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Wang S, Lu Y, Chi T, Zhang Y, Zhao Y, Guo H, Feng L. Identification of ferroptosis-related genes in type 2 diabetes mellitus based on machine learning. Immun Inflamm Dis 2023; 11:e1036. [PMID: 37904700 PMCID: PMC10566453 DOI: 10.1002/iid3.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM), which has a high incidence and several harmful consequences, poses a severe danger to human health. Research on the function of ferroptosis in T2DM is increasing. This study uses bioinformatics techniques identify new diagnostic T2DM biomarkers associated with ferroptosis. METHODS To identify ferroptosis-related genes (FRGs) that are differentially expressed between T2DM patients and healthy individuals, we first obtained T2DM sequencing data and FRGs from the Gene Expression Omnibus (GEO) database and FerrDb database. Then, drug-gene interaction networks and competitive endogenous RNA (ceRNA) networks linked to the marker genes were built after marker genes were filtered by two machine learning algorithms (LASSO and SVM-RFE algorithms). Finally, to confirm the expression of marker genes, the GSE76895 dataset was utilized. The protein and RNA expression of some marker genes in T2DM and nondiabetic tissues was also examined by Western blotting, immunohistochemistry (IHC), immunofluorescence (IF) and quantitative real-time PCR (qRT-PCR). RESULTS We obtained 58 differentially expressed genes (DEGs) associated with ferroptosis. GO and KEGG enrichment analyses showed that these DEGs were significantly enriched in hypoxia and ferroptosis. Subsequently, eight marker genes (SCD, CD44, HIF1A, BCAT2, MTF1, HILPDA, NR1D2, and MYCN) were screened by LASSO and SVM-RFE machine learning algorithms, and a model was constructed based on these eight genes. This model also has high diagnostic power. In addition, based on these eight genes, we obtained 48 drugs and constructed a complex ceRNA network map. Finally, Western blotting, IHC, IF, and qRT-PCR results of clinical samples further confirmed the results of public databases. CONCLUSIONS The diagnosis and aetiology of T2DM can be greatly aided by eight FRGs, providing novel therapeutic avenues.
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Affiliation(s)
- Sen Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalShandong First Medical UniversityJinanShandongChina
| | - Yongpan Lu
- Department of Plastic Surgery, The First Clinical Medical College, Shandong University of Traditional Chinese MedicineThe First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalJinanShandongChina
| | - Tingting Chi
- Department of Acupuncture and RehabilitationThe Affiliated Qingdao Hai Ci Hospital of Qingdao University (West Hospital Area)QingdaoShandongChina
| | - Yixin Zhang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalShandong First Medical UniversityJinanShandongChina
| | - Yuli Zhao
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalShandong First Medical UniversityJinanShandongChina
| | - Huimin Guo
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalShandong First Medical UniversityJinanShandongChina
| | - Li Feng
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qian Foshan HospitalShandong First Medical UniversityJinanShandongChina
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Arvind A, Memel ZN, Philpotts LL, Zheng H, Corey KE, Simon TG. Thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, sulfonylureas, and hepatocellular carcinoma risk: A meta-analysis. Metabolism 2021; 120:154780. [PMID: 33891949 PMCID: PMC8217281 DOI: 10.1016/j.metabol.2021.154780] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related death worldwide. Effects of second-line oral antidiabetic medications on incident HCC risk in individuals with type 2 diabetes mellitus remain unclear. This study evaluated associations between sulfonylureas, thiazolidinediones, meglitinides and alpha-glucosidase inhibitors, and incident HCC risk. METHODS We systematically reviewed all studies on PubMed, Embase and Web of Science databases. Studies were included if they documented: (1) exposure to oral antidiabetic medication classes; (2) HCC incidence; (3) relative risks/odds ratios (OR) for HCC incidence. Eight eligible observational studies were identified. We performed random-effects meta-analyses to calculate pooled adjusted ORs (aORs) and 95% confidence intervals (CI). RESULTS Thiazolidinedione use (7 studies, 280,567 participants, 19,242 HCC cases) was associated with reduced HCC risk (aOR = 0.92, 95% CI = 0.86-0.97, I2 = 43%), including among Asian subjects (aOR = 0.90, 95% CI = 0.83-0.97), but not Western subjects (aOR = 0.95, 95% CI = 0.87-1.04). Alpha-glucosidase inhibitor use (3 studies, 56,791 participants, 11,069 HCC cases) was associated with increased HCC incidence (aOR = 1.08; 95% CI = 1.02-1.14, I2 = 21%). Sulfonylurea use (8 studies, 281,180 participants, 19,466 HCC cases) was associated with increased HCC risk in studies including patients with established liver disease (aOR = 1.06, 95% CI = 1.02-1.11, I2 = 75%). Meglitinide use (4 studies, 58,237 participants, 11,310 HCC cases) was not associated with HCC incidence (aOR = 1.19; 95% CI = 0.89-1.60, I2 = 72%). CONCLUSIONS Thiazolidinedione use was associated with reduced HCC incidence in Asian individuals with diabetes. Alpha-glucosidase inhibitor or sulfonylurea use was associated with modestly increased HCC risk; future research should determine whether those agents should be avoided in patients with chronic liver disease.
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Affiliation(s)
- Ashwini Arvind
- Harvard Medical School, Boston, MA, United States of America; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, United States of America
| | - Zoe N Memel
- Harvard Medical School, Boston, MA, United States of America; Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, MA, United States of America
| | - Hui Zheng
- Harvard Medical School, Boston, MA, United States of America; Biostatistics Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Kathleen E Corey
- Harvard Medical School, Boston, MA, United States of America; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, United States of America; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Tracey G Simon
- Harvard Medical School, Boston, MA, United States of America; Liver Center and Gastrointestinal Division, Massachusetts General Hospital, Boston, MA, United States of America; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, United States of America.
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Ingrasciotta Y, Bertuccio MP, Crisafulli S, Ientile V, Muscianisi M, L’Abbate L, Pastorello M, Provenzano V, Scorsone A, Scondotto S, Trifirò G. Real World Use of Antidiabetic Drugs in the Years 2011-2017: A Population-Based Study from Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249514. [PMID: 33353081 PMCID: PMC7765957 DOI: 10.3390/ijerph17249514] [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] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/21/2022]
Abstract
Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia. The availability of new antidiabetic drugs (ADs) has led to complex treatment patterns and to changes in the patterns of specific drug utilization. The aim of this population-based study was to describe the pattern of antidiabetic drugs (ADs) use in Southern Italy in the years 2011–2017, in relation to the updated type 2 diabetes mellitus (T2DM) therapy guidelines. A retrospective cohort study was conducted on T2DM patients using data from the Palermo Local Health Unit (LHU) claims database and diabetologist registry. The first-line treatment was investigated and incident treatments were identified and characterized at baseline in terms of demographics, complications, comorbidities, concomitant drugs and clinical parameters. Persistence to AD treatment was also evaluated. During the study period, one-third of first ever ADs users started the treatment with ADs other than metformin, in contrast to guideline recommendations. Among 151,711 incident AD treatments, the male to female ratio was 1.0 and the median age was 66 (57–75) years. More than half (55.0%) of incident treatments discontinued the therapy during the first year of treatment. In Italy, general practitioners (GPs) can only prescribe first-generation ADs, while the prescription of more recently marketed ADs, such as GLP-1RA, DPP4i and SGLT2i, is restricted to diabetologists only, based on a therapeutic plan. The role of GPs in the management of T2DM in Italy should be re-evaluated.
