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Pennap D, Swain RS, Akhtar S, Liao J, Wei Y, Li J, Wernecke M, MaCurdy TE, Kelman JA, Mosholder AD, Graham DJ. Comparing the Centers for Medicare and Medicaid Services (CMS) enrollment data death dates to the National Death Index (NDI). Pharmacoepidemiol Drug Saf 2024; 33:e5772. [PMID: 38449020 DOI: 10.1002/pds.5772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE In the United States, the National Death Index (NDI) is the most complete source of death information, while epidemiologic studies with mortality outcomes often rely on U.S. Medicare data for outcome ascertainment. The purpose of this study was to assess the agreement of death information between the Centers for Medicare & Medicaid Services (CMS) Medicare enrolment data and NDI. METHODS Using Medicare and NDI data from 1999 through 2016, we identified Medicare beneficiaries who were reported dead in the CMS Medicare enrolment database (EDB) and Common Medicare Environment (CME), linked these beneficiaries to the NDI using CMS Health Insurance Claim number, and compared death dates between the two data sources. To assess agreement between our data sources, we calculated kappa scores; where a kappa of 1 indicates perfect agreement and a kappa of 0 indicates agreement equivalent to chance. We also examined CMS to NDI linkage and death date matching for stability over time. RESULTS Of the 36 785 640, Medicare beneficiaries reported dead in CMS enrollment data from 1999 to 2016, 97.5% were linked to the NDI. A kappa score of 0.98 showed a near perfect agreement between NDI and CMS reported deaths. The percentage of linked cases exactly matching on death dates increased from 94.8% in 1999 to 99.4% in 2016. CONCLUSIONS Our findings suggest strong concordance between death dates as recorded by CMS enrollment data and the NDI in the entire Medicare population.
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Affiliation(s)
- Dinci Pennap
- Formerly Division of Epidemiology, U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | - Richard S Swain
- Formerly Division of Epidemiology, U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | | | | | - Yuqin Wei
- Acumen LLC, Burlingame, California, USA
| | - Jiaqi Li
- Acumen LLC, Burlingame, California, USA
| | | | - Thomas E MaCurdy
- Acumen LLC, Burlingame, California, USA
- Department of Economics, Stanford University, Stanford, California, USA
| | - Jeffrey A Kelman
- Centers for Medicare and Medicaid Services, Washington, District of Columbia, USA
| | - Andrew D Mosholder
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
| | - David J Graham
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, Maryland, USA
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Simon GE, Cruz M, Shortreed SM, Sterling SA, Coleman KJ, Ahmedani BK, Yaseen ZS, Mosholder AD. Stability of Suicide Risk Prediction Models During Changes in Health Care Delivery. Psychiatr Serv 2024; 75:139-147. [PMID: 37587793 DOI: 10.1176/appi.ps.20230172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
OBJECTIVE The authors aimed to use health records data to examine how the accuracy of statistical models predicting self-harm or suicide changed between 2015 and 2019, as health systems implemented suicide prevention programs. METHODS Data from four large health systems were used to identify specialty mental health visits by patients ages ≥11 years, assess 311 potential predictors of self-harm (including demographic characteristics, historical risk factors, and index visit characteristics), and ascertain fatal or nonfatal self-harm events over 90 days after each visit. New prediction models were developed with logistic regression with LASSO (least absolute shrinkage and selection operator) in random samples of visits (65%) from each calendar year and were validated in the remaining portion of the sample (35%). RESULTS A model developed for visits from 2009 to mid-2015 showed similar classification performance and calibration accuracy in a new sample of about 13.1 million visits from late 2015 to 2019. Area under the receiver operating characteristic curve (AUC) ranged from 0.840 to 0.849 in the new sample, compared with 0.851 in the original sample. New models developed for each year for 2015-2019 had classification performance (AUC range 0.790-0.853), sensitivity, and positive predictive value similar to those of the previously developed model. Models selected similar predictors from 2015 to 2019, except for more frequent selection of depression questionnaire data in later years, when questionnaires were more frequently recorded. CONCLUSIONS A self-harm prediction model developed with 2009-2015 visit data performed similarly when applied to 2015-2019 visits. New models did not yield superior performance or identify different predictors.
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Affiliation(s)
- Gregory E Simon
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Maricela Cruz
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Susan M Shortreed
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Stacy A Sterling
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Karen J Coleman
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Brian K Ahmedani
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Zimri S Yaseen
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
| | - Andrew D Mosholder
- Washington Health Research Institute, Kaiser Permanente, Seattle (Simon, Cruz, Shortreed); Bernard J. Tyson School of Medicine (Simon, Coleman) and Southern California Department of Research and Evaluation (Coleman), Kaiser Permanente, Pasadena; Department of Biostatistics, University of Washington, Seattle (Cruz, Shortreed); Northern California Division of Research, Kaiser Permanente, Oakland (Sterling); Henry Ford Health Center for Health Services Research, Detroit (Ahmedani); U.S. Food and Drug Administration (FDA), Silver Spring, Maryland (Yaseen, Mosholder)
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3
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Simon GE, Shortreed SM, Johnson E, Yaseen ZS, Stone M, Mosholder AD, Ahmedani BK, Coleman KJ, Coley RY, Penfold RB, Toh S. Predicting risk of suicidal behavior from insurance claims data vs. linked data from insurance claims and electronic health records. Pharmacoepidemiol Drug Saf 2024; 33:e5734. [PMID: 38112287 PMCID: PMC10843611 DOI: 10.1002/pds.5734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Observational studies assessing effects of medical products on suicidal behavior often rely on health record data to account for pre-existing risk. We assess whether high-dimensional models predicting suicide risk using data derived from insurance claims and electronic health records (EHRs) are superior to models using data from insurance claims alone. METHODS Data were from seven large health systems identified outpatient mental health visits by patients aged 11 or older between 1/1/2009 and 9/30/2017. Data for the 5 years prior to each visit identified potential predictors of suicidal behavior typically available from insurance claims (e.g., mental health diagnoses, procedure codes, medication dispensings) and additional potential predictors available from EHRs (self-reported race and ethnicity, responses to Patient Health Questionnaire or PHQ-9 