conducted using the National Sample Cohort database from 2003 to 2013. We included adult patients with T2DM who were prescribed TZD and PPIs together for the first time. The Cox proportional hazard model was used to determine the risk ratio of fracture or osteoporosis in the co-administration cohort (TZD + PPI) compared with the TZD-only group (TZD). We adjusted for age, sex, use of other medications and other diseases that affect the bone. RESULTS AND DISCUSSION Of 9073 patients administered TZD, the number of eligible patients was 7240 (545 TZD + PPI, 6695 TZD-only). After 1:3 propensity score matching, 545 patients remained in the TZD + PPI group and 1635 in the TZD-only group. The risk of osteoporosis or fracture was significantly higher in the TZD + PPI cohort than in the TZD-only cohort. The adjusted hazard ratio (HR) for fracture or osteoporosis was 1.47 (95% CI 1.05-2.07). TZD and PPI use in women were associated with an increased risk of skeletal outcomes. WHAT IS NEW AND CONCLUSION TZD and PPI use were associated with an increased risk of osteoporosis or fracture in patients with T2DM.
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Affiliation(s)
- Miyoung Ock
- College of Pharmacy, Sookmyung Women's University, Seoul, South Korea
| | - Sera Lee
- College of Pharmacy, Sookmyung Women's University, Seoul, South Korea
| | - Hyunah Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, South Korea.,Drug Information Research Institute, Sookmyung Women's University, Seoul, South Korea
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2
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Tomlinson B, Chan P, Lam CWK. An overview of alogliptin + pioglitazone for the treatment of type 2 diabetes. Expert Opin Pharmacother 2021; 23:29-42. [PMID: 34591742 DOI: 10.1080/14656566.2021.1985465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Type 2 diabetes (T2D) is a progressive condition, and sequential additions of therapy are usually required to maintain glycemic control. The options for glucose lowering therapies have increased considerably in recent years. Fixed-dose combinations such as alogliptin with pioglitazone provide a convenient choice which can improve medication adherence. AREAS COVERED The authors performed a literature search to identify publications describing the efficacy and safety of alogliptin and pioglitazone when used separately and in combinations. EXPERT OPINION Pioglitazone activates peroxisome proliferator-activated receptor-gamma which improves insulin sensitivity and helps to preserve β-cell function with a durable improvement in glycemic control. Pioglitazone can retard the progression of atherosclerosis and reduce cardiovascular events, but it is associated with adverse events including weight gain, fluid retention, and increased risk of fractures. Alogliptin improves glycemic control and appears neutral in terms of cardiovascular events. It does not appear to increase the adverse events associated with pioglitazone and use of the combination may permit the use of lower doses of pioglitazone with reduced adverse effects. There are no cardiovascular outcome studies with the combination but the cardiovascular benefits of pioglitazone and additional glucose lowering effects of alogliptin provide a useful combination with convenient once daily dosing.
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Affiliation(s)
- Brian Tomlinson
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Paul Chan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
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3
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Al-Mashhadi Z, Viggers R, Fuglsang-Nielsen R, de Vries F, van den Bergh JP, Harsløf T, Langdahl B, Gregersen S, Starup-Linde J. Glucose-Lowering Drugs and Fracture Risk-a Systematic Review. Curr Osteoporos Rep 2020; 18:737-758. [PMID: 33165875 DOI: 10.1007/s11914-020-00638-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. RECENT FINDINGS Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.
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Affiliation(s)
- Z Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - R Viggers
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - R Fuglsang-Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - F de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - T Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - B Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - S Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark.
