1
|
Overbeek JA, Nijpels G, Swart KMA, Blom MT, Elders PJM, Herings RMC. Type 2 Diabetes, the Epidemic: Trends in Prevalence and Incidence, 2004-2020. Diabetes Metab Syndr Obes 2024; 17:1503-1509. [PMID: 38562280 PMCID: PMC10984193 DOI: 10.2147/dmso.s445288] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Aims/Hypothesis Only a few studies reported the incidence of type 2 diabetes (T2D). Understanding recent trends in diabetes is vital for planning future diabetes care. This study updated national trends in the prevalence and incidence of type 2 diabetes (T2D) in the Netherlands from 2004-2020. Methods The DIAbetes, MANagement and Treatment (DIAMANT) cohort was used. A cross-sectional design with yearly measurements for the study period was used. The prevalence was calculated by dividing the total number of people with T2D by the total number of all residents. The incidence was calculated by dividing new cases of T2D by the resident population at risk during the calendar year of interest. Results Among men, the prevalence of T2D in the Netherlands increased from 2.3% in 2004 to 6.3% in 2020. Women's prevalence increased from 2.3% in 2004 to 5.3% in 2020. During 2005-2009, the incidence rate for both men and women was relatively stable Between 2010 and 2020, the incidence rate fell about 1.5 per 1000 in both men and women. Conclusion From 2004-2020, the prevalence of T2D in the Netherlands more than doubled, with a decreasing incidence from 2010 onwards.
Collapse
Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Giel Nijpels
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Marieke T Blom
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Petra J M Elders
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands
| |
Collapse
|
2
|
van Trier TJ, Snaterse M, Herings RMC, Overbeek JA, Peters RJG, Jørstad HT. Impact of implementing Dutch versus European guideline risk factor targets in older patients with ischaemic heart disease. Neth Heart J 2024; 32:45-54. [PMID: 37870710 PMCID: PMC10781920 DOI: 10.1007/s12471-023-01823-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND In patients with ischaemic heart disease (IHD) aged > 70 years, Dutch and European guidelines recommend different treatment targets: low-density lipoprotein cholesterol (LDL-c) < 2.6 versus < 1.4 mmol/l and systolic blood pressure (SBP) < 140 versus < 130 mm Hg, respectively. How this impacts cardiovascular event-free life expectancy has not been investigated. The study objective was to compare estimated lifelong treatment benefits of implementing Dutch and European LDL‑c and SBP targets. METHODS Data from patients aged 71-80 years hospitalised for IHD in 2017-2019 were extracted from the PHARMO Database Network, which links primary and secondary healthcare settings, with follow-up until 31 December 2020. Potential benefit according to treatment strategy (in gain in event-free years) was estimated using the SMART-REACH model. RESULTS Of the 3003 eligible patients, 1186 (39%) had missing LDL‑c and/or SBP measurements. Of the 1817 included patients (36% women, median age at event: 74 years (interquartile range (IQR): 72-77), 84% achieved the Dutch targets for both LDL‑c and SBP; for European targets, this was 23% and 61%, respectively. If Dutch targets were met for LDL‑c and SBP (n = 1281), the additional effect of reaching European targets was a median gain of 0.6 event-free life years (IQR: 0.3-1.0). The greatest effect could be reached in patients not reaching Dutch targets (n = 501), with a median gain of 0.6 (IQR: 0.2-1.2) and 1.7 (IQR: 1.2-2.5) event-free years with Dutch versus European targets. CONCLUSION In patients aged > 70 years with IHD, implementation of European targets resulted in a greater gain of event-free years compared with Dutch targets, especially in patients with poorer risk factor control. The considerable number of patients with missing risk factor documentation suggested additional opportunities for risk reduction.