depression questionnaires). Nonfatal self-harm events following each visit were identified from insurance claims data and fatal self-harm events were identified by linkage to state mortality records. Random forest models predicting nonfatal or fatal self-harm over 90 days following each visit were developed in a 70% random sample of visits and validated in a held-out sample of 30%. Performance of models using linked claims and EHR data was compared to models using claims data only. RESULTS Among 15 845 047 encounters by 1 574 612 patients, 99 098 (0.6%) were followed by a self-harm event within 90 days. Overall classification performance did not differ between the best-fitting model using all data (area under the receiver operating curve or AUC = 0.846, 95% CI 0.839-0.854) and the best-fitting model limited to data available from insurance claims (AUC = 0.846, 95% CI 0.838-0.853). Competing models showed similar classification performance across a range of cut-points and similar calibration performance across a range of risk strata. Results were similar when the sample was limited to health systems and time periods where PHQ-9 depression questionnaires were recorded more frequently. CONCLUSION Investigators using health record data to account for pre-existing risk in observational studies of suicidal behavior need not limit that research to databases including linked EHR data.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Zimri S Yaseen
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Marc Stone
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Karen J Coleman
- Department of Health Systems Science, Bernard J. Tyson Kaiser Permanente School of Medicine, Pasadena, California, USA
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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Graham DJ, Izurieta HS, Zhang D, Avagyan A, Lyu H, Wiederhorn R, Lu Y, Mosholder AD, Smith ER, Zhao Y, Shangguan S, Tsai HT, Pennap D, Sandhu AT, Wernecke M, MaCurdy TE, Kelman JA, Forshee RA. Risk of Severe COVID-19 in Prevalent Users of Alpha-1 Adrenergic Receptor Antagonists: A National Case-Control Study of Medicare Beneficiaries. Am J Med 2023; 136:1018-1025.e3. [PMID: 37454868 DOI: 10.1016/j.amjmed.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Alpha-1 adrenergic receptor antagonists prevent cytokine storm in mouse sepsis models. This led to the hypothesis that alpha-1 blockers may prevent severe coronavirus disease 2019 (COVID-19), which is characterized by hypercytokinemia and progressive respiratory failure. METHODS We performed an observational case-control study in male Medicare beneficiaries aged 65 years or older, with or without benign prostatic hyperplasia (BPH), and treated with alpha-1 receptor blockers or 5-alpha reductase inhibitors. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated for outcomes of uncomplicated and severe COVID-19 hospitalization (intensive care unit admission, invasive mechanical ventilation, or death). RESULTS There were 20,963 cases of hospitalized COVID-19 matched to 101,161 controls on calendar date and neighborhood of residence. In the primary analysis (males with BPH), there was no difference in risk of uncomplicated COVID-19 hospitalization (aOR 1.08, 95% CI 0.996-1.17) or hospitalization with severe complications (aOR 0.97, 95% CI 0.88-1.08). In the secondary analysis (males with or without BPH), the corresponding aORs were 1.02 (95% CI, 0.96-1.09) (uncomplicated) and 0.99 (95% CI, 0.91-1.07) (complicated), respectively. Subgroup and sensitivity analyses yielded similar results. Of note, there was no difference in risk of severe COVID-19 hospitalization when comparing non-selective vs selective alpha-1 blocker use (aOR 0.98, 95% CI 0.86-1.10), higher- vs lower-dose alpha-1 blocker use (aOR 0.96, 95% CI 0.86-1.08), or current vs remote alpha-1 blocker use (aOR 1.04, 95% CI 0.91-1.18). CONCLUSIONS Prevalent use of alpha-1 receptor blockers was not associated with a protective or harmful effect on risk of uncomplicated or severe hospitalized COVID-19.
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Affiliation(s)
- David J Graham
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md.
| | - Hector S Izurieta
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Di Zhang
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | | | - Roger Wiederhorn
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Yun Lu
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Andrew D Mosholder
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | - Yueqin Zhao
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | | | - Huei-Ting Tsai
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Dinci Pennap
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
| | - Alexander T Sandhu
- Acumen, LLC; Division of Cardiology, Department of Medicine, Stanford University, Calif
| | | | - Thomas E MaCurdy
- Acumen, LLC; Department of Economics, Stanford University, Calif
| | | | - Richard A Forshee
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Md
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Apata J, Pennap DD, Mosholder AD. The use of analgesics for intentional self-poisoning: Trends in U.S. poison center data. J Psychiatr Res 2023; 163:402-405. [PMID: 37270880 DOI: 10.1016/j.jpsychires.2023.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
In the U.S., intentional self-poisonings with analgesics that are available without a prescription increased from 2000 to 2018. Given concerns regarding mental health outcomes during the COVID-19 pandemic, we examined and compared trends in pediatric and adult intentional self-poisoning with acetaminophen, aspirin, ibuprofen, and naproxen from 2016 to 2021 using the National Poison Data System (NPDS) to see if these trends have continued. We extracted annual case counts of all suspected suicide attempts from intentional poisoning, and of suspected suicide attempts resulting in major effects or death, from the NPDS for non-prescription single ingredient adult formulation acetaminophen, non-prescription single ingredient adult formulation aspirin, single ingredient formulation ibuprofen, and single ingredient formulation naproxen. We enumerated the cases by year, age, and gender. Most cases of intentional self-poisoning within the review period involved acetaminophen and ibuprofen and the 13-19-year-olds constituted the highest proportion of intentional self-poisoning cases across age groups for all four analgesics. Cases involving females predominated cases involving males by 3:1 or greater. The 13-19-year-old age group also represented the largest proportion of cases that resulted in major clinical effects or deaths. An increasing trend in suicide poisoning cases with acetaminophen and ibuprofen was observed in the 6-19-years age group and this trend appeared to exacerbate from 2020 to 2021 corresponding with the start of the COVID-19 pandemic period.
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Affiliation(s)
- Jummai Apata
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology 1, Silver Spring, MD, United States
| | - Dinci D Pennap
- Formerly U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology 1, Silver Spring, MD, United States
| | - Andrew D Mosholder
- U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology 1, Silver Spring, MD, United States.