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Affiliation(s)
- Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
- Correspondence: ; Tel.: +39-090-2213877
| | - Maria Paola Bertuccio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | - Marco Muscianisi
- Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Luca L’Abbate
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98125 Messina, Italy; (M.P.B.); (S.C.); (V.I.); (L.L.)
| | | | - Vincenzo Provenzano
- Regional Referral Centre for Insulin Pump Implantation and Diabetes, Civic Hospital, Partinico, 90047 Palermo, Italy; (V.P.); (A.S.)
| | - Alessandro Scorsone
- Regional Referral Centre for Insulin Pump Implantation and Diabetes, Civic Hospital, Partinico, 90047 Palermo, Italy; (V.P.); (A.S.)
| | - Salvatore Scondotto
- Department of Epidemiologic Observatory, Health Department of Sicily, 90127 Palermo, Italy;
| | - Gianluca Trifirò
- Department of Diagnostic and Public Health, University of Verona, 37134 Verona, Italy;
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Hooimeyer A, Bhasale A, Perry L, Fabbri A, Mohammad A, McEwin E, Mintzes B. Regulatory post-market drug safety advisories on cardiac harm: A comparison of four national regulatory agencies. Pharmacol Res Perspect 2020; 8:e00680. [PMID: 33169534 PMCID: PMC7652786 DOI: 10.1002/prp2.680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
Information on rare adverse effects is often limited when a medication is initially approved for marketing. Medicines regulators use safety advisories to warn health professionals and consumers about emerging harms. This study aimed to identify characteristics and advice provided in cardiac safety advisories released by regulators in Australia, Canada, the United Kingdom, and the United States. This was a retrospective study of safety advisories about cardiac-related adverse events issued by these four international medicines regulators between 2010 and 2016. A descriptive overview was followed by a more detailed content analysis, focusing on recommended actions for health professionals, including monitoring advice. For the latter, we applied the systematic information for monitoring (SIM) scale to assess adequacy. Over this period, 164 safety advisories about cardiac harms were issued by the four regulators. There were 61 drugs with advisories of cardiac risk, only 9 (14.7%) of which had advisories from all regulators in countries where the drug was approved. The most common adverse events were cardiac arrhythmias (n = 97, 59.1%) and coronary artery disorders (n = 39, 23.8%). The most frequent advice to prescribers was to monitor patients (n = 74, 45.1%), although only 41.2% of these advisories provided detailed advice on how monitoring should occur. We found many differences in the decision to warn and the advice provided. Patient monitoring was most often recommended, but key information such as frequency or thresholds for action was often lacking. Healthcare professionals and consumers need consistent information about rare serious harms so that they can make informed decisions.
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Affiliation(s)
- Ashleigh Hooimeyer
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Bhasale
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Lucy Perry
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Alice Fabbri
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
- Centre for Evidence‐Based Medicine Odense (CEBMO)Odense University Hospital and University of Southern DenmarkOdenseDenmark
| | - Annim Mohammad
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Eliza McEwin
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
| | - Barbara Mintzes
- Charles Perkins Centre and School of PharmacyFaculty of Medicine and HealthThe University of SydneyCamperdownAustralia
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Berencsi K, Sami A, Ali MS, Marinier K, Deltour N, Perez-Gutthann S, Pedersen L, Rijnbeek P, Van der Lei J, Lapi F, Simonetti M, Reyes C, Sturkenboom MCJM, Prieto-Alhambra D. Impact of risk minimisation measures on the use of strontium ranelate in Europe: a multi-national cohort study in 5 EU countries by the EU-ADR Alliance. Osteoporos Int 2020; 31:721-755. [PMID: 31696274 DOI: 10.1007/s00198-019-05181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION In May 2013 and March 2014, the European Medicines Agency (EMA) issued two decisions restricting the use of strontium ranelate (SR). These risk minimisation measures (RMM) introduced new contraindications and limited the indications of SR therapy. The EMA required an assessment of the impact of RMMs on the use of SR in Europe. Methods design: multi-national, multi-database cohort Setting: electronic medical record databases based on hospital (Denmark) and primary care provenance (Italy, Spain, the Netherlands, UK). PARTICIPANTS the database source populations were included for population-based analyses, and SR users for patient-level analyses. INTERVENTION New RMMs included contraindications (ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, uncontrolled hypertension) and restricted SR indication to severe osteoporosis with initiation by experienced physician and not as first line anti-osteoporosis therapy. METHODS Prevalence and incidence rates of SR use in the population; prevalence of contraindications and restricted indications in SR users, plus 1-year therapy persistence. Drug use measures were calculated in three periods for comparison: reference (2004 to May 2013), transition (June 2013 to March 2014) and assessment (from April 2014 to end 2016). RESULTS The study population included 143 million person-years(PY) of follow-up and 76,141 incident episodes of SR treatment. Average monthly prevalence rates of SR use dropped by 86.4% from 62.6/10,000 PY (95 CI 62.4-62.9) in the reference to 8.5 (8.5-8.6) in the assessment period. Similarly, the incidence rate of SR use fell by 97.3% from 7.4/10,000 PY (7.4-7.4) to 0.2 (0.2-0.2) between the reference and assessment period. The prevalence of any contraindication decreased, whilst the prevalence of restricted indications increased in these periods. One-year persistence decreased in the assessment compared with reference period. CONCLUSIONS Our study demonstrates a substantial impact of the regulatory action to restrict use of SR in Europe: SR utilisation overall decreased strongly. The proportion of patients fulfilling the restricted indications, without contraindications, increased after the proposed RMMs.
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Affiliation(s)
- K Berencsi
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - A Sami
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - M S Ali
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - K Marinier
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | - N Deltour
- Department of Pharmacoepidemiology, Servier, Suresnes, France
| | | | - L Pedersen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - P Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Van der Lei
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - M Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - C Reyes
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | | | - D Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK.
- GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain.
- Botnar Research Centre, Windmill Road, Oxford, OX37LD, UK.
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Georgi U, Lämmel J, Datzmann T, Schmitt J, Deckert S. Do drug-related safety warnings have the expected impact on drug therapy? A systematic review. Pharmacoepidemiol Drug Saf 2020; 29:229-251. [PMID: 32045502 DOI: 10.1002/pds.4968] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/22/2019] [Accepted: 01/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The need for drug-related safety warnings is undisputed, and their impact should also be evaluated. This systematic review investigates and assesses the impact of safety warnings on drug therapy. METHODS Studies published in English between January 1998 and December 2018 were searched in EMBASE and MEDLINE, complemented by manual search. Randomised controlled trials, cohort studies with a before/after component, and case-control studies were included, selected to predefined criteria, and assessed for their reporting and methodological quality. RESULTS Out of 7454 references identified, 72 studies were included. A total of 28/72 (39%) studies described the impact of safety warnings on drug therapy as being effective, whereas 12/72 (17%) studies did not. Further, 26/72 (36%) studies described a partial implementation of the warnings (one part of the warning had an impact on drug therapy and another did not). Unintended effects were investigated in 6/72 (8%) studies. While 34 (47%) studies examined safety warnings on psychotropic drugs using an interrupted time series (ITS) design (53%), a before/after (26%), and a time series design (21%), 38 (53%) studied other substances using an ITS design (34%), a before/after (40%), and a time series design (26%). The proportion of an effective impact on drug therapy was lower in the "psychotropic drugs" group (23%) than in the "others" group (53%). CONCLUSION Drug-related safety warnings induce intended and unintended effects. The included studies are of broadly varying methodological quality. To better compare their effectiveness, studies should be conducted using standardised procedures.
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Affiliation(s)
- Ulrike Georgi
- Pharmacy Service of Clinical Center, Chemnitz, Germany.,Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Julia Lämmel
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Thomas Datzmann
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Stefanie Deckert
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
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Weatherburn CJ, Guthrie B, Dreischulte T, Morales DR. Impact of medicines regulatory risk communications in the UK on prescribing and clinical outcomes: Systematic review, time series analysis and meta-analysis. Br J Clin Pharmacol 2019; 86:698-710. [PMID: 31465123 DOI: 10.1111/bcp.14104] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022] Open
Abstract
AIMS Regulatory risk communications are important to ensure medication safety, but their impact is poorly understood. The aim was to quantify the impact of UK risk communications on medication use and other outcomes. METHODS We conducted a systematic review of studies reporting prescribing/health outcome data relevant to UK regulatory risk communication. Data were reanalysed using interrupted time series regression 12 months after each regulatory intervention. Mean changes were pooled using random-effects generic inverse variance examining the following subgroups: drug withdrawals; restrictions/changes in indications; be aware messages without specific recommendations for action; communication via direct healthcare practitioner communications; communication via drug bulletins. RESULTS Of 11 466 articles screened, 40 studies examining 25 UK regulatory risk communications were included. Product withdrawals, restriction in indications and be aware communications were associated with relative mean changes of -78% (95% confidence interval [CI] -60 to -96%), -34% (95% confidence interval [CI] -12 to -55%) and -11% (95%CI -8 to -15%) in targeted drug prescribing respectively. Direct healthcare professional communications were associated with relative mean changes of -47% (95%CI -27 to -68%) compared to -13% (95%CI -6 to -20%) for drug bulletins. Of 7 studies examining unique health outcomes related to the safety concern, risk communications were associated with a mean -10% (95%CI -3 to -16%) decrease in intended and a 7% (95%CI 4 to 10%) increase in unintended health outcomes. DISCUSSION UK regulatory risk communications were associated with significant changes in targeted prescribing and potential changes in clinical outcomes. Further research is needed to systematically study the impact of regulatory interventions.