Collapse
Affiliation(s)
- Tinka J van Trier
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
| | - Marjolein Snaterse
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron M C Herings
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Centres, location Free University Medical Centre, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Department of General Practice, Amsterdam University Medical Centres, location Free University Medical Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Vervloet MG, de Jong HJ, Pander J, Overbeek JA. Prevalence of chronic kidney disease in the Netherlands and its cardiovascular and renal complications. BMC Nephrol 2023; 24:337. [PMID: 37957561 PMCID: PMC10644456 DOI: 10.1186/s12882-023-03384-y] [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: 06/19/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Knowledge on prevalence, comorbidities and consequences of chronic kidney disease (CKD) is mandatory to estimate the potential of cardiovascular risk management on a population level. We studied the prevalence of CKD with or without type 2 diabetes mellitus (T2D) and/or heart failure and its cardiorenal complications in The Netherlands. METHODS A descriptive cross-sectional and longitudinal cohort study was performed, using data from the Dutch PHARMO Data Network. Prevalence of CKD at a single time point was determined by a recorded diagnosis or by ≥ 2 estimated glomerular filtration rate (eGFR) measurements and urine albumin/creatinine ratio (UACR) that define CKD. A representative group of adults with CKD was included in a longitudinal analysis to study cardiorenal complications. Those were followed until first complication, end of study or death, whichever occurred first. RESULTS The prevalence of CKD was 8.9% in a representative population of 2,187,962 adult Dutch individuals. The average age of persons with CKD was 72 years, 57% were female, 19.9% had T2D, 7.7% heart failure, and 3.0% both T2D and heart failure. In the longitudinal analysis, cerebrovascular events (11/1,000 person-years), hospitalizations for heart failure (10/1,000 person-years), myocardial infarction (5.5/1,000 person-years), and hospitalization for CKD (6.2/1,000 person-years) were the most common first cardiorenal complications. People with CKD with T2D and/or heart failure generally had higher rates of cardiovascular or renal complications or mortality than people with CKD without these comorbidities. CONCLUSION The prevalence of CKD in The Netherlands is 8.9%. People with T2D or heart failure, or both, in addition to CKD, had numerically higher mortality and cardiorenal complication rates than people without these comorbidities. Optimizing up-to-date cardiovascular risk management in these high-risk individuals may provide health benefits.
Collapse
Affiliation(s)
- Marc G Vervloet
- Nephrology Department, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Hilda Ji de Jong
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jan Pander
- Evidence Generation Lead, AstraZeneca BV, The Hague, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| |
Collapse
|
4
|
Swart KM, van der Heijden AA, Blom MT, Overbeek JA, Nijpels G, van Hout HP, Elders PJ, Herings RM. Identification of frailty in primary care: accuracy of electronically derived measures. Br J Gen Pract 2023; 73:e752-e759. [PMID: 37487641 PMCID: PMC10394609 DOI: 10.3399/bjgp.2022.0574] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Routinely collected clinical data based on electronic medical records could be used to define frailty. AIM To estimate the ability of four potential frailty measures that use electronic medical record data to identify older patients who were frail according to their GP. DESIGN AND SETTING This retrospective cohort study used data from 36 GP practices in the Dutch PHARMO Data Network. METHOD The measures were the Dutch Polypharmacy Index, Charlson Comorbidity Index (CCI), Chronic Disease Score (CDS), and Frailty Index. GPs' clinical judgement of patients' frailty status was considered the reference standard. Performance of the measures was assessed with the area under the receiver operating characteristic curve (AUC). Analyses were done in the total population and stratified by age and sex. RESULTS Of 31 511 patients aged ≥65 years, 3735 (11.9%) patients were classified as frail by their GP. The CCI showed the highest AUC (0.79, 95% confidence interval [CI] = 0.78 to 0.80), followed by the CDS (0.69, 95% CI = 0.68 to 0.70). Overall, the measures showed poorer performance in males and females aged ≥85 years than younger age groups (AUC 0.55-0.58 in females and 0.57-0.60 in males). CONCLUSION This study showed that of four frailty measures based on electronic medical records in primary care only the CCI had an acceptable performance to assess frailty compared with frailty assessments done by professionals. In the youngest age groups diagnostic performance was acceptable for all measures. However, performance declined with older age and was least accurate in the oldest age group, thereby limiting the use in patients of most interest.