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Simon GE, Shortreed SM, Boggs JM, Clarke GN, Rossom RC, Richards JE, Beck A, Ahmedani BK, Coleman KJ, Bhakta B, Stewart CC, Sterling S, Schoenbaum M, Coley RY, Stone M, Mosholder AD, Yaseen ZS. Accuracy of ICD-10-CM encounter diagnoses from health records for identifying self-harm events. J Am Med Inform Assoc 2022; 29:2023-2031. [PMID: 36018725 PMCID: PMC9667165 DOI: 10.1093/jamia/ocac144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/02/2022] [Accepted: 08/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Assess the accuracy of ICD-10-CM coding of self-harm injuries and poisonings to identify self-harm events. MATERIALS AND METHODS In 7 integrated health systems, records data identified patients reporting frequent suicidal ideation. Records then identified subsequent ICD-10-CM injury and poisoning codes indicating self-harm as well as selected codes in 3 categories where uncoded self-harm events might be found: injuries and poisonings coded as undetermined intent, those coded accidental, and injuries with no coding of intent. For injury and poisoning encounters with diagnoses in those 4 groups, relevant clinical text was extracted from records and assessed by a blinded panel regarding documentation of self-harm intent. RESULTS Diagnostic codes selected for review include all codes for self-harm, 43 codes for undetermined intent, 26 codes for accidental intent, and 46 codes for injuries without coding of intent. Clinical text was available for review for 285 events originally coded as self-harm, 85 coded as undetermined intent, 302 coded as accidents, and 438 injury events with no coding of intent. Blinded review of full-text clinical records found documentation of self-harm intent in 254 (89.1%) of those originally coded as self-harm, 24 (28.2%) of those coded as undetermined, 24 (7.9%) of those coded as accidental, and 48 (11.0%) of those without coding of intent. CONCLUSIONS Among patients at high risk, nearly 90% of injuries and poisonings with ICD-10-CM coding of self-harm have documentation of self-harm intent. Reliance on ICD-10-CM coding of intent to identify self-harm would fail to include a small proportion of true self-harm events.
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Affiliation(s)
- Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Susan M Shortreed
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Gregory N Clarke
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | | | - Julie E Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, Denver, Colorado, USA
| | - Brian K Ahmedani
- Center for Health Policy and Services Research, Henry Ford Health, Detroit, Michigan, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Bhumi Bhakta
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California, USA
| | - Christine C Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Stacy Sterling
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | | | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Marc Stone
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | | | - Zimri S Yaseen
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
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Mosholder AD, Ma Y, Akhtar S, Podskalny GD, Feng Y, Lyu H, Liao J, Wei Y, Wernecke M, Leishear K, Nelson LM, MaCurdy TE, Kelman JA, Graham DJ. Mortality Among Parkinson's Disease Patients Treated With Pimavanserin or Atypical Antipsychotics: An Observational Study in Medicare Beneficiaries. Am J Psychiatry 2022; 179:553-561. [PMID: 35702829 DOI: 10.1176/appi.ajp.21090876] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pimavanserin, a serotonin 5-HT2 antagonist, is indicated for treatment of hallucinations and delusions associated with Parkinson's disease psychosis. In premarketing trials in patients with Parkinson's disease psychosis, 11% of patients died during open-label pimavanserin treatment. Antipsychotics, which are used off-label in Parkinson's disease psychosis, increase mortality in dementia patients. The authors compared mortality with pimavanserin and atypical antipsychotics in a large database. METHODS This was a retrospective new-user cohort study of Medicare beneficiaries with Parkinson's disease initiating pimavanserin (N=3,227) or atypical antipsychotics (N=18,442) from April 2016 to March 2019. All-cause mortality hazard ratios and 95% confidence intervals were estimated for pimavanserin compared with atypical antipsychotics, using segmented proportional hazards regression over 1-180 and 181+ days of treatment. Potential confounding was addressed through inverse probability of treatment weighting (IPTW). RESULTS Pimavanserin users had a mean age of approximately 78 years, and 45% were female. Before IPTW, some comorbidities were more prevalent in atypical antipsychotic users; after IPTW, comorbidities were well balanced between groups. In the first 180 days of treatment, mortality was approximately 35% lower with pimavanserin than with atypical antipsychotics (hazard ratio=0.65, 95% CI=0.53, 0.79), with approximately one excess death per 30 atypical antipsychotic-treated patients; however, during treatment beyond 180 days, there was no additional mortality advantage with pimavanserin (hazard ratio=1.05, 95% CI=0.82, 1.33). Pimavanserin showed no mortality advantage in nursing home patients. CONCLUSIONS Pimavanserin use was associated with lower mortality than atypical antipsychotic use during the first 180 days of treatment, but only in community-dwelling patients, not nursing home residents.
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Affiliation(s)
- Andrew D Mosholder
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yong Ma
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Sandia Akhtar
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Gerald D Podskalny
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yuhui Feng
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Hai Lyu
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Jiemin Liao
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Yuqin Wei
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Michael Wernecke
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Kira Leishear
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Lorene M Nelson
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Thomas E MaCurdy
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - Jeffrey A Kelman
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
| | - David J Graham
- Division of Epidemiology 1 (Mosholder, Leishear), Division of Neurology 1 (Podskalny), Office of Pharmacovigilance and Epidemiology (Graham), and Division of Biometrics 7 (Ma), U.S. Food and Drug Administration Center for Drug Evaluation and Research, Silver Spring, Md.; Acumen LLC, Burlingame, Calif. (Akhtar, Feng, Lyu, Liao, Wei, Wernecke, Nelson, MaCurdy); Guardant Health, Redwood City, Calif. (Liao); Department of Epidemiology and Population Health (Nelson) and Department of Economics (MaCurdy), Stanford University, Stanford, Calif.; Centers for Medicare and Medicaid Services, Washington, DC (Kelman)
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8
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Hada M, Mosholder AD, Leishear K, Perez-Vilar S. Systematic review of risk of SARS-CoV-2 infection and severity of COVID-19 with therapies approved to treat multiple sclerosis. Neurol Sci 2022; 43:1557-1567. [PMID: 35006442 PMCID: PMC8743352 DOI: 10.1007/s10072-021-05846-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/19/2021] [Indexed: 12/15/2022]
Abstract
There is growing concern that multiple sclerosis (MS) patients on certain therapies may be at higher risk for severe coronavirus disease 2019 (COVID-19). We conducted a systematic literature review to examine the available data on U.S. therapies approved to treat MS and the risk of SARS-CoV-2 infection or severe COVID-19 outcomes. We conducted searches in PubMed, Embase, and the WHO COVID-19 database through May 2, 2021, and retrieved articles describing clinical data on therapies approved to treat MS and the risk of infection with SARS-CoV-2 or the effects of such therapies on clinical outcomes of COVID-19. The literature search identified a total of 411 articles: 97 in PubMed, 227 in Embase, and 87 in the WHO database. After excluding duplicates and screening, we identified 15 articles of interest. We identified an additional article through a broader secondary weekly search in PubMed. Thus, ultimately, we reviewed 16 observational studies. Available data, which suggest that MS patients treated with anti-CD20 monoclonal antibodies may be at increased risk for severe COVID-19, are subject to relevant limitations. Generally, studies did not identify increased risk for COVID-19 worsening with other therapies approved to treat MS. Based on observational data, biological plausibility, novelty of the drug-event association, and public health implications in a subpopulation with potential impaired response to the COVID-19 vaccines, this safety signal merits further monitoring.