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4
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Lai SW, Lin CL, Liao KF. Evaluating the association between avascular necrosis of femoral head and oral corticosteroids use in Taiwan. Medicine (Baltimore) 2020; 99:e18585. [PMID: 32011437 PMCID: PMC7220204 DOI: 10.1097/md.0000000000018585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to assess a correlation between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. A population-based case-control study was performed to analyze the database of Taiwan National Health Insurance Program. The study consisted of 3002 subjects aged 20 to 84 with newly diagnosed avascular necrosis of femoral head between 2000 and 2013 as the cases and 11279 sex-matched and age-matched subjects without avascular necrosis of femoral head as the matched controls. Use of oral corticosteroids was defined as subjects who had at least a prescription for oral corticosteroids before the index date. No use of oral corticosteroids was defined as subjects who did not have a prescription for oral corticosteroids before the index date. The logistic regression model revealed that subjects with avascular necrosis of femoral head were 1.65 times more likely to be exposed to oral corticosteroids than those subjects without avascular necrosis of femoral head (OR 1.65, 95% CI = 1.51-1.80). A sub-analysis revealed that there was a significant association between avascular necrosis of femoral head and increasing cumulative duration of oral corticosteroids for each additional month of use (OR 1.03, 95% CI = 1.02-1.03). A significant association is detected between avascular necrosis of femoral head and oral corticosteroids use in the general population in Taiwan. There is a duration-dependent effect of oral corticosteroids use on the risk of avascular necrosis of femoral head. Clinicians should be aware of the risk of avascular necrosis of femoral head when oral corticosteroids are prescribed for a long time.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical University
- Department of Family Medicine, and China Medical University Hospital
| | - Cheng-Li Lin
- College of Medicine, China Medical University
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Taichung, Taiwan
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5
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Liu JM, Zhu DL, Mu YM, Xia WB. Management of fracture risk in patients with diabetes-Chinese Expert Consensus. J Diabetes 2019; 11:906-919. [PMID: 31219236 DOI: 10.1111/1753-0407.12962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jian-Min Liu
- Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China
| | - Da-Long Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Yi-Ming Mu
- Department of Endocrinology, The General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Wei-Bo Xia
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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6
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[Diabetes mellitus and risk of hip fracture. A systematic review]. Rev Esp Geriatr Gerontol 2019; 55:34-41. [PMID: 31668564 DOI: 10.1016/j.regg.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/22/2019] [Accepted: 08/25/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES It has been reported that the risk of fracture is increased in patients with diabetes mellitus (DM). The aim of this study was to investigate the possible relationship between DM and hip fracture, as well as any associated risk factors, by means of a systemic review of the literature. METHODS PubMed and SCOPUS databases were used to search for relevant studies published from January 2001 to August 2018. Retrospective and prospective cohort studies were selected in which the estimated risk of hip fracture was demonstrated by comparing groups of diabetic patients with non-diabetics. A search was also made for risk factors independent from the association between DM and hip fracture. RESULTS A total of 27 articles that fulfilled the inclusion criteria were included. A clear association was observed in diabetic patients (women and men) compared to non-diabetics patients. Among the risk factors, the most important ones were the fact that diabetes was type 1, probably associated with greater risk to a longer duration of DM, and being a female. CONCLUSIONS There is an increased risk of hip fracture in patients diagnosed with DM. This association is more significant in diabetes type 1 and women.
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7
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Liao KF, Lin CL, Lai SW. Association between colorectal cancer and thiazolidinediones administration in a case-control study. Biomedicine (Taipei) 2019; 9:4. [PMID: 30794151 PMCID: PMC6385609 DOI: 10.1051/bmdcn/2019090104] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 06/15/2018] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study was designed to assess whether there was an association between colorectal cancer and thiazolidinediones use. METHODS A population-based case-control study was performed using the database of the Taiwan National Health Insurance Program. The case group consisted of 20218 type 2 diabetic subjects aged 20 to 84 years with newly diagnosed colorectal cancer between 2000 and 2011. The date of a subject being diagnosed with colorectal cancer was defined as the index date. The control group consisted of 20218 randomly selected type 2 diabetic subjects aged 20 to 84 years without colorectal cancer between 2000 and 2011. A subject who had at least a prescription of thiazolidinediones before the index date was defined as "ever used". A subject who did not have a prescription of thiazolidinediones before the index date was defined as "never used". The odds ratio (OR) and 95% confidence interval (CI) was used to estimate the association between colorectal cancer and thiazolidinediones use by the multivariable logistic regression model. RESULTS After adjustment for potential confounders, the odds of thiazolidinediones use in cases with colorectal cancer were lower than the odds of thiazolidinediones use in subjects without colorectal cancer (adjusted OR 0.94, 95% CI 0.89-0.99). CONCLUSIONS The odds of thiazolidinediones use in cases with colorectal cancer were lower than subjects without colorectal cancer. A prospective study is required to test whether thiazolidinediones use has a protective effect against colorectal cancer.