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Affiliation(s)
| | - Bruce Guthrie
- General Practice, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, UK
| | - Tobias Dreischulte
- Clinical Health Services Research, Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Germany
| | - Daniel R Morales
- Discovery Fellow and General Practitioner, Division of Population Health and Genomics, University of Dundee, UK
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8
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Mazzaglia G, Straus SMJ, Arlett P, da Silva D, Janssen H, Raine J, Alteri E. Study Design and Evaluation of Risk Minimization Measures: A Review of Studies Submitted to the European Medicines Agency for Cardiovascular, Endocrinology, and Metabolic Drugs. Drug Saf 2018; 41:191-202. [PMID: 29124666 PMCID: PMC5808048 DOI: 10.1007/s40264-017-0604-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Studies measuring the effectiveness of risk minimization measures (RMMs) submitted by pharmaceutical companies to the European Medicines Agency are part of the post-authorization regulatory requirements and represent an important source of data covering a range of medicinal products and safety-related issues. Their objectives, design, and the associated regulatory outcomes were reviewed, and conclusions were drawn that may support future progress in risk minimization evaluation. Methods Information was obtained from risk management plans, study protocols, clinical study reports, and assessment reports of 157 medicinal products authorized for cardiovascular, endocrinology, and metabolic indications. We selected observational studies measuring, as outcomes of interest, the relationship between the RMMs in place and (1) implementation measures, such as clinical knowledge or physicians` compliance to recommendations contained in the RMMs; and (2) occurrence or reduced severity of the adverse drug reactions for which the RMMs were required. Results Of 59 eligible studies (24 completed, 35 ongoing), 44 assessed implementation measures, whereas only 15 assessed safety outcomes (1 study as a single endpoint and 14 studies with other endpoints). Fifty-one studies used non-experimental designs and 25 studies employed electronic healthcare databases for analysis. Of the 24 completed studies, 17 were considered satisfactory and supported immediate regulatory decision making, 6 were considered inconclusive and required new evaluations, and 1 was terminated early because new safety restrictions were required, thereby necessitating a new evaluation. Compliance with agreed deadlines was considered acceptable in 21 of 24 completed studies; the average time for a submission was 37 months (standard deviation ± 17), with differences observed by type of data source employed. Conclusions Three important gaps in the evaluation plans of RMMs were identified: lack of early feedback on implementation, limited evaluation of safety outcomes, and inability to provide information on the effectiveness from an integrated measurement of different elements of a set of risk minimization tools. More robust evidence is needed to advance regulatory science and support more rapid adjustment of risk minimization strategies as needed. Electronic supplementary material The online version of this article (doi:10.1007/s40264-017-0604-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giampiero Mazzaglia
- Human Medicines Evaluation Division, Scientific and Regulatory Management Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK.
| | - Sabine M J Straus
- Dutch Medicines Evaluation Board, PO Box 8275, 3503 RG, Utrecht, The Netherlands.,Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter Arlett
- Pharmacovigilance and Epidemiology Department, European Medicines Agency, 30 Churchill Place, London, E14 5EU, UK
| | - Daniela da Silva
- Human Medicines Evaluation Division, Scientific and Regulatory Management Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK
| | - Heidi Janssen
- Human Medicines Evaluation Division, Scientific and Regulatory Management Department, European Medicines Agency, 30 Churchill Place, Canary Wharf, London, E14 5EU, UK
| | - June Raine
- Vigilance and Risk Management of Medicines, Medicines and Healthcare Products Regulatory Agency, 151 Buckingham Palace Road, Victoria, London, SW1W 9SZ, UK
| | - Enrica Alteri
- Human Medicines Research and Development Support Division, European Medicines Agency, 30 Churchill Place, London, E14 5EU, UK
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9
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Evolución clínica de una cohorte de pacientes con diabetes mellitus tipo 2 tras su valoración en endocrinología. Estudio a 26 semanas. ENDOCRINOL DIAB NUTR 2018; 65:220-228. [DOI: 10.1016/j.endinu.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/02/2017] [Accepted: 11/08/2017] [Indexed: 01/17/2023]
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10
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Goedecke T, Morales DR, Pacurariu A, Kurz X. Measuring the impact of medicines regulatory interventions - Systematic review and methodological considerations. Br J Clin Pharmacol 2018; 84:419-433. [PMID: 29105853 PMCID: PMC5809349 DOI: 10.1111/bcp.13469] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
AIMS Evaluating the public health impact of regulatory interventions is important but there is currently no common methodological approach to guide this evaluation. This systematic review provides a descriptive overview of the analytical methods for impact research. METHODS We searched MEDLINE and EMBASE for articles with an empirical analysis evaluating the impact of European Union or non-European Union regulatory actions to safeguard public health published until March 2017. References from systematic reviews and articles from other known sources were added. Regulatory interventions, data sources, outcomes of interest, methodology and key findings were extracted. RESULTS From 1246 screened articles, 229 were eligible for full-text review and 153 articles in English language were included in the descriptive analysis. Over a third of articles studied analgesics and antidepressants. Interventions most frequently evaluated are regulatory safety communications (28.8%), black box warnings (23.5%) and direct healthcare professional communications (10.5%); 55% of studies measured changes in drug utilization patterns, 27% evaluated health outcomes, and 18% targeted knowledge, behaviour or changes in clinical practice. Unintended consequences like switching therapies or spill-over effects were rarely evaluated. Two-thirds used before-after time series and 15.7% before-after cross-sectional study designs. Various analytical approaches were applied including interrupted time series regression (31.4%), simple descriptive analysis (28.8%) and descriptive analysis with significance tests (23.5%). CONCLUSION Whilst impact evaluation of pharmacovigilance and product-specific regulatory interventions is increasing, the marked heterogeneity in study conduct and reporting highlights the need for scientific guidance to ensure robust methodologies are applied and systematic dissemination of results occurs.
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Affiliation(s)
- Thomas Goedecke
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
| | - Daniel R. Morales
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Division of Population Health SciencesUniversity of DundeeDundeeDD2 4BFUK
| | - Alexandra Pacurariu
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
- Dutch Medicines Evaluation Board3531AHUtrechtThe Netherlands
| | - Xavier Kurz
- Pharmacovigilance and Epidemiology Department, Inspections Human Medicines Pharmacovigilance and Committees DivisionEuropean Medicines Agency (EMA)LondonE14 5EUUK
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11
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Advances in Managing Type 2 Diabetes in the Elderly: A Focus on Inpatient Care and Transitions of Care. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Loh RKC, Formosa MF, Eikelis N, Bertovic DA, Anderson MJ, Barwood SA, Nanayakkara S, Cohen ND, La Gerche A, Reutens AT, Yap KS, Barber TW, Lambert GW, Cherk MH, Duffy SJ, Kingwell BA, Carey AL. Pioglitazone reduces cold-induced brown fat glucose uptake despite induction of browning in cultured human adipocytes: a randomised, controlled trial in humans. Diabetologia 2018; 61:220-230. [PMID: 29046921 DOI: 10.1007/s00125-017-4479-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 09/21/2017] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS Increasing brown adipose tissue (BAT) activity is a possible therapeutic strategy to increase energy expenditure and glucose and lipid clearance to ameliorate obesity and associated comorbidities. The thiazolidinedione (TZD) class of glucose-lowering drugs increase BAT browning in preclinical experimental models but whether these actions extend to humans in vivo is unknown. The aim of this study was to determine the effect of pioglitazone treatment on adipocyte browning and adaptive thermogenesis in humans. METHODS We first examined whether pioglitazone treatment of cultured human primary subacromioclavicular-derived adipocytes induced browning. Then, in a blinded, placebo-controlled, parallel trial, conducted within the Baker Institute clinical research laboratories, 14 lean male participants who were free of cardiometabolic disease were randomised to receive either placebo (lactose; n = 7, age 22 ± 1 years) or pioglitazone (45 mg/day, n = 7, age 21 ± 1 years) for 28 days. Participants were allocated to treatments by Alfred Hospital staff independent from the study via electronic generation of a random number sequence. Researchers conducting trials and analysing data were blind to treatment allocation. The change in cold-stimulated BAT activity, assessed before and after the intervention by [18F]fluorodeoxyglucose uptake via positron emission tomography/computed tomography in upper thoracic and cervical adipose tissue, was the primary outcome measure. Energy expenditure, cardiovascular responses, core temperature, blood metabolites and hormones were measured in response to acute cold exposure along with body composition before and after the intervention. RESULTS Pioglitazone significantly increased in vitro browning and adipogenesis of adipocytes. In the clinical trial, cold-induced BAT maximum standardised uptake value was significantly reduced after pioglitazone compared with placebo (-57 ± 6% vs -12 ± 18%, respectively; p < 0.05). BAT total glucose uptake followed a similar but non-significant trend (-50 ± 10% vs -6 ± 24%, respectively; p = 0.097). Pioglitazone increased total and lean body mass compared with placebo (p < 0.05). No other changes between groups were detected. CONCLUSIONS/INTERPRETATION The disparity in the actions of pioglitazone on BAT between preclinical experimental models and our in vivo human trial highlight the imperative to conduct human proof-of-concept studies as early as possible in BAT research programmes aimed at therapeutic development. Our clinical trial findings suggest that reduced BAT activity may contribute to weight gain associated with pioglitazone and other TZDs. TRIAL REGISTRATION ClinicalTrials.gov NCT02236962 FUNDING: This work was supported by the Diabetes Australia Research Program and OIS scheme from the Victorian State Government.