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Affiliation(s)
- Manila Hada
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Room 2481, Silver Spring, MD, 20993-0002, USA
| | - Andrew D Mosholder
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Room 2481, Silver Spring, MD, 20993-0002, USA
| | - Kira Leishear
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Room 2481, Silver Spring, MD, 20993-0002, USA
| | - Silvia Perez-Vilar
- Division of Epidemiology I, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave., Bldg. 22, Room 2481, Silver Spring, MD, 20993-0002, USA.
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9
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Pennap DD, Swain RS, Welch EC, Bohn J, Lyons JG, Dutcher S, Mosholder AD. Risk of hospitalized depression and intentional self-harm with brand and authorized generic sertraline. J Affect Disord 2022; 296:635-641. [PMID: 34619154 DOI: 10.1016/j.jad.2021.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent suggestions of therapeutic inequivalence of brand and generic sertraline have raised concerns about disproportionately higher adverse events among generic users. OBJECTIVE To assess the impact of confounding in a comparison of the risks of worsening depression and intentional self-harm (ISH) between users of brand name sertraline and its pharmaceutically equivalent authorized generic (AG). METHODS Using a retrospective new-user cohort design, we identified patients with a diagnosis code for depression aged ≥12 years who were continuously enrolled in a Sentinel Data Partner health plan for ≥180 days before their first sertraline dispensing between June 30, 2006 and September 30, 2015. New use was defined as no evidence of sertraline dispensing in the 180 days before index date. We matched each brand name user to up to 10 AG users using propensity scores (PS) and conducted case-centered logistic regression to assess the risks of hospitalized depression and ISH. RESULTS Before PS matching, brand name users were significantly less likely to be hospitalized for depression [Hazard Ratio (HR) = 0.70 (95% confidence interval (CI): 0.53-0.94)]. However, in the matched analysis, we observed no statistical difference between brand and AG users [HR = 0.84 (95% CI: 0.59-1.21)]. The risk of ISH did not significantly differ between the exposure groups in unmatched (HR = 0.99 (95% CI: 0.60-1.62) and matched analyses [HR = 0.91 (95% CI: 0.49-1.70). CONCLUSION In depressed patients receiving brand versus AG sertraline, patient characteristics confounded the association with hospitalization. Baseline differences were ameliorated by PS matching resulting in no statistical difference between brand and AG sertraline users.
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Affiliation(s)
- Dinci D Pennap
- U.S. Food and Drug Administration Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring MD, United States.
| | - Richard S Swain
- U.S. Food and Drug Administration Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring MD, United States
| | - Emily C Welch
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA, United States
| | - Justin Bohn
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA, United States
| | - Jennifer G Lyons
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA, United States
| | - Sarah Dutcher
- U.S. Food and Drug Administration Center for Drug Evaluation and Research, Regulatory Science Staff, Silver Spring MD, United States
| | - Andrew D Mosholder
- U.S. Food and Drug Administration Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring MD, United States
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10
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Swain RS, Taylor LG, Braver ER, Liu W, Pinheiro SP, Mosholder AD. A systematic review of validated suicide outcome classification in observational studies. Int J Epidemiol 2020; 48:1636-1649. [PMID: 30907424 DOI: 10.1093/ije/dyz038] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. METHODS We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. RESULTS We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2-19% sensitivity, and 83-100% positive predictive value (PPV). ICD algorithms that included events with 'uncertain' intent had 4-70% PPV. The three best-performing algorithms had 74-92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14-68% sensitivity and 0-56% PPV. Studies estimated 19-80% sensitivity for chart review, and 41-97% sensitivity and 100% PPV for vital records. CONCLUSIONS Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.
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Affiliation(s)
- Richard S Swain
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Lockwood G Taylor
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Elisa R Braver
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Wei Liu
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Simone P Pinheiro
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
| | - Andrew D Mosholder
- Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
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11
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Pennap DD, Mosholder AD, Swain RS. Challenges of Suicide Outcomes Ascertainment in Administrative Claims Databases. JAMA Psychiatry 2020; 77:101. [PMID: 31483450 DOI: 10.1001/jamapsychiatry.2019.2338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dinci D Pennap
- US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring, Maryland
| | - Andrew D Mosholder
- US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring, Maryland
| | - Richard S Swain
- US Food and Drug Administration, Center for Drug Evaluation and Research, Division of Epidemiology I, Silver Spring, Maryland
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12
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Mosholder AD, Kim J, Davis M, Farchione TR. Re: "Dasotraline in Children with Attention-Deficit/Hyperactivity Disorder: A Six-Week, Placebo-Controlled, Fixed-Dose Trial" by Findling et al. (J Child Adolesc Psychopharmacol 2019;29:80-89). J Child Adolesc Psychopharmacol 2019; 29:725. [PMID: 31094581 DOI: 10.1089/cap.2019.0061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Andrew D Mosholder
- Divisions of Epidemiology 1, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Jean Kim
- Divisions of Psychiatric Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Michael Davis
- Divisions of Psychiatric Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Tiffany R Farchione
- Divisions of Psychiatric Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland
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13
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Taylor LG, Panucci G, Mosholder AD, Toh S, Huang TY. Antipsychotic Use and Stroke: A Retrospective Comparative Study in a Non-Elderly Population. J Clin Psychiatry 2019; 80. [PMID: 31163104 DOI: 10.4088/jcp.18m12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/11/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate stroke risk among users of typical antipsychotics compared to users of atypical antipsychotics in a non-elderly and non-demented US population. METHODS New users of antipsychotics aged 18-64 years without dementia were identified via electronic health care data from 13 health plans participating in the Sentinel System from January 2001 to September 2015. The risk of hospitalized stroke events, identified via ICD-9-CM diagnostic criteria, was compared between typical and atypical antipsychotic users using 1:1 matching on propensity score. Adjusted hazard ratios (HRs) and 95% CIs during the entire follow-up period and during 1- to 15-day and 16- to 90-day risk windows were estimated. The risk associated with haloperidol use was estimated separately. RESULTS A total of 45,495 typical antipsychotic users were matched 1:1 to atypical antipsychotic users. While unmatched HRs suggest an increased stroke risk among typical antipsychotic users compared to atypical antipsychotic users, no increased risk was observed after matching during the entire follow-up period (HR = 0.87; 95% CI, 0.54-1.41), the 1- to 15-day risk window (HR = 1.16; 95% CI, 0.41-3.32), or the 16- to 90-day risk window (HR = 0.52; 95% CI, 0.20-1.36). The adjusted HR for haloperidol was 1.31 (95% CI, 0.54-3.21). CONCLUSION These findings were not suggestive of an increased stroke risk in typical antipsychotic users compared to atypical antipsychotic users in a non-elderly and non-demented population.