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Affiliation(s)
- Kuan-Fu Liao
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College of Medicine, Tzu Chi University Hualien 970 Taiwan
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Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi Hospital Taichung 427 Taiwan
| | - Cheng-Li Lin
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College of Medicine, China Medical University Taichung 404 Taiwan
- Management Office for Health Data
| | - Shih-Wei Lai
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College of Medicine, China Medical University Taichung 404 Taiwan
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Department of Family Medicine, China Medical University Hospital Taichung 404 Taiwan
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8
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Lin HF, Liao KF, Chang CM, Lin CL, Lai SW, Hsu CY. Correlation of the tamoxifen use with the increased risk of deep vein thrombosis and pulmonary embolism in elderly women with breast cancer: A case-control study. Medicine (Baltimore) 2018; 97:e12842. [PMID: 30572423 PMCID: PMC6320050 DOI: 10.1097/md.0000000000012842] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 09/24/2018] [Indexed: 01/23/2023] Open
Abstract
The association between tamoxifen use and risk of deep vein thrombosis or pulmonary embolism in women with breast cancer has been reported in the Western population. The study aimed to evaluate the association between tamoxifen use and deep vein thrombosis or pulmonary embolism in older women with breast cancer in Taiwan.We conducted a retrospective case-control study using the database of the Taiwan National Health Insurance Program. A total of 281 women subjects with breast cancer aged ≥65 years with newly diagnosed deep vein thrombosis/or pulmonary embolism from 2000 to 2011 were identified as the cases. Additionally, 907 women subjects with breast cancer aged ≥65 years without deep vein thrombosis or pulmonary embolism were randomly selected as the controls. The cases and the controls were matched with age and comorbidities. Ever use of tamoxifen was defined as subjects who had at least a prescription for tamoxifen before index date. Never use of tamoxifen was defined as subjects who never had a prescription for tamoxifen before index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and the 95% confidence interval (CI) of deep vein thrombosis or pulmonary embolism associated with tamoxifen use.After adjustment for confounding variables, the adjusted OR of deep vein thrombosis or pulmonary embolism was 1.95 for subjects with ever use of tamoxifen (95% CI 1.45, 2.62), as compared with never use of tamoxifen. In addition, atrial fibrillation (adjusted OR 3.73, 95% CI 1.89, 7.35) and chronic kidney disease (adjusted OR 1.72, 95% CI 1.06, 2.80) were also associated with deep vein thrombosis or pulmonary embolism.Tamoxifen use is associated with 1.95-fold increased odds of deep vein thrombosis or pulmonary embolism among older women with breast cancer in Taiwan.