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Affiliation(s)
- Rebecca K C Loh
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Melissa F Formosa
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Nina Eikelis
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Iverson Health Innovation Research Institute, Swinburne Institute of Technology, Melbourne, VIC, Australia
| | - David A Bertovic
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia
| | - Mitchell J Anderson
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia
- Melbourne Orthopaedic Group, Windsor, VIC, Australia
| | | | - Shane Nanayakkara
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Andre La Gerche
- Sports Cardiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Anne T Reutens
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kenneth S Yap
- The Department of Nuclear Medicine and PET, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, Australia
| | - Thomas W Barber
- The Department of Nuclear Medicine and PET, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, Australia
| | - Gavin W Lambert
- Human Neurotransmitters Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Iverson Health Innovation Research Institute, Swinburne Institute of Technology, Melbourne, VIC, Australia
| | - Martin H Cherk
- The Department of Nuclear Medicine and PET, Alfred Health, Melbourne, VIC, Australia
- Department of Medicine, Monash University, Alfred Hospital Campus, Melbourne, VIC, Australia
| | - Stephen J Duffy
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia.
| | - Andrew L Carey
- Metabolic and Vascular Physiology Laboratory, Baker Heart and Diabetes Institute, P. O. Box 6492, Melbourne, VIC, 3004, Australia.
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Heintjes EM, Overbeek JA, Hall GC, Prieto-Alhambra D, Lapi F, Hammar N, Bezemer ID. Factors Associated with Type 2 Diabetes Mellitus Treatment Choice Across Four European Countries. Clin Ther 2017; 39:2296-2310.e14. [PMID: 29108837 DOI: 10.1016/j.clinthera.2017.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/29/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this analysis was to identify factors associated with the choice of type 2 diabetes mellitus (T2DM) therapy at the time of intensification of antidiabetic treatment across 4 European countries. METHODS Antidiabetic drug prescription/dispensing records and patients' characteristics were obtained from the electronic health care records of patients with T2DM from the Netherlands (NL), Italy, and Spain (ES) (all, 2007-2011); and the United Kingdom (UK; 2008-2012). Oral monotherapy was defined as first-line; oral dual therapy, as second-line; >2 oral treatments or oral combined with an injectable, as third-line; and injectables only, as fourth-line treatment. Treatment intensification was defined as the start of a higher line of treatment. Comedication, comorbidities, clinical parameters, and other factors associated with treatment choice were identified using multivariate relative risk estimation by Poisson regression with robust error variance. FINDINGS In the 5-year study period, 485,120 patients (79% of the treated T2DM population) underwent treatment intensification. Changes in treatment choice were clearly visible over the study period, such as a decline in the use of thiazolidinediones (NL, ES, UK) and increases in the use of dipeptidyl peptidase-4 inhibitors (DPP4i) (NL, ES, UK) and glucagon-like peptide-1 receptor agonists (UK). With first-line treatment, advanced age and renal comorbidity were associated with the use of sulfonylureas (SUs; all countries), whereas high body mass index (BMI) was inversely associated with SU use in the United Kingdom and Spain. With second-line treatment, advanced age was associated with metformin + SU use (all countries); and renal comorbidity with SU + DPP4i use in the United Kingdom and the Netherlands. High BMI was associated with metformin + thiazolidinedione (TZD) use in the United Kingdom and Spain, and with metformin + DPP4i in the United Kingdom. With third-line treatment, advanced age and renal comorbidity were associated with the use of SU + insulin (NL, ES, UK). Hemoglobin A1c >8.5% was positively associated, and high BMI was inversely associated, with the use of any third-line combination containing insulin. Across treatment lines TZD and metformin were negatively associated with renal and cardiac morbidity. Second and third line treatment choices strongly depended on prior treatments. With fourth-line treatment, women were more likely to receive glucagon-like peptide-1 receptor agonists than were men in the United Kingdom and Spain. IMPLICATIONS The results suggest that the main factors driving treatment choice at any stage of intensification were age, hemoglobin A1c, BMI, renal and cardiac morbidity, and treatment history. These drivers were consistent with guidelines on, and contraindications of, specific medications. Differences between countries were generally consistent with, but not solely attributable to, differences in local guidelines and reimbursement policies.
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Affiliation(s)
- Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | - Daniel Prieto-Alhambra
- Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFes), Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Niklas Hammar
- AstraZeneca R&D, Mölndal, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irene D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
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14
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Chu WM, Ho HE, Huang KH, Tsan YT, Liou YS, Wang YH, Lee MC, Li YC. The prescribing trend of oral antidiabetic agents for type 2 diabetes in Taiwan: An 8-year population-based study. Medicine (Baltimore) 2017; 96:e8257. [PMID: 29068991 PMCID: PMC5671824 DOI: 10.1097/md.0000000000008257] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate the prescription trend and pattern of oral antidiabetic (OAD) medications, which are extensively used worldwide for treating type 2 diabetes, in 2 age groups.In this population-based study, data obtained from the National Health Insurance Research Database, Taiwan, were analyzed to investigate the prescription trend of all types of OAD medications during 2005 to 2012. We used descriptive statistics to demonstrate the trend of prescription patterns stratified by age (aged 65 years and above or younger than 65).Sulfonylurea (SU) was once the most commonly used drug, but the proportion of its prescription had declined gradually (76.83% in 2005 to 63.70% in 2012). Consequently, biguanide (BG) became the most commonly used drug since 2010 (64.31% in 2005 to 74.41% in 2012). In addition, the prescriptions of thiazolidinedione decreased significantly (9.20% in 2005 to 2.86% in 2012), whereas the usage of DPP-4 inhibitor increased with time (3.73% in 2009 to 19.64% in 2012). The treatment choice of SU and α-glucosidase inhibitor (AGI) was higher in elderly patients compared with the younger population (SU: 62.70% in 2012, AGI: 12.78% in 2012). Two-drug combination therapies were the prevalent treatment choices for patients with type 2 diabetes (44.77% in 2012), particularly in the elderly group; however, ≥3 drug combination therapies increased gradually during the study period, particularly in the younger group.This descriptive study presents the change in the prescription of OAD medication for different age groups during 2005 to 2012.
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Affiliation(s)
- Wei-Min Chu
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Family Medicine, Taichung Veterans General Hospital, Chiayi Branch, Chiayi
- School of Medicine, National Yang-Ming University, Taipei
| | - Hsin-En Ho
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Family Medicine, Taichung Armed Force General Hospital, Taichung
- School of Medicine, National Defense Medical Center, Taipei
| | - Kuang-Hua Huang
- Department of Health Service Administration, College of Public Health, China Medical University
| | - Yu-Tse Tsan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital
- School of Medicine, Chung Shan Medical University, Taichung
| | - Yi-Sheng Liou
- School of Public Health, National Defense Medical Center, Taipei
- Department of Family Medicine, Taichung Veterans General Hospital
| | - Yueh-Hsin Wang
- Department of Health Service Administration, College of Public Health, China Medical University
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung
- Institute of Population Sciences, National Health Research Institutes, Miaoli County
- College of Management, Chao-Yung University of Technology
| | - Yu-Ching Li
- Department of Public Health, China Medical University, Taichung
- Department of Family Medicine, Yuan Rung Hospital, Yuanlin, Changhwa, Taiwan
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15
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Webb R, Hughes MG, Thomas AW, Morris K. The Ability of Exercise-Associated Oxidative Stress to Trigger Redox-Sensitive Signalling Responses. Antioxidants (Basel) 2017; 6:antiox6030063. [PMID: 28796154 PMCID: PMC5618091 DOI: 10.3390/antiox6030063] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/17/2022] Open
Abstract
In this review, we discuss exercise as an oxidative stressor, and elucidate the mechanisms and downstream consequences of exercise-induced oxidative stress. Reactive oxygen species (ROS) are generated in the mitochondria of contracting skeletal myocytes; also, their diffusion across the myocyte membrane allows their transport to neighbouring muscle tissue and to other regions of the body. Although very intense exercise can induce oxidative damage within myocytes, the magnitudes of moderate-intensity exercise-associated increases in ROS are quite modest (~two-fold increases in intracellular and extracellular ROS concentrations during exercise), and so the effects of such increases are likely to involve redox-sensitive signalling effects rather than oxidative damage. Therefore, the responses of muscle and non-muscle cells to exercise-associated redox-sensitive signalling effects will be reviewed; for example, transcription factors such as Peroxisome Proliferator Activated Receptor-gamma (PPARγ) and Liver X-Receptor-alpha (LXRα) comprise redox-activable signalling systems, and we and others have reported exercise-associated modulation of PPARγ and/or LXRα-regulated genes in skeletal myocyte and in non-muscle cell-types such as monocyte-macrophages. Finally, the consequences of such responses in the context of management of chronic inflammatory conditions, and also their implications for the design of exercise training programmes (particularly the use of dietary antioxidants alongside exercise), will be discussed.