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Affiliation(s)
- Lockwood G Taylor
- US Food and Drug Administration, Office of Surveillance and Epidemiology, 10903 New Hampshire Ave, Bldg 22, Room 2406, Silver Spring, MD 20993. .,US Food and Drug Administration, Office of Surveillance and Epidemiology, Silver Spring, Maryland, USA
| | - Genna Panucci
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Andrew D Mosholder
- US Food and Drug Administration, Office of Surveillance and Epidemiology, Silver Spring, Maryland, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ting-Ying Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
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14
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Swain RS, Taylor LG, Woodworth TS, Fuller CC, Petrone AB, Menzin TJ, Haug NR, Toh S, Mosholder AD. Overall and cause‐specific mortality in the Sentinel system: A power analysis. Pharmacoepidemiol Drug Saf 2018; 27:1416-1421. [DOI: 10.1002/pds.4692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Richard S. Swain
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology Food and Drug Administration Silver Spring Maryland USA
| | - Lockwood G. Taylor
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology Food and Drug Administration Silver Spring Maryland USA
| | - Tiffany S. Woodworth
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Candace C. Fuller
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Andrew B. Petrone
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Talia J. Menzin
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Nicole R. Haug
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute Harvard Medical School Boston Massachusetts USA
| | - Andrew D. Mosholder
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology Food and Drug Administration Silver Spring Maryland USA
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15
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Suggs CM, Levin RL, Mosholder AD, Swain RS, Zhao L. Comment on: "Mixed Approach Retrospective Analyses of Suicide and Suicidal Ideation for Brand Compared with Generic Central Nervous System Drugs". Drug Saf 2018; 41:1419-1421. [PMID: 30232739 DOI: 10.1007/s40264-018-0726-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Courtney M Suggs
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
| | - Robert L Levin
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Andrew D Mosholder
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Richard S Swain
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Liang Zhao
- US Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
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16
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Mosholder AD, Lee JY, Zhou EH, Kang EM, Ghosh M, Izem R, Major JM, Graham DJ. Long-Term Risk of Acute Myocardial Infarction, Stroke, and Death With Outpatient Use of Clarithromycin: A Retrospective Cohort Study. Am J Epidemiol 2018; 187:786-792. [PMID: 29036565 DOI: 10.1093/aje/kwx319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/12/2017] [Indexed: 11/14/2022] Open
Abstract
In a retrospective cohort study of patients enrolled in the UK Clinical Practice Research Datalink during 2000-2013, we evaluated long-term risks of death, stroke, and acute myocardial infarction (AMI) in adults prescribed clarithromycin. Patients were outpatients aged 40-85 years, who were prescribed clarithromycin (n = 287,748), doxycycline (n = 267,729), or erythromycin (n = 442,999), or Helicobacter pylori eradication therapy with a proton pump inhibitor, amoxicillin, and either clarithromycin (n = 27,639) or metronidazole (n = 14,863). We analyzed time to death, stroke, or AMI with Cox proportional hazards regression. The long-term hazard ratio for death following 1 clarithromycin versus 1 doxycycline prescription was 1.29 (95% confidence interval (CI): 1.21, 1.25), increasing to 1.62 (95% CI: 1.43, 1.84) for ≥5 prescriptions of clarithromycin versus ≥5 prescriptions for doxycycline. Erythromycin showed smaller risks in comparison with doxycycline. Stroke and AMI incidences were also increased after clarithromycin but with smaller hazard ratios than for mortality. For H. pylori eradication, the hazard ratio for mortality following clarithromycin versus metronidazole regimens was 1.09 (95% CI: 1.00, 1.18) overall, and it was higher (hazard ratio = 1.65, 95% CI: 0.88, 3.08) following ≥2 prescriptions in subjects not on statins at baseline. Outpatient clarithromycin use was associated with long-term mortality increases, with evidence for a similar, smaller increase with erythromycin.
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Affiliation(s)
- Andrew D Mosholder
- Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Joo-Yeon Lee
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Esther H Zhou
- Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Elizabeth M Kang
- Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Mayurika Ghosh
- Division of Anti-infective Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Rima Izem
- Office of Biostatistics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - David J Graham
- Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
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17
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Cunningham FE, Hur K, Dong D, Miller DR, Zhang R, Wei X, McCarren M, Mosholder AD, Graham DJ, Aspinall SL, Good CB. A comparison of neuropsychiatric adverse events during early treatment with varenicline or a nicotine patch. Addiction 2016; 111:1283-92. [PMID: 26826702 DOI: 10.1111/add.13329] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/29/2015] [Accepted: 01/22/2016] [Indexed: 11/27/2022]
Abstract
AIMS We compared the risk of mental health episodes requiring hospitalization (primary aim) or out-patient clinic visits (secondary aim) associated with varenicline versus the nicotine patch (NP) in an era prior to psychiatric boxed warnings. DESIGN Retrospective cohort. SETTING Department of Veterans Affairs (VA), USA. PARTICIPANTS VA patients with or without psychiatric comorbidities and a new prescription for varenicline (15 255) were propensity score-matched (1 : 2) to new users of NP (123 054) between 1 May 2006 and 30 September 2007, resulting in 11 774 and 23 548 patients in the varenicline and NP groups, respectively. MEASUREMENTS The primary outcomes were hospitalizations with a primary discharge diagnosis of a range of mental health disorders: depression, schizophrenia, bipolar disorder, suicide attempt, post-traumatic stress disorder, other psychosis and drug-induced mental disorders. Secondary outcomes were out-patient clinic visits with a primary diagnosis of the above list of mental health disorders. FINDINGS Background characteristics of the treatment groups were similar after matching. There was no statistically significant difference in risk of hospitalization for any of the studied mental health disorders with varenicline compared with NP. Among secondary outcomes there was an increased risk of out-patient clinic visits for schizophrenia among patients who received varenicline [hazard ratio (HR) = 1.27; 95% confidence interval (CI) = 1.07, 1.51], this increase being evident only in those with a pre-existing mental health disorder. CONCLUSION In US VA patients studied prior to the boxed warning being implemented, use of varenicline for smoking cessation was not associated with a detectable increase compared with nicotine patches in hospitalization for any mental health outcomes. There was an increased rate of out-patient attendances with a primary diagnosis of schizophrenia amounting to five per 100 person years of treatment. This increase was found only in patients with a pre-existing mental health disorder.