Collapse
Affiliation(s)
- Karin Ma Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, the Netherlands
| | - Amber Awa van der Heijden
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Marieke T Blom
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, the Netherlands
| | - Giel Nijpels
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Hein Pj van Hout
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Petra Jm Elders
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice, Amsterdam, and Amsterdam Public Health, Amsterdam, the Netherlands
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, and Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology & Data Science, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Serné EH, Overbeek JA, Palmen J, de Jong HJI, Stehouwer CDA. [Prevalence and drug treatment of people with type 2 diabetes mellitus and a very high risk of cardiovascular disease]. Ned Tijdschr Geneeskd 2023; 167:D7569. [PMID: 37742128] [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] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Dutch diabetes guidelines have been updated to incorporate specific therapies with cardiovascular and kidney outcomes benefit in type 2 diabetes patients (T2D) at very high risk for cardiorenal complications. This is part of a comprehensive approach to reduce the risk of diabetes-related complications, including management of glycemia, blood pressure, and lipids. The current study examines the prevalence of T2D at very high cardiorenal risk and the deployment of evidence-based approaches to lower this risk. DESIGN Cross-sectional, observational study. METHOD A representative population) with T2D in primary care (N= 64,224) was selected from the PHARMO Data Network. A very high risk of CVD was defined as: 1) established CVD, 2) CKD with (very) high cardiovascular risk and 3) heart failure. Drug treatment was determined according to prescriptions in 2019. RESULTS 25,901 subjects with T2D had a very high risk of CVD (mean age 73.3 years; 42% female). Established CVD, CKD with (very) high cardiovascular risk, and heart failure were observed in 82%, 26% and 22% of patients, respectively. Low-dose salicylates, lipid-lowering and blood pressure-lowering medication were used by 39%, 70% and 69%, respectively. Glucose-lowering medication use included metformin (53%), sulfonylurea-derivatives (24%), and insulin (19%). 2% of the population used a SGLT2 inhibitor or GLP1-receptor agonist. CONCLUSION 40% of people with DM2 have a very high risk of CVD. Although our findings reflect the recommendations of the previous treatment guideline for DM2, they also show that the new guideline has significant implications for the treatment of a large proportion of people with DM2.
Collapse
Affiliation(s)
- Erik H Serné
- Amsterdam UMC, afd. Interne Geneeskunde, Amsterdam
- Contact: Erik H. Serné
| | | | | | | | | |
Collapse
|
6
|
Faessen JP, Oerlemans DJ, de Jong MR, Overbeek JA, Vissers PA, Aben KK, Janssen-Heijnen ML, van den Bergh JP, van Osch FH. The Association between Diabetes Medication Use and Tumour Characteristics at Diagnosis in Patients with Urothelial Carcinoma: A Retrospective Registry-Based Study1. Bladder Cancer 2023. [DOI: 10.3233/blc-220082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND: Observational studies indicate a potential association between diabetes medication use and aggressiveness of bladder cancer. OBJECTIVE: The objective is to exploratively study the association between diabetes medication use, as proxy for diabetes, and cancer characteristics of urothelial carcinoma at diagnosis. Furthermore, differences in associations between specific types of diabetes medication are studied. METHODS: The association between use of diabetes medication and urothelial carcinoma (UC) characteristics at diagnosis is studied. A retrospective registry-based study among UC patients in the Netherlands was performed for which two large linked registries from PHARMO and IKNL were used. Patients diagnosed with UC between 2000 and 2016 and no previous cancer were included in this study. UC patients using diabetes medication were matched on age and sex with subjects not using diabetes medication (ratio 1:2), resulting in 1,164 diabetes medication users and 2,318 non-users. Conditional logistic regression analysis was performed to determine odds ratios comparing cancer characteristics between different types of diabetes medication users to non-users. RESULTS: Noninsulin antidiabetic drugs (NIAD) use was associated with a muscle-invasive type of UC compared to non-users (OR = 1.31, 95% CI: 1.10–1.55 for T2+ versus Ta) as well as a poorly differentiated tumour (OR = 1.31, 95% CI: 1.07–1.59 for poorly versus well differentiated tumours). CONCLUSION: Users of diabetes medication are potentially more likely to be diagnosed with a more aggressive tumour than non-users; however, lifestyle factors could not be adjusted for.