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Affiliation(s)
- Richard Webb
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
| | - Michael G Hughes
- Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff CF23 6XD, UK.
| | - Andrew W Thomas
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
| | - Keith Morris
- Department of Biomedical Sciences, Cardiff School of Health Sciences, Cardiff Metropolitan University, Cardiff CF5 2YB, UK.
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16
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Noh Y, Kang DR, Kim DJ, Lee KJ, Lee S, Shin S. Impact of clinical evidence communications and drug regulation changes concerning rosiglitazone on prescribing patterns of antidiabetic therapies. Pharmacoepidemiol Drug Saf 2017; 26:1338-1346. [PMID: 28771933 DOI: 10.1002/pds.4262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE Cardiovascular safety alerts about rosiglitazone resulted in regulatory actions in several countries in 2010, but the Food and Drug Administration eliminated access restrictions in 2013, reflecting new evidence concerning the drug safety. We investigated the effects of safety signals and regulation shifts concerning rosiglitazone on prescribing of antidiabetic drugs (ADs). METHODS Patient data were extracted from the Korean health insurance claims database for 2007 to 2015. Linear regression and interrupted time series analyses were performed to examine drug utilization trends and the impact of 5 milestone events regarding rosiglitazone safety on AD utilization. RESULTS A steady growth was observed in the AD consumption, with metformin preserving its dominant market share throughout the period. Pioglitazone use has increased since 2008 in response to safety issues surrounding rosiglitazone. A significant decline in rosiglitazone use was observed after Nissen's meta-analysis and safety warnings (2007) and after restriction/suspension of access to rosiglitazone (2010), associated with a drop in prevalence by 29.5%/year and 99.5%/year, respectively. The most common AD newly started among users who discontinued rosiglitazone in 2010 was pioglitazone, followed by dipeptidyl peptidase-4 (DPP-4) inhibitors. Our concomitancy analysis showed that DPP-4 inhibitors have overtaken sulfonylureas since 2014 as the most common add-on to metformin. CONCLUSIONS The most frequently added AD in diabetes patients who had switched off rosiglitazone in 2010 was pioglitazone, followed by DPP-4 inhibitors. Despite new evidence from a long-term clinical trial and the Food and Drug Administration's subsequent decision to eliminate access restrictions on rosiglitazone in 2013, domestic regulations were left intact; hence, its use remained negligible in Korea.
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Affiliation(s)
- Yoojin Noh
- College of Pharmacy, Ajou University, Suwon, Gyeonggi-do, South Korea
| | - Dae Ryong Kang
- Center of Biomedical Data Science/Institute of Genomic Cohort, Wonju College of Medicine, Yonsei University, Wonju, Gangwon-do, South Korea
| | - Dae Jung Kim
- Department of Endocrinology and Metabolism, School of Medicine, Ajou University, Suwon, Gyeonggi-do, South Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, School of Medicine, Ajou University, Suwon, Gyeonggi-do, South Korea
| | - Sukhyang Lee
- College of Pharmacy, Ajou University, Suwon, Gyeonggi-do, South Korea.,Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Gyeonggi-do, South Korea
| | - Sooyoung Shin
- College of Pharmacy, Ajou University, Suwon, Gyeonggi-do, South Korea.,Research Institute of Pharmaceutical Science and Technology (RIPST), Ajou University, Suwon, Gyeonggi-do, South Korea
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17
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López-Sepúlveda R, García Lirola MÁ, Espínola García E, Martín Sances S, Anaya Ordóñez S, Jurado Martínez JM, Cabeza Barrera J. Effects of a primary care intervention to improve the quality of zolpidem prescriptions in elderly patients. Eur J Clin Pharmacol 2016; 73:455-461. [PMID: 28028585 DOI: 10.1007/s00228-016-2180-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 12/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE The objective of this study was to measure the impact of an intervention on the prescription habits of general practitioners (GPs) in order to improve the quality of zolpidem prescriptions in patients aged 75 or older. METHODS A prospective multicentric non-randomized trial was performed in the Metropolitan Granada Primary Healthcare Area (Andalusian Public Healthcare Service, Spain), which serves a total population of approximately 675,000 inhabitants. All health centers volunteering to participate in the trial were included. The intervention consisted of training sessions, individualized feedback, clinical information, and financial incentives. A daily dose over 5 mg was considered non-safe. Reduction in non-safe prescriptions of zolpidem in the elderly population became a quality prescribing indicator in a pay-for-performance scheme. RESULTS Statistically significant differences versus baseline were found between the intervention and control groups in mean zolpidem prescription prevalence (28.5 vs. 37.5‰, respectively; p = 0.008) and mean non-safe zolpidem prescription prevalence (16.5 vs. 34.2‰, respectively; p < 0.001). At the end of the study period, the total number of non-safe prescriptions was 1309, 35% lower versus baseline, with a significant difference of p < 0.001; the number in the intervention (510 vs. 1118; p < 0.001) and control (799 vs. 893; p = 0.0064) groups was also significantly lower, with a significantly greater percentage reduction in the intervention group (54.4 vs. 10.5%, p < 0.001). CONCLUSION The quality prescribing indicator in our area was improved by the intervention developed. Further studies that include an intervention group of GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.
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Affiliation(s)
- Rocío López-Sepúlveda
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain
| | - María Ángeles García Lirola
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain.
| | - Esther Espínola García
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain
| | - Salvadora Martín Sances
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain
| | - Sonia Anaya Ordóñez
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain
| | - José María Jurado Martínez
- Unidad Gestión Clínica de Farmacia Provincial de Granada, Distrito Sanitario Granada Metropolitano, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada, Granada, Spain
| | - José Cabeza Barrera
- Unidad de Gestión Clínica de Farmacia Provincial de Granada, Complejo Hospitalario de Granada, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada - Universidad de Granada., Granada, Spain
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Hostenkamp G, Fischer KE, Borch-Johnsen K. Drug safety and the impact of drug warnings: An interrupted time series analysis of diabetes drug prescriptions in Germany and Denmark. Health Policy 2016; 120:1404-1411. [DOI: 10.1016/j.healthpol.2016.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 01/29/2023]
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Mata-Cases M, Franch-Nadal J, Real J, Mauricio D. Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study. BMJ Open 2016; 6:e012463. [PMID: 27707830 PMCID: PMC5073475 DOI: 10.1136/bmjopen-2016-012463] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM). DESIGN Cross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database. SETTING Primary healthcare centres, including the entire population attended by the Institut Català de la Salut in Catalonia, Spain, from 2007 to 2013. PARTICIPANTS Patients aged 31-90 years with a diagnosis of T2DM. RESULTS The number of registered patients with T2DM in the database was 257 072 in 2007, increasing up to 343 969 in 2013. The proportion of patients not pharmacologically treated decreased by 9.7% (95% CI -9.48% to -9.92%), while there was an increase in the percentage of patients on monotherapy (4.4% increase; 95% CI 4.16% to 4.64%), combination therapy (2.8% increase; 95% CI 2.58% to 3.02%), and insulin alone or in combination (increasing 2.5%; 95% CI 2.2% to 2.8%). The use of metformin and dipeptidyl peptidase-IV inhibitors increased gradually, while sulfonylureas, glitazones and α-glucosidase inhibitors decreased. The use of glinides remained stable, and the use of glucagon-like peptide-1 receptor agonists was still marginal. Regarding glycaemic control, there were no relevant differences across years: mean glycated haemoglobin (HbA1c) value was around 7.2%; the percentage of patients reaching an HbA1c≤7% target ranged between 52.2% and 55.6%; and those attaining their individualised target from 72.8% to 75.7%. CONCLUSIONS Although the proportion of patients under pharmacological treatment increased substantially over time and there was an increase in the use of combination therapies, there have not been relevant changes in glycaemic control during the 2007-2013 period in Catalonia.