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Affiliation(s)
| | - Kwan Hur
- VA Center for Medication Safety, Hines, IL, USA
| | - Diane Dong
- VA Center for Medication Safety, Hines, IL, USA
| | - Donald R Miller
- Boston University School of Public Health, Boston, MA, USA.,Center for Health Quality Outcomes and Economic Research, Bedford, MA, USA
| | | | | | | | | | | | - Sherrie L Aspinall
- VA Center for Medication Safety, Hines, IL, USA.,VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
| | - Chester B Good
- VA Center for Medication Safety, Hines, IL, USA.,VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh, School of Pharmacy, Pittsburgh, PA, USA
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Epperly H, Vaughn FL, Mosholder AD, Maloney EM, Rubinson L. Nonsteroidal Anti-Inflammatory Drug and Aspirin Use, and Mortality among Critically Ill Pandemic H1N1 Influenza Patients: an Exploratory Analysis. Jpn J Infect Dis 2015; 69:248-51. [PMID: 26255728 DOI: 10.7883/yoken.jjid.2014.577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We explored nonsteroidal anti-inflammatory drug (NSAID) and aspirin (ASA) use and mortality in the U.S. Department of Health and Human Services' registry of 683 adult and 838 pediatric critically ill pandemic 2009 H1N1 influenza (pH1N1) patients. Among adults, 88 (12.9%) and 101 (14.8%) reported pre-admission use of an NSAID and ASA, respectively; mortality was similar (23-24%) regardless of NSAID or ASA use. Mortality among 89 pediatric NSAID users and 749 nonusers did not differ significantly (10.1% and 8.8%, respectively). One of 16 pediatric ASA users died. Among pediatric patients, the adjusted relative risk estimate for NSAID use and 90-day mortality was higher when influenza vaccination was included in the model (risk ratio [RR] = 1.5; 95% confidence interval, 0.7-3.2), although not statistically significant. Among adults, RR estimates did not change appreciably after adjusting for age, sex, health status, or vaccine status. We found no compelling evidence that NSAID or ASA use influenced mortality in severe pH1N1.
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Affiliation(s)
- Holly Epperly
- Division of Epidemiology II, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, U.S. Food and Drug Administration
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Affiliation(s)
- Andrew D Mosholder
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Lockwood G Taylor
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Victor Crentsil
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA
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Mosholder AD, Racoosin JA, Young S, Wernecke M, Shoaibi A, MaCurdy TE, Worrall C, Kelman JA. Bleeding events following concurrent use of warfarin and oseltamivir by Medicare beneficiaries. Ann Pharmacother 2014; 47:1420-8. [PMID: 24285759 DOI: 10.1177/1060028013500940] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the 2009 H1N1 influenza pandemic, the UK Medicines and Healthcare Products Regulatory Agency received case reports suggesting a potentiation of warfarin anticoagulation by the antiviral drug oseltamivir. We evaluated this putative interaction using Medicare data. OBJECTIVE To determine the frequency of bleeding following addition of oseltamivir or comparator drugs among Medicare beneficiaries taking warfarin. METHODS This was a retrospective cohort evaluation using Medicare nationwide data. Cohort members were Medicare Parts A, B, and D beneficiaries from June 30, 2006 to October 31, 2010 receiving warfarin for at least 1 month prior to a concomitant drug of interest (oseltamivir, ampicillin, trimethoprim-sulfamethoxazole (TMP-SMX), and angiotensin-converting enzyme (ACE) inhibitors). Bleeding within 14 days of new prescriptions for oseltamivir or comparators was identified using inpatient or emergency department ICD-9 (International Classification of Diseases, ninth revision) discharge diagnosis codes for gastrointestinal hemorrhage, epistaxis, hematuria, and intracranial bleeding. Patients with bleeding within 30 days preceding the prescription concomitant to warfarin were excluded. RESULTS With concomitant ACE inhibitors as reference, adjusted odds ratios (ORs) for any bleeding events within 14 days were 1.47 (95% confidence interval [CI] = 1.08-1.88), 1.24 (95% CI = 0.97-1.57), and 2.74 (95% CI = 2.53-3.03), for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. In a sensitivity analysis, adjusted ORs over a 7-day period were 1.89 (95% CI = 1.29-2.59), 1.47 (95% CI = 1.06-2.02), and 3.07 (95% CI = 2.76-3.49) for warfarin plus ampicillin, oseltamivir, and TMP-SMX, respectively. CONCLUSIONS Bleeding with oseltamivir plus warfarin was not significantly increased over a 14-day observation period; a sensitivity analysis showed a statistically significant increase over a 7-day period; in contrast, the data consistently showed the known tendency of TMP-SMX to potentiate the effects of warfarin. The results should be interpreted with the limitations of this approach in mind, including the inability to control for unmeasured confounders.
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Affiliation(s)
- Andrew D Mosholder
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA
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21
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Affiliation(s)
- Andrew D Mosholder
- Office of Surveillance and Epidemiology, Division of Epidemiology II, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
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Meyer TE, Taylor LG, Xie S, Graham DJ, Mosholder AD, Williams JR, Moeny D, Ouellet-Hellstrom RP, Coster TS. Neuropsychiatric events in varenicline and nicotine replacement patch users in the Military Health System. Addiction 2013; 108:203-10. [PMID: 22812921 DOI: 10.1111/j.1360-0443.2012.04024.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/28/2012] [Accepted: 07/12/2012] [Indexed: 11/30/2022]
Abstract
AIM To determine the rate ratio of neuropsychiatric hospitalizations in new users of varenicline compared to new users of nicotine replacement therapy (NRT) patch in the Military Health System (MHS). DESIGN, SETTING AND PARTICIPANTS Varenicline (n = 19,933) and NRT patch (n = 15,867) users who initiated therapy from 1 August 2006 to 31 August 2007 within the MHS were included in this retrospective cohort study. After matching according to propensity scores, 10,814 users remained in each cohort. The study population included those with and without a history of neuropsychiatric disease. MEASUREMENTS Patients were followed for neuropsychiatric hospitalizations defined by primary neuropsychiatric discharge diagnosis using ICD-9 codes from in-patient administrative claims. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated after propensity score matching on exposure for socio-demographic factors, health-care utilization, comorbidities, medication history and neuropsychiatric history. FINDINGS There was no increase in the rate of neuropsychiatric hospitalizations in patients treated with varenicline compared to NRT patch when followed for 30 days (propensity-score matched HR = 1.14, 95% CI: 0.56-2.34). Results were similar after 60 days of follow-up. CONCLUSIONS There does not appear to be an increase in neuropsychiatric hospitalizations with varenicline compared with nicotine replacement therapy patch over 30 or 60 days after drug initiation.