Collapse
Affiliation(s)
- Janine P.M. Faessen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | | | | | - Jetty A. Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Pauline A.J. Vissers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Katja K.H. Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maryska L.G. Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Joop P.W. van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Frits H.M. van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
7
|
Overbeek JA, Swart KMA, Houben E, Penning-van Beest FJA, Herings RMC. Completeness and Representativeness of the PHARMO General Practitioner (GP) Data: A Comparison with National Statistics. Clin Epidemiol 2023; 15:1-11. [PMID: 36636730 PMCID: PMC9830053 DOI: 10.2147/clep.s389598] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose When using incomplete or non-representative real-world data (RWD), bias is more likely to occur. The aim of the current study was to assess the completeness and representativeness of the PHARMO GP data for the Dutch population. Patients and Methods A cross-sectional study was performed. The PHARMO GP data comprise data from electronic health records registered by GPs. Data on the Dutch population were obtained from Statistics Netherlands (CBS), which offers publicly available data on several themes. The standardized difference (std.diff) was used to compare proportions between the PHARMO GP population and the Dutch population. An absolute std.diff >0.2 was considered a difference. Results On January 1st, 2018, 3,466,321 persons were included in the PHARMO GP data (mean age: 41.6 years, 49.7% males). The sex and age distribution was similar to the Dutch population. The PHARMO GP data captured less not urbanized areas compared to the Dutch population (not urbanized areas: 9.4% vs 17.1% [std.diff: -0.23]). Regarding medication use, only the pharmacological subgroups "viral vaccines" and "hormonal contraceptives for systemic use" differed (std.diff >0.2); use in the GP data was more complete than in the Statistics Netherlands (CBS) data. No differences were observed regarding diagnoses. Conclusion The PHARMO GP data are representative of the Dutch population with regard to the demographic characteristics and diagnoses in primary care. Medication data in the PHARMO GP data are more complete than national statistics, and differences are related to reimbursement. Use of the data and interpretation of results based on these sources should be done with experts on the data sources, the Dutch healthcare system and (pharmaco)epidemiology.
Collapse
Affiliation(s)
- Jetty A Overbeek
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands,Correspondence: Jetty A Overbeek, Department Research, PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, the Netherlands, Tel +3130 7440 800, Email
| | - Karin M A Swart
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Eline Houben
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | - Ron M C Herings
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| |
Collapse
|
8
|
Overbeek JA, Swart KMA, van der Pal EYM, Blom MT, Beulens JWJ, Nijpels G, Elders PJM, Herings RMC. The DIAbetes MANagement and Treatment (DIAMANT) Cohort. Clin Epidemiol 2022; 14:1453-1462. [PMID: 36506003 PMCID: PMC9733447 DOI: 10.2147/clep.s381728] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
Introduction The increasing number of people with diabetes and the unclear long-term safety and effectiveness of newer and older blood-glucose-lowering treatments emphasize the need for more pharmaco-epidemiological studies in this field. A prospective, regularly updated cohort of people with diabetes would provide quick and up-to-date information regarding prevalence, treatment, safety and effectiveness. The current aim was to describe the design of the DIAbetes MANagement and Treatment (DIAMANT) cohort. Methods The DIAMANT cohort is a population-based, dynamic, prospective cohort of persons with diabetes. It contains real-world data (RWD) from general practitioners (GP), including diagnoses, symptoms, examinations, communication to/from specialists and medication. Diabetes is defined as a recorded diabetes diagnosis or a prescription of drugs used in diabetes. The cohort is part of the national infrastructure of "Stichting Informatievoorziening voor Zorg en Onderzoek" (STIZON) and is linked to other data sources. Results Currently, the cohort enables access to information of 89,883 patients in 2004 to 344,914 in 2020 (6% T1D, 84% T2D and 10% unclassified type of diabetes), with 193,931 participants still registered as being present in the GP practice (active) in 2020. The frequency of follow-up of persons with diabetes is practice dependent. The Dutch guidelines advise 2-4 contacts per year with a more extensive yearly check-up. The DIAMANT cohort is updated several times a year. Anonymised data from the DIAMANT cohort are available to researchers. Discussion The DIAMANT cohort provides the opportunity to gain RWD insights into the treatment and outcomes among people with diabetes in daily general practice. The data can be enriched by established linkages to other data sources (eg, hospital data, the Perinatal Registry, the Cancer Registry). The DIAMANT cohort serves as a start of a national infrastructure to study, manage and provide personalised care in order to ultimately improve care and outcomes for people with diabetes.
Collapse
Affiliation(s)
- Jetty A Overbeek
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Correspondence: Jetty A Overbeek, Department Research, PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, Netherlands