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Affiliation(s)
- Manel Mata-Cases
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
- Primary Health Care Center La Mina, Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Sant Adrià de Besòs, Spain
| | - Josep Franch-Nadal
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
- Primary Health Care Center Raval Sud, Gerència d’Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Jordi Real
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Internacional de Catalunya, Epidemiologia i Salut Pública, Sant Cugat, Spain
| | - Dídac Mauricio
- DAP-Cat group. Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Spain
- Department of Endocrinology & Nutrition, Health Sciences Research Institute & Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Watson L, Das R, Farquhar R, Langerman H, Barnett AH. Consequences of delaying treatment intensification in type 2 diabetes: evidence from a UK database. Curr Med Res Opin 2016; 32:1465-75. [PMID: 26907851 DOI: 10.1185/03007995.2016.1157462] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Type 2 diabetes mellitus (TD2M) treatment focuses on achieving glycemic control, with HbA1c targeted at 6.5-7.5%. Clinicians commonly delay treatment intensification despite patients failing glycemic targets. This study evaluated longitudinal clinical and cost outcomes in patients failing metformin monotherapy using electronic medical records. RESEARCH DESIGN AND METHODS Adults with incident T2DM were identified in the UK Clinical Practice Research Datalink (CPRD) from 1 January 2000 to 31 March 2014. Patients were initiated on metformin monotherapy but had not reached target (HbA1c <7%). Patients were grouped by time to intensification of second-line therapy from first recorded HbA1c ≥7%: Group A, rapid intensification within 365 days; Group B, delayed intensification days 366-1824; Group C, never intensified. Patients were followed from day 366 for 5 years until end of study, switch to insulin, migration or death. MAIN OUTCOME MEASURES The study evaluated baseline clinical and medication characteristics which were re-evaluated each year, including HbA1c, weight, cholesterol and concomitant prescribing. RESULTS A total of 6710 patients were included (Group A 2647, Group B 2452, Group C 1611). Group A achieved a significant decline in HbA1c at 1 year post-index date compared to Groups B and C (-1.13% Group A; +0.26% Group B, +0.16% Group C). A significantly higher proportion of patients achieved HbA1c target < 7% in Group A (Group A [45.8%]; Group B [19.1%], p < 0.0001). Using an adjusted hazard model, Group A was found to achieve the HbA1c target from the index date significantly faster than Group B (hazard ratio 3.25 [95% CI 2.87-3.69]). The most commonly prescribed second-line medications were sulfonylureas in Groups A and B throughout observation and were associated with significant weight gain (+1.3 kg per patient) in the adjusted models. CONCLUSIONS Patients who were rapidly intensified achieved a maintained reduction in HbA1c faster than those with delayed intensification or no second-line therapy, despite a higher baseline HbA1c.
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Affiliation(s)
| | | | | | | | - Anthony H Barnett
- c Diabetes and Endocrine Centre , Heart of England NHS Foundation Trust and University of Birmingham , UK
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Carracedo-Martínez E, Pia-Morandeira A. Influence of health warnings on the use of rosiglitazone and pioglitazone in an area of Spain: A time-series study. SAGE Open Med 2016; 4:2050312116653054. [PMID: 27579167 PMCID: PMC4989582 DOI: 10.1177/2050312116653054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/10/2016] [Indexed: 01/23/2023] Open
Abstract
Background: Throughout 2007 and January 2008, several glitazones health warnings were published on rosiglitazone myocardial infarction risk. The impact of such warnings on glitazones prevalence of utilization has been extensively studied in the United States but only in one European country (England), which has showed different pattern from US studies. The aim of this study is to evaluate the impact of such safety warnings on glitazones utilization in an area of another European country. Methods: We calculated the number of defined daily doses per thousand inhabitants per day of glitazones each month during the period from 2006 to 2008 in a health area of Spain. We analyzed the data graphically and through a segmented regression analysis. Results: Rosiglitazone defined daily doses per thousand inhabitants per day were growing before the safety warnings, after the warnings a change in trend occurred and rosiglitazone utilization showed a downturn slope. Pioglitazone defined daily doses per thousand inhabitants per day were stable before the safety warnings, and a linear growth was observed after the safety warnings. Throughout the study period, rosiglitazone defined daily doses per thousand inhabitants per day were higher than pioglitazone defined daily doses per thousand inhabitants per day until near the end of 2008. Conclusion: Despite the fact that cardiovascular warnings affected rosiglitazone and not pioglitazone, rosiglitazone was more utilized than pioglitazone until near the end of 2008 which is a pattern similar to the one found in another European studies in England, but very different from studies in the United States, where rosiglitazone was less utilized than pioglitazone from the first month after rosiglitazone cardiovascular safety warnings.
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Affiliation(s)
- Eduardo Carracedo-Martínez
- Santiago of Compostela Health Area, Galician Health Service (Servizo Galego de Saude (Sergas)), Spanish National Health System, Santiago de Compostela, Spain
| | - Agustin Pia-Morandeira
- Santiago of Compostela Health Area, Galician Health Service (Servizo Galego de Saude (Sergas)), Spanish National Health System, Santiago de Compostela, Spain
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Herdeiro MT, Soares S, Silva T, Roque F, Figueiras A. Impact of rosiglitazone safety alerts on oral antidiabetic sales trends: a countrywide study in Portugal. Fundam Clin Pharmacol 2016; 30:440-9. [PMID: 27259384 DOI: 10.1111/fcp.12207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/12/2016] [Accepted: 06/02/2016] [Indexed: 11/27/2022]
Abstract
Pharmacovigilance systems are important to monitor the safety of on-market drugs after approval. The aim of this study was to assess the impact of rosiglitazone safety alerts on trends in the sale of rosiglitazone and other oral antidiabetic drugs. An ecological study was conducted, using temporally aggregated data and linking safety alerts to countrywide sales of all oral antidiabetic drugs in Portugal from January 2002 to December 2012. Sales figures for oral antidiabetic drugs marketed in Portugal were supplied by IMS Health Portugal with a breakdown by active substance and fixed combinations. The number of defined daily doses per 1000 inhabitants per day (DIDs) of each oral antidiabetic drug sold to the estimated diabetic population using oral antidiabetic drugs in Portugal was calculated. Particular attention was paid to the case of rosiglitazone, with the results being adjusted for changes in rosiglitazone reimbursement policies. A total of four safety alerts were issued about rosiglitazone. Rosiglitazone sales registered an increase of 32.9% (0.202 DIDs; P < 0.001) after the first alert (risk of macular oedema or worsening of pre-existent macular oedema) in January 2006. After subsequent alerts about cardiovascular risks, this trend was not, however, repeated and sales fell. Following the January 2006 and January 2008 safety alerts, rosiglitazone sales described a long-term downward trend, with decreases of 3.75% (-0023 DIDs; P > 0.05) and 0.24% (-0.001 DIDs; P > 0.05), respectively. It is important to promote the dissemination and publication of drug safety alerts.
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Affiliation(s)
- Maria T Herdeiro
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal. .,CESPU, Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde, Rua Central de Gandra, 1317 4585-116, Gandra, Portugal.
| | - Sara Soares
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Tânia Silva
- IMS Health Portugal, Lagoas Park Edifício 3-piso, 32740-266, Oeiras, Portugal
| | - Fátima Roque
- Department of Medical Sciences and Institute for Biomedicine - iBiMED, University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal.,Research Unit for Inland Development, Polytechnic Institute of Guarda (UDI/IPG), Av. Dr. Francisco Sá Carneiro n°50, 6300-559, Guarda, Portugal
| | - Adolfo Figueiras
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), University of Santiago de Compostela, R/ de San Francisco, s/n15782, Santiago de Compostela, Spain
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Sharma S, Tandon VR, Roshi, Mahajan A. Prescribing Pattern of Oral Antihyperglycaemic Drugs, Rationality and Adherence to American Diabetes Association (ADA) Treatment Guidelines among Type 2 Diabetes Mellitus (T2DM) Postmenopausal Women. J Clin Diagn Res 2016; 10:OC11-5. [PMID: 26894107 DOI: 10.7860/jcdr/2016/16044.7063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/20/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Oral antihyperglycaemic prescription trends keep on changing and thus the drug prescription trend study may prove to be powerful exploratory tool for health care providers. AIM To investigate trends in prescriptions of oral antihyperglycaemic drugs (OHDs) among postmenopausal women suffering from T2DM in India and evaluate the rationality and adherence to ADA treatment guidelines. MATERIALS AND METHODS An observational, cross-sectional descriptive prescription audit (n=500) was carried. Postmenopausal women were interviewed in their local language using pre-tested pre validated questionnaire after verbal informed consent at a teaching tertiary care hospital of north India. Oral antihyperglycaemic drugs (OHDs) drugs were categorized as per the pharmacological classification. Adherence to available clinical practice guidelines/recommendations issued under American Diabetes Association (ADA) 2015 Guidelines as well as rationality of these prescriptions were assessed using WHO Guide to Good Prescribing. RESULTS Mean age of the study population was 58.14±12.86. Mean duration since menopause was 5.3 years and of T2DM was 9.5 years. A 93.4% of the prescriptions had only OHDs whereas 6.6% of the prescriptions had various insulin preprations + OHDs (p<0.0001). Biguanides followed by sulfonylureas, thiazolidinediones, DPP-inhibitors and alpha-glucosidases inhibitor were prescribed in 85.6%, 59.8%, 26.6%, 26% and 12.2% respectively as monotherapy or in combination. Among biguanides, metformin was the most frequently prescribed OHDs. In spite of black box warning on pioglitazone, it was prescribed in 26.6% as FDC. However, clear increase use of vidagliptine was noticed upto 26%. Among combinations most frequent was metformin plus glimipride followed by voglibose plus metformin, whereas, among FDC, metformin plus glimipride followed by metformin plus vidagliptine were most frequently prescribed. CONCLUSION Metformin was the most common OHDs to be prescribed followed by glimepiride. Although pioglitazone still continues to be prescribed after safety alert but apparently it appears that the share of pioglitazone has been shifted to vidagliptin or combinations like metformin plus glimipride. Polypharmacy, high use of FDC, & prescription by brand names were some of the irrationalities. Relatively low adherence to ADA treatment guidelines was observed.