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Affiliation(s)
- Tamra E Meyer
- Department of the Army, Office of the Surgeon General, Pharmacovigilance Center, Falls Church, VA 22042-5142, USA.
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Abstract
OBJECTIVE To determine the risk, by age group, of serious asthma-related events with long-acting β(2)-adrenergic receptor agonists marketed in the United States for asthma. METHODS The US Food and Drug Administration performed a meta-analysis of controlled clinical trials comparing the risk of LABA use with no LABA use for patients 4 to 11, 12 to 17, 18 to 64, and older than 64 years old. The effects of age on a composite of asthma-related deaths, intubations, and hospitalizations (asthma composite index) and the effects of concomitant inhaled corticosteroid (ICS) use were analyzed. RESULTS One hundred ten trials with 60 954 patients were included in the meta-analysis. The composite event incidence difference for all ages was 6.3 events per 1000 patient-years (95% confidence interval [CI]: 2.2-10.3) for using LABAs compared with not using LABAs. The largest incidence difference was observed for the 4- to 11-year age group (30.4 events per 1000 patient-years [95% CI: 5.7-55.1]). Differences according to age were statistically significant (P = .020). Results for the subgroup of patients with concomitant ICS use (n = 36 210) were similar to the overall results; with assigned ICSs (n = 15 192), the incidence difference was 0.4 events per 1000 patient-years (95% CI: -3.8 to 4.6), and there was no statistically significant difference according to age group. CONCLUSIONS The excess of serious asthma-related events attributable to LABAs was greatest among children. Additional data are needed to assess risks of LABA use for children with simultaneous ICS use.
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Affiliation(s)
- Ann W McMahon
- Office of Pediatric Therapeutics, Office of the Commissioner, Food and Drug Administration, Silver Spring, MD 20993, USA.
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Pamer CA, Hammad TA, Wu YT, Kaplan S, Rochester G, Governale L, Mosholder AD. Changes in US antidepressant and antipsychotic prescription patterns during a period of FDA actions. Pharmacoepidemiol Drug Saf 2010; 19:158-74. [PMID: 20049836 DOI: 10.1002/pds.1886] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To determine if paroxetine versus non-paroxetine selective serotonin reuptake inhibitors (SSRIs) prescribing changed after the June 2003 FDA Paroxetine Public Health Advisory (PPHA) and if antidepressant and antipsychotic prescribing changed after the February 2004 FDA Advisory Committee Meeting (FDACM). METHODS Ecologic analysis using estimates of patients dispensed antidepressants and antipsychotics, census data, and promotional spending data. Data sources were SDI: Vector One(R), US Census, and IMS Health(R). Measures were monthly use levels (number of patients dispensed antidepressants, antipsychotics, paroxetine, and non-paroxetine SSRIs prescriptions by age group per population count). Percent changes pre- to post-PPHA were used to assess changes in paroxetine versus non-paroxetine SSRIs prescribing. Interrupted time series (ITS) analysis was performed to examine use level changes post-FDACM by drug groups (all antidepressants and all antipsychotics). RESULTS Post-PPHA mean paroxetine use levels decreased for all age groups (range: 5.5-34.1%). Mean non-paroxetine SSRIs use levels increased (range: 4.6-17.1%). Post-PPHA changes were greatest for 6-12 and 13-17 year olds. Decreased mean antidepressant drug use levels from pre- to post-FDACM were observed in all groups under 25 years old. A statistically significant decrease in the slopes from pre- to post-FDACM was observed for persons aged 13-17 and 18-24 years. The difference between the forecasted mean use level and the observed mean use level (in 12-month intervals) was statistically significant for all ages combined (-107.26; 95% CI: -166.32, -48.20) and 1-5 (-3.1; 95% CI: -4.62, -1.58), 6-12 (-36.02; 95% CI: -62.92, -9.12) and 25 years, and older groups (-83.17; 95% CI: -153.95, -12.39). For all age groups, decreases in the slopes of antipsychotic drugs use from pre- to post-FDACM were observed, although these slope changes were not statistically significant. The difference between the forecasted mean antipsychotic drugs use level and the observed mean use level (in 12-month intervals) was statistically significantly lower for all age groups. CONCLUSIONS Antidepressant use changed post-PPHA and -FDACM, with a differential pattern by age. There was no evidence of increased antipsychotic use post-FDACM. Ecologic data cannot determine if changes were due to depression not treated with medications or the prescribing of fewer antidepressants for other conditions.
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Affiliation(s)
- Carol A Pamer
- FDA Office of Surveillance and Epidemiology, Silver Spring, MD 20993, United States.
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Gish P, Mosholder AD, Truffa M, Johann-Liang R. Spectrum of central anticholinergic adverse effects associated with oxybutynin: comparison of pediatric and adult cases. J Pediatr 2009; 155:432-4. [PMID: 19732583 DOI: 10.1016/j.jpeds.2009.01.074] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 12/08/2008] [Accepted: 01/30/2009] [Indexed: 02/04/2023]
Abstract
We reviewed Food and Drug Administration postmarketing reports of central nervous system (CNS) anticholinergic effects in association with oxybutynin. Taking domestic usage by age group into account, there is a disproportionately higher number of CNS adverse event cases reported in pediatric patients as compared with adult patients. CNS stimulation was prominent in the pediatric cases.
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Affiliation(s)
- Paula Gish
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, The United States Food and Drug Administration, Silver Spring, MD 20993, USA.