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Affiliation(s)
- Hsien-Feng Lin
- School of Chinese Medicine, China Medical University, Taichung
- Department of Family Medicine, China Medical University Hospital, Taichung
| | - Kuan-Fu Liao
- Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung
- College of Medicine, Tzu Chi University, Hualien
| | - Ching-Mei Chang
- Department of Nursing, Tungs’ Taichung Metro Habor Hospital, Taichung
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Shih-Wei Lai
- Department of Family Medicine, China Medical University Hospital, Taichung
- College of Medicine, China Medical University, Taichung
| | - Chung-Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
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9
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Lai SW, Lin CL, Liao KF. Weight loss might be an early clinical feature of undiagnosed human immunodeficiency virus infection in Taiwan. Biomedicine (Taipei) 2018; 8:19. [PMID: 30141406 PMCID: PMC6108225 DOI: 10.1051/bmdcn/2018080319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/24/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/OBJECTIVE Little research is available on the relationship between weight loss and human immunodeficiency virus (HIV) infection in Taiwan. We hope to evaluate whether weight loss could be an early clinical feature of undiagnosed HIV infection in Taiwan. METHODS We conducted a retrospective population-based cohort study using the database of the Taiwan National Health Insurance (NHI) Program. There were 4748 male subjects aged 1-84 with newly diagnosed weight loss as the weight loss group from 1998-2012 and 18982 age-matched male subjects without weight loss as the non-weight loss group. The incidence of HIV infection at the end of 2013 was measured in both groups. The multivariable Cox proportional hazards regression model was used to measure the hazard ratio (HR) and 95% confidence interval (CI) for HIV risk associated with weight loss. RESULTS The overall incidence of HIV infection was 3.79-fold higher in the weight loss group than in the non-weight loss group (6.83 vs. 1.80 per 10000 person-years, 95% CI 3.41, 4.21). The incidence was the highest during the first 6 months of follow-up in the weight loss group (39.0 per 10000 person-years). After adjusting for confounding factors, the adjusted HR of HIV infection was 3.63 (95% CI 1.77, 7.44) for the weight loss group, compared with the non-weight loss group. CONCLUSION Weight loss might be an early clinical feature of undiagnosed HIV infection in Taiwan. Male patients with weight loss who have risk factors for HIV infection should be recommended to regularly be tested for HIV infection.
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Affiliation(s)
- Shih-Wei Lai
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College of Medicine, China Medical University Taichung
404 Taiwan
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Department of Family Medicine, China Medical University Hospital Taichung
404 Taiwan
| | - Cheng-Li Lin
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College of Medicine, China Medical University Taichung
404 Taiwan
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Management Office for Health Data, China Medical University Hospital Taichung
404 Taiwan
| | - Kuan-Fu Liao
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College of Medicine, Tzu Chi University Hualien
970 Taiwan
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Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital Taichung
427 Taiwan
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10
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Lai SW, Lin CL, Liao KF. Case-control study examining the association between allopurinol use and ischemic cerebrovascular disease. J Investig Med 2018; 67:48-51. [PMID: 30042112 DOI: 10.1136/jim-2018-000774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/25/2022]
Abstract
Few studies focus on the relationship between allopurinol and ischemic cerebrovascular disease. The goal of the study was to investigate the association of long-term therapy of allopurinol with the first-time attack of ischemic cerebrovascular disease in Taiwan. We performed a case-control study using the database of the Taiwan National Health Insurance Program. The case group included 14,937 subjects aged 20-84 years with the first-time attack of ischemic cerebrovascular disease from 2000 to 2013. The control group included 14,937 sex-matched and age-matched subjects aged 20-84 years without any type of cerebrovascular disease. Ever use of allopurinol was defined as subjects who had at least a prescription for allopurinol before the index date. The OR and the 95% CI for ischemic cerebrovascular disease associated with allopurinol use were measured by the multivariable logistic regression model. The adjusted OR of ischemic cerebrovascular disease was 0.992 (95% CI 0.989 to 0.996) for subjects with increasing cumulative duration of allopurinol use for every 1 month, compared with never use. In a further analysis, the adjusted OR of ischemic cerebrovascular disease was 0.74 (95% CI 0.57 to 0.96) for cumulative duration of allopurinol use >3 years, compared with never use. Our findings suggest that lone-term therapy of allopurinol >3 years is associated with decreased risk of the first-time attack of ischemic cerebrovascular disease, compared with no allopurinol therapy.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Hepatogastroenterology, Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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11