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Affiliation(s)
- Sudhaa Sharma
- Post Graduate Student, Department of Obstetrics and Gyanecology, Government Medical College Jammu- J&K, India
| | - Vishal R Tandon
- Post Graduate Student, Department of Pharmacology, Government Medical College Jammu- J&K, India
| | - Roshi
- Post Graduate Student, Department of Pharmacology, Government Medical College Jammu- J&K, India
| | - Annil Mahajan
- Professor and Head, Department of General Medicine, Government Medical College Jammu- J&K, India
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Iczkovitz S, Dhalla D, Terres JAR. Rosiglitazone use and associated adverse event rates in Canada: an updated analysis. BMC Res Notes 2015; 8:505. [PMID: 26419903 PMCID: PMC4588901 DOI: 10.1186/s13104-015-1448-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/16/2015] [Indexed: 01/14/2023] Open
Abstract
Background We previously reported on the change in the use of rosiglitazone-containing products (RCP) and adverse event reporting rates in Canadian patients between 2004 and 2010. The present study extends this analysis to include the January 2011 to December 2012 time period. Methods RCP utilization rates were obtained from IMS Health Brogan’s longitudinal de-identified patient database, LRx. GlaxoSmithKline’s global adverse events database was used to extract adverse events (AE), serious adverse events (SAE), and cardiac adverse events (CAE) reported in Canadian patients receiving RCP from April 2004 to December 2012. The patient utilization information from the LRx database was used to estimate rates per 100,000 patients. Results An estimated 182,841 patients were dispensed RCP prescriptions between April 2004 and December 2012. The total number of patients using RCP decreased by 85 % from 2011 to 2012. From its peak use in 2007, the number of patients filling a prescription decreased 97 %. A total of 1069 AEs were reported during the study period, of which 32 AE’s were reported from Jan 2011 to Dec 2012. The average monthly reporting rates of AE’s, SAE’s and CAE’s over 2011–2012 were 10.8/100,000 patients, 9.1/100,000 patients and 5.0/100,000 patients, respectively. Conclusions The utilization of RCP in Canada has significantly declined. The significance of the adverse event rate information presented is uncertain and must be evaluated within the context of the well known factors that can influence AE reporting rates, as well as limitations to the methods used to estimate these reporting rates.
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Affiliation(s)
- Sandra Iczkovitz
- Medical Affairs, GlaxoSmithKline Inc., 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada.
| | - Daniella Dhalla
- Medical Affairs, GlaxoSmithKline Inc., 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada.
| | - Jorge A Ross Terres
- Medical Affairs, GlaxoSmithKline Inc., 7333 Mississauga Road, Mississauga, ON, L5N 6L4, Canada. .,GlaxoSmithKline Inc., 2301 Renaissance Boulevard, King of Prussia, PA, 19406, USA.
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Hamada S, Gulliford MC. Antidiabetic and cardiovascular drug utilisation in patients diagnosed with type 2 diabetes mellitus over the age of 80 years: a population-based cohort study. Age Ageing 2015; 44:566-73. [PMID: 26015163 PMCID: PMC4476852 DOI: 10.1093/ageing/afv065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND there is a lack of evidence to inform treatment recommendations for very old people with type 2 diabetes mellitus (T2DM). OBJECTIVE to evaluate trends in antidiabetic and cardiovascular drug utilisation for patients developing T2DM over 80 years of age. METHODS a population-based cohort was sampled from the UK Clinical Practice Research Datalink between 1990 and 2013. Eligible patients were those with T2DM diagnosed after the age of 80 years and prescribed antidiabetic drugs. RESULTS twelve thousand eight hundred and eighty-one patients, with 61% of females, were included. From 1990 to 2013, use of sulphonylureas declined from 94 to 29%, while metformin use increased from 22 to 86%. Prescribing of antihypertensive drugs increased substantially from 46 to 77%, lipid-lowering drugs from 1 to 64%, antiplatelets from 34 to 47% and oral anticoagulants from 5 to 19%. Women were more frequently prescribed antihypertensive drugs (odds ratio 1.26, 95% confidence interval 1.17 to 1.37) but less prescribed antiplatelets (0.83, 0.78 to 0.89). Compared with those diagnosed with T2DM from 80 to 89 years (n = 11,467, 89%), patients diagnosed after the age of 90 years (n = 1,414, 11%) were less likely to be prescribed insulin (0.37, 0.24 to 0.58), metformin (0.67, 0.60 to 0.75), antihypertensive drugs (0.42, 0.38 to 0.48), lipid-lowering drugs (0.26, 0.23 to 0.30) and anticoagulants (0.55, 0.44 to 0.68). CONCLUSIONS there have been major increases in the intensity of pharmacological management of patients diagnosed with T2DM over 80 years of age, but the effectiveness and safety of these interventions in very old people require further evaluation.
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Affiliation(s)
- Shota Hamada
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Martin C Gulliford
- Department of Primary Care and Public Health Sciences and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St. Thomas' NHS Foundation Trust, King's College London, London, UK
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Hartung DM, Middleton L, Markwardt S, Williamson K, Ketchum K. Changes in long-acting β-agonist utilization after the FDA's 2010 drug safety communication. Clin Ther 2014; 37:114-123.e1. [PMID: 25465946 DOI: 10.1016/j.clinthera.2014.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/24/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE In February 2010, the US Food and Drug Administration (FDA) issued new recommendations for the safe use of long-acting β-agonists (LABAs) in patients with asthma. The objective of this study was to determine the impact of the FDA's 2010 safety advisory on LABA utilization. METHODS Using administrative data from the Oregon Medicaid program, we performed an interrupted time series regression to evaluate changes in the trend in new LABA prescriptions before and after the FDA's 2010 advisory. Trends in incident fills were examined among those with and without an asthma diagnosis code and previous respiratory controller medication use; trends were also assessed according to patient age. FINDINGS The average age of the 8646 study patients was 37 years, 53% had a diagnosis of asthma, 21% had no respiratory diagnosis, and 32% had not used a respiratory controller medication in the recent past. The trend in new LABA prescriptions declined by 0.09 new start per 10,000 patients per month (95% CI, -0.19 to -0.01) after the FDA's advisory. Among those with a diagnosis of asthma, there was an immediate drop of 0.48 (95% CI, -0.93 to -0.03) and a 0.10 (95% CI, -0.13 to -0.06) decline in the monthly rate of new starts per 10,000 patients. Immediately after the FDA's advisory, we observed a statistically significant 4.7% increase (95% CI, 0.8 to 8.7) in the proportion of new LABA starts with history of previous respiratory controller medication use. Utilization of LABAs did not change in those without a diagnosis of asthma. IMPLICATIONS The FDA's 2010 advisory was associated with modest reductions in LABA utilization overall and in ways highlighted in their recommendations.
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Affiliation(s)
- Daniel M Hartung
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon.
| | - Luke Middleton
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
| | - Sheila Markwardt
- Oregon Health & Science University, Department of Public Health & Preventive Medicine, Portland, Oregon
| | - Kaylee Williamson
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
| | - Kathy Ketchum
- Oregon State University/Oregon Health & Science University, College of Pharmacy, Portland, Oregon
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Davies NA, Watkeys L, Butcher L, Potter S, Hughes MG, Moir H, Morris K, Thomas AW, Webb R. The contributions of oxidative stress, oxidised lipoproteins and AMPK towards exercise-associated PPARγ signalling within human monocytic cells. Free Radic Res 2014; 49:45-56. [DOI: 10.3109/10715762.2014.978311] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Type 2 diabetes is caused by insulin resistance coupled with an inability to produce enough insulin to control blood glucose, and thiazolidinediones (TZDs) are the only current antidiabetic agents that function primarily by increasing insulin sensitivity. However, despite clear benefits in glycemic control, this class of drugs has recently fallen into disuse due to concerns over side effects and adverse events. Here we review the clinical data and attempt to balance the benefits and risks of TZD therapy. We also examine potential mechanisms of action for the beneficial and harmful effects of TZDs, mainly via agonism of the nuclear receptor PPARγ. Based on critical appraisal of both preclinical and clinical studies, we discuss the prospect of harnessing the insulin sensitizing effects of PPARγ for more effective, safe, and potentially personalized treatments of type 2 diabetes.
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Affiliation(s)
- Raymond E Soccio
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Department of Genetics, and The Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eric R Chen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Department of Genetics, and The Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mitchell A Lazar
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Department of Genetics, and The Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Comment on: prescribing of rosiglitazone and pioglitazone following safety signals analysis of trends in dispensing patterns in The Netherlands from 1998 to 2008. Drug Saf 2014; 37:1069-70. [PMID: 25249047 DOI: 10.1007/s40264-014-0227-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Punthakee Z, Alméras N, Després JP, Dagenais GR, Anand SS, Hunt DL, Sharma AM, Jung H, Yusuf S, Gerstein HC. Impact of rosiglitazone on body composition, hepatic fat, fatty acids, adipokines and glucose in persons with impaired fasting glucose or impaired glucose tolerance: a sub-study of the DREAM trial. Diabet Med 2014; 31:1086-92. [PMID: 24890138 DOI: 10.1111/dme.12512] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/01/2014] [Accepted: 05/30/2014] [Indexed: 11/29/2022]
Abstract
AIMS Thiazolidinediones reduce ectopic fat, increase adiponectin and reduce inflammatory adipokines, fatty acids and glucose in people with Type 2 diabetes. We aimed to measure these effects in people with impaired fasting glucose and/or impaired glucose tolerance. METHODS After approximately 3.5 years of exposure to rosiglitazone 8 mg (n = 88) or placebo (n = 102), 190 DREAM trial participants underwent abdominal computed tomography and dual-energy X-ray absorptiometry scans. Visceral and subcutaneous adipose tissue areas, estimated hepatic fat content, total fat and lean mass were calculated and changes in levels of fasting adipokines, free fatty acids, glucose and post-load glucose were assessed. RESULTS Compared with the placebo, participants on rosiglitazone had no difference in lean mass, had 4.1 kg more body fat (P < 0.0001) and 31 cm(2) more subcutaneous abdominal adipose tissue area (P = 0.007). Only after adjusting for total fat, participants on rosiglitazone had 23 cm² less visceral adipose tissue area (P = 0.01) and an 0.08-unit higher liver:spleen attenuation ratio (i.e. less hepatic fat; P = 0.02) than those on the placebo. Adiponectin increased by 15.0 μg/ml with rosiglitazone and by 0.4 μg/ml with placebo (P < 0.0001). Rosiglitazone's effect on fat distribution was not independent of changes in adiponectin. Rosiglitazone's effects on fasting (-0.36 mmol/l; P = 0.0004) and 2-h post-load glucose (-1.21 mmol/l; P = 0.0008) were not affected by adjustment for fat distribution or changes in adiponectin or free fatty acids. CONCLUSIONS In people with impaired fasting glucose/impaired glucose tolerance, rosiglitazone is associated with relatively less hepatic and visceral fat, increased subcutaneous fat and increased adiponectin levels. These effects do not appear to explain the glucose-lowering effect of rosiglitazone.
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Affiliation(s)
- Z Punthakee
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Baviera M, Cortesi L, Tettamanti M, Avanzini F, Marelli G, Marzona I, Nobili A, Riva E, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Changes in prescribing patterns and clinical outcomes in elderly diabetic patients in 2000 and 2010: analysis of a large Italian population-based study. Eur J Clin Pharmacol 2014; 70:965-74. [DOI: 10.1007/s00228-014-1678-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 03/31/2014] [Indexed: 01/21/2023]
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Morales E, Sakurai R, Husain S, Paek D, Gong M, Ibe B, Li Y, Husain M, Torday JS, Rehan VK. Nebulized PPARγ agonists: a novel approach to augment neonatal lung maturation and injury repair in rats. Pediatr Res 2014; 75:631-40. [PMID: 24488089 PMCID: PMC4016987 DOI: 10.1038/pr.2014.8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/26/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND By stimulating lipofibroblast maturation, parenterally administered peroxisome proliferator-activated receptor γ (PPARγ) agonists promote lung homeostasis and injury repair in the neonatal lung. In this study, we determined whether PPARγ agonists could be delivered effectively via nebulization to neonates, and whether this approach would also protect against hyperoxia-induced lung injury. METHODS One-day old Sprague-Dawley rat pups were administered PPARγ agonists rosiglitazone (RGZ, 3 mg/kg), pioglitazone (PGZ, 3 mg/kg), or the diluent, via nebulization every 24 h; animals were exposed to 21% or 95% O2 for up to 72 h. Twenty-four and 72 h following initial nebulization, the pups were sacrificed for lung tissue and blood collection to determine markers of lung maturation, injury repair, and RGZ and PGZ plasma levels. RESULTS Nebulized RGZ and PGZ enhanced lung maturation in both males and females, as evidenced by the increased expression of markers of alveolar epithelial and mesenchymal maturation. This approach also protected against hyperoxia-induced lung injury, since hyperoxia-induced changes in bronchoalveolar lavage cell and protein contents and lung injury markers were all blocked by nebulized PGZ. CONCLUSION Nebulized PPARγ agonist administration promotes lung maturation and prevents neonatal hyperoxia-induced lung injury in both males and females.
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Affiliation(s)
- Edith Morales
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA,Children’s Hospital Orange County, Orange, CA
| | - Reiko Sakurai
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Sumair Husain
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Dave Paek
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Ming Gong
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Basil Ibe
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Yishi Li
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Maleha Husain
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - John S. Torday
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
| | - Virender K. Rehan
- Departments of Pediatrics, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, David Geffen School of Medicine at UCLA, Torrance, CA
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Niyomnaitham S, Page A, La Caze A, Whitfield K, Smith AJ. Utilisation trends of rosiglitazone and pioglitazone in Australia before and after safety warnings. BMC Health Serv Res 2014; 14:151. [PMID: 24708579 PMCID: PMC3994196 DOI: 10.1186/1472-6963-14-151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background A see on cardiovascular diseases and bladder cancer. The changes to the patterns of rosiglitazone and pioglitazone utilisation in Australia following the timing of these various health authority warnings such as the Australian Therapeutic Good Administration (TGA), European Medicines Agency (EMA) press releases or U.S. Food and Drug Administration (FDA) is unknown. This study investigated the utilisation patterns of rosiglitazone and pioglitazone in Australia before and after warnings of major drug authorities. Methods We evaluated rosiglitazone and pioglitazone dispensing using the Pharmaceutical Benefit Scheme (PBS) subsidised drug dispensing data for the Australian population from February 2004 to July 2012. The World Health Organisation Anatomic Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) system was used to compare the drug utilisation patterns following the announcements of EMA, FDA, and TGA safety warnings, which first occurred in May 2007. The DDD/1000population/day were examined in a series of time-series regression analysis with the drug safety warnings specified as interventions. Results Rosiglitazone utilisation increased steadily from 2004 until reaching a peak at 1.96/1000population/day in January 2007. Then rosiglitazone use decreased significantly after the initial EMA press release and FDA warning on cardiovascular risk in May 2007 (with a 15.04% average monthly decline, p-value <0.001), however use did not significantly decrease after the TGA warning or subsequent EMA and FDA warnings. Pioglitazone utilisation proceeded rosiglitazone in September 2008 and remained above 1.5/1000/day during 2009–2010. However, pioglitazone utilisation has slightly declined after the FDA, EMA, and TGA warnings related to bladder cancer. Conclusions Drug safety warnings were associated with a decrease in rosiglitazone and pioglitazone utilisation in Australia. Rosiglitazone began to decline prior to TGA warnings in December 2007, which suggests that Australian prescribers may have acted in response to scientific evidence or international safety warnings (EMA, FDA), prior to the response of the TGA. Minor effects were observed after bladder cancer warnings on pioglitazone utilisation.
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Affiliation(s)
- Suvimol Niyomnaitham
- School of Pharmacy, University of Queensland, 20 Cornwall Street, Woolloongabba, Australia.
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Kashour T, AL-Tannir M, Bahamid R. Changing Prescription Pattern of Omeprazole Among Patients Receiving Clopidogrel. Int Heart J 2014; 55:93-5. [DOI: 10.1536/ihj.13-169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Tarek Kashour
- Department of Interventional Cardiology, Cardiac Center, King Khalid Hospital
| | - Mohamad AL-Tannir
- Department of Clinical and Applied Research, Research and Publication Center
| | - Reem Bahamid
- Prince Salman Heart Center, King Fahad Medical City
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