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Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R. Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics 2009; 123:611-6. [PMID: 19171629 DOI: 10.1542/peds.2008-0185] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To gain a better understanding of the capacity of psychostimulant medications to induce adverse psychiatric reactions and determine the frequency of such reactions, we analyzed postmarketing surveillance data and clinical trial data for drugs, either approved or under development, for the treatment of attention-deficit/hyperactivity disorder. METHODS The US Food and Drug Administration requested manufacturers of drugs approved for attention-deficit/hyperactivity disorder or with active clinical development programs for that indication to search their electronic clinical trial databases for cases of psychosis or mania using prespecified search terms. The manufacturers supplied descriptions of clinical trials, numbers of patients exposed to study drug, and duration of exposure to permit calculations of incidence rates. Independently, cases of psychosis or mania in children and adults for drugs used to treat attention-deficit/hyperactivity disorder from the Food and Drug Administration Adverse Event Reporting System safety database were analyzed. Manufacturers were asked to conduct similar analyses of their postmarketing surveillance databases. RESULTS We analyzed data from 49 randomized, controlled clinical trials in the pediatric development programs for these products. A total of 11 psychosis/mania adverse events occurred during 743 person-years of double-blind treatment with these drugs, and no comparable adverse events occurred in a total of 420 person-years of placebo exposure in the same trials. The rate per 100 person-years in the pooled active drug group was 1.48. The analysis of spontaneous postmarketing reports yielded >800 reports of adverse events related to psychosis or mania. In approximately 90% of the cases, there was no reported history of a similar psychiatric condition. Hallucinations involving visual and/or tactile sensations of insects, snakes, or worms were common in cases in children. CONCLUSIONS Patients and physicians should be aware that psychosis or mania arising during drug treatment of attention-deficit/hyperactivity disorder may represent adverse drug reactions.
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Affiliation(s)
- Andrew D Mosholder
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, , MD 20993-0002, USA
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Mosholder AD, Willy M. Suicidal adverse events in pediatric randomized, controlled clinical trials of antidepressant drugs are associated with active drug treatment: a meta-analysis. J Child Adolesc Psychopharmacol 2006; 16:25-32. [PMID: 16553526 DOI: 10.1089/cap.2006.16.25] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the incidence of suicidal ideation and behaviors observed with antidepressant drug treatment to the incidence with placebo, in randomized, controlled pediatric clinical trials. METHODS Manufacturers of nine antidepressant drugs identified suicidal adverse events in randomized, placebo-controlled, pediatric clinical trials that they had sponsored. Events were found with an electronic search for adverse event descriptions, including key words suggesting suicidal ideation or self-injury, along with a manual review of all adverse events meeting the standard regulatory definition for seriousness. Incidence rate data for these events supplied by the manufacturers were combined across trials to yield Mantel-Haenszel combined risk estimates. RESULTS Data from 22 randomized, short-term, placebo-controlled, pediatric trials in various indications, involving nine different antidepressant drugs, were available for analysis. A total of 2298 pediatric subjects were exposed to active drug, and 1952 to placebo. Seventy eight (78) serious suicidal adverse events occurred in these trials (54 with active drug and 24 with placebo); there were no completed suicides. The combined incidence rate ratio across all trials for serious suicidal adverse events was 1.89 (95% Confidence Interval, 1.18-3.04). CONCLUSIONS In short-term, placebo-controlled, pediatric studies of antidepressants, active drug treatment was associated with a rate of serious suicidal events almost twice that of placebo.
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Affiliation(s)
- Andrew D Mosholder
- Division of Drug Risk Evaluation, Office of Drug Safety, U.S. Food and Drug Administration, Rockville, Maryland 20993, USA.
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Abstract
OBJECTIVE The aim of this analysis was to delineate trends in spontaneous postmarketing reporting data with antidepressant drugs for adverse events involving suicidal behaviors in children and adolescents. METHODS The U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) was searched for postmarketing adverse event reports of suicidal thoughts and behaviors occurring in children and adolescents treated with 10 antidepressant drugs. The search covered the period from market launch of each drug through November 2003. RESULTS A total of 524 reports were returned by the search. All drugs had reports, and most drugs demonstrated 15 or fewer reports annually, with the following two exceptions. We observed a peak of reporting for fluoxetine in the early 1990s, and another peak of reporting for paroxetine in recent years. Further investigation revealed that the peak in recent paroxetine reporting was accounted for by reports from consumers, whereas reporting by health professionals remained fairly constant. In contrast, the earlier peak in reports for fluoxetine was not accounted for by an increase in consumer reporting. CONCLUSIONS Spontaneous reporting data for suicidal events in pediatric patients treated with antidepressant drugs appears to be highly variable and subject to various influences. The most appropriate method to assess an association of antidepressant drug treatment with suicidal behaviors is examination of systematically collected data with appropriate comparison groups, such as randomized, controlled trial data.
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Affiliation(s)
- Andrew D Mosholder
- Division of Drug Risk Evaluation, Office of Drug Safety, U.S. Food and Drug Administration, Rockville, Maryland 20993, USA.
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Phelan KM, Mosholder AD, Lu S. Lithium interaction with the cyclooxygenase 2 inhibitors rofecoxib and celecoxib and other nonsteroidal anti-inflammatory drugs. J Clin Psychiatry 2003; 64:1328-34. [PMID: 14658947 DOI: 10.4088/jcp.v64n1108] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to increase serum lithium concentrations. We sought to determine whether NSAIDs that selectively inhibit cyclooxygenase (COX) 2 also elevate serum lithium concentrations. METHOD The U.S. Food and Drug Administration's Adverse Event Reporting System (AERS) database was searched in January 2003 for reports of interactions between lithium and rofecoxib or celecoxib, the selective COX-2 inhibitors marketed in the United States. Additionally, a literature search was performed using PubMed with the MeSH terms anti-inflammatory agents, nonsteroidal and lithium. Reports of interactions between NSAIDs and lithium were selected for review based on titles of retrieved citations. RESULTS Eighteen cases of increased serum lithium concentrations after the addition of one of the COX-2 inhibitors to stable lithium therapy were retrieved from AERS, 13 with rofecoxib and 5 with celecoxib. Serum lithium concentration increases of up to 99% and 448% with concomitant celecoxib and rofecoxib use, respectively, were reported. Thirty-six English-language literature articles report interactions between lithium and various NSAIDs. Although some articles report no effect or decreased serum lithium concentrations with concomitant aspirin or sulindac, increased serum lithium concentration reports exist for aspirin, sulindac, and 14 other NSAIDs, including celecoxib and rofecoxib. CONCLUSION Clinicians should consider NSAID use in the differential diagnosis of lithium toxicity, monitor patients' serum lithium concentrations during the initiation or discontinuation of NSAID therapy, and be aware that the selective COX-2 inhibitors can increase serum lithium concentrations leading to toxicity.
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Affiliation(s)
- Kathleen M Phelan
- Office of Drug Safety, Center for Drug Evaluation and Research, Food and Drug Administration, Rockville, MD 20857, USA
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