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Proton pump inhibitors therapy and the risk of hip fracture in older people in Taiwan. Eur Geriatr Med 2018; 9:169-174. [DOI: 10.1007/s41999-017-0022-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
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12
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Lai SW, Liao KF, Lin CL, Lin HF. Dipeptidyl Peptidase-4 Inhibitors Use and Relative Risk of Ischemic Cerebrovascular Disease in Type 2 Diabetic Patients in a Case-Control Study. Front Pharmacol 2017; 8:859. [PMID: 29213240 PMCID: PMC5702655 DOI: 10.3389/fphar.2017.00859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/09/2017] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: Limited research focuses on the risk of ischemic cerebrovascular disease associated with use of dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) in patients with type 2 diabetes mellitus in Taiwan. This study aimed to investigate the association between DPP-4 inhibitors use and the first episode of ischemic cerebrovascular disease. Methods: We designed a case-control study using the database of the Taiwan National Health Insurance Program. There were 1999 type 2 diabetic subjects aged 20-84 years with the first episode of ischemic cerebrovascular disease from 2000 to 2013 as the cases, and 7996 sex- and age-matched, randomly selected type 2 diabetic subjects aged 20-84 years without any type of cerebrovascular diseases as the matched controls. We estimated the odds ratio (OR) and 95% confidence interval (CI) of ischemic cerebrovascular disease associated with cumulative duration of DPP-4 inhibitors use by the multivariable logistic regression model. Results: After adjustment for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 0.96 (95% CI 0.95, 0.97) in subjects with ever use of DPP-4 inhibitors as increase in use duration for every 1 month, compared with never use. The sub-analysis disclosed that the adjusted ORs of ischemic cerebrovascular disease were 1.57 (95% CI 1.36, 1.80) for subjects with cumulative duration of DPP-4 inhibitors use <1 year, and 0.70 (95% CI 0.57, 0.87) for subjects with cumulative duration of DPP-4 inhibitors use ≥1 year, compared with never use. Conclusion: Our findings suggest that DPP-4 inhibitors use correlates with relative risk reduction of the first episode of ischemic cerebrovascular disease in type 2 diabetic patients in a duration-dependent response. The beneficial effect will be marked when DPP-4 inhibitors use is ≥1 year.
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Affiliation(s)
- Shih-Wei Lai
- Department of Medicine, China Medical University, Taichung, Taiwan
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsien-Feng Lin
- Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University, Taichung, Taiwan
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13
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Lai SW, Lin CL, Liao KF. Tamoxifen Use Correlates with Increased Risk of the First Episode of Ischemic Cerebrovascular Disease in Older Women with Breast Cancer: A Case-Control Study in Taiwan. Front Pharmacol 2017; 8:742. [PMID: 29089895 PMCID: PMC5651079 DOI: 10.3389/fphar.2017.00742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: There are inconsistent results about the association between ischemic cerebrovascular disease and tamoxifen use in women with breast cancer. The study aimed to evaluate the association between the risk of ischemic cerebrovascular disease and tamoxifen use in older women with breast cancer in Taiwan. Methods: We designed a retrospective, nationwide, case-control study using the database of the Taiwan National Health Insurance Program. A total of 800 female subjects with breast cancer aged ≥65 years with the first episode of ischemic cerebrovascular disease from 2000 to 2011 were identified as the cases. Additionally, 2,876 female subjects with breast cancer aged ≥65 years without any type of cerebrovascular diseases were selected as the control subjects. The cases and the control subjects were matched with age and comorbidities. Ever use of tamoxifen was defined as a subject who had at least a prescription for tamoxifen before the index date. Never use of tamoxifen was defined as a subject who never had a prescription for tamoxifen before the index date. We used the multivariable logistic regression model to calculate the odds ratio (OR) and 95% confidence interval (CI) for ischemic cerebrovascular disease associated with tamoxifen use. Results: After adjusting for confounding variables, the adjusted OR of ischemic cerebrovascular disease was 2.5 for subjects with ever use of tamoxifen (95% CI 2.10, 2.97), compared with never use of tamoxifen. In addition, the adjusted OR of ischemic cerebrovascular disease was 1.15 (95% CI 1.10, 1.21) in subjects with ever use of tamoxifen as increase in use duration per 1 year. The adjusted OR of ischemic cerebrovascular disease was 2.54 (95% CI 2.03, 3.17) in subjects with ever use of tamoxifen as increase in dosage per 1 mg. Conclusions: Tamoxifen use is significantly associated with 2.5-fold increased odds of ischemic cerebrovascular disease among older women with breast cancer in Taiwan. There are duration-dependent and dose-dependent effects of tamoxifen use on the risk of ischemic cerebrovascular disease.
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Affiliation(s)
- Shih-Wei Lai
- Department of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Department of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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Lai SW, Lin CL, Liao KF. Head and neck cancer associated with increased rate of pulmonary tuberculosis in a population-based cohort study. Medicine (Baltimore) 2017; 96:e8366. [PMID: 29069025 PMCID: PMC5671858 DOI: 10.1097/md.0000000000008366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to examine the incidence and hazard ratio (HR) of pulmonary tuberculosis in patients with head and neck cancer in Taiwan.This population-based retrospective cohort study was conducted to analyze the database of the Taiwan National Health Insurance Program. There were 2522 subjects aged 20 to 84 years with newly diagnosed head and neck cancer as the head and neck cancer group between 2000 and 2012, and 10,064 randomly selected sex- and age-matched subjects without any cancer as the noncancer group. The incidence of pulmonary tuberculosis at the end of 2013 was estimated in both groups. A multivariable Cox proportional hazards regression model was used to estimate the HR and 95% confidence interval (CI) for pulmonary tuberculosis being associated with head and neck cancer.The overall incidence of pulmonary tuberculosis was 2.86-fold greater in the head and neck cancer group than that in the noncancer group (4.70 vs 1.64 per 1000 person-years, 95% CI, 2.53-3.24). After adjusting for confounding factors, the adjusted HR of pulmonary tuberculosis became 2.90 for the head and neck cancer group (95% CI, 2.11-3.99), compared with the noncancer group. In addition, male (adjusted HR 2.27, 95% CI, 1.29-4.00) and age (increase for 1 year, adjusted HR 1.06, 95% CI, 1.05-1.08) were associated with pulmonary tuberculosis.Head and neck cancer is significantly associated with 2.90-fold increased hazard of pulmonary tuberculosis in Taiwan, compared with the general population.
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Affiliation(s)
- Shih-Wei Lai
- College of Medicine, China Medical University, Taichung
- Department of Family Medicine, China Medical University Hospital, Taichung
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung
- Management Office for Health Data, China Medical University Hospital, Taichung
| | - Kuan-Fu Liao
- College of Medicine, Tzu Chi University, Hualien
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan
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Cheng KC, Liao KF, Lin CL, Lai SW. Increased Risk of Pulmonary Tuberculosis in Patients with Depression: A Cohort Study in Taiwan. Front Psychiatry 2017; 8:235. [PMID: 29180971 PMCID: PMC5694036 DOI: 10.3389/fpsyt.2017.00235] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVE Tuberculosis (TB) and depression were major public health issues worldwide and the mutual causative relationships between them were not exhaustive. This study was performed to explore the association between depression, comorbidities, and the risk of pulmonary TB in Taiwan. METHODS The cohort study used the database of the Taiwan National Health Insurance Program. The depression group included 34,765 subjects aged 20-84 years with newly diagnosed depression from 2000 to 2012, and the non-depression group included 138,187 randomly selected subjects without depression. Both depression and non-depression groups were matched with respect to sex, age, and comorbidities. We explored the incidence of pulmonary TB at the end of 2013 in both the groups and used multivariable Cox proportional hazards regression model to explore the hazard ratio (HR) and 95% confidence interval (CI) for the risk of pulmonary TB associated with depression. RESULTS The overall incidence of pulmonary TB was 1.16-fold greater in the depression group than that in the non-depression group (1.52 vs. 1.31 per 1,000 person-years, 95% CI 1.12, 1.21). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of pulmonary TB was 1.15 for the depression group (95% CI 1.03, 1.28), compared with the non-depression group. CONCLUSION Depression is associated with 1.15-fold increased hazard of pulmonary TB in Taiwan.
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Affiliation(s)
- Kao-Chi Cheng
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuan-Fu Liao
- Department of Internal Medicine, Taichung Tzu Chi General Hospital, Taichung, Taiwan.,College of Medicine, Tzu Chi University, Hualien, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- College of Medicine, China Medical University, Taichung, Taiwan.,Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Wei Lai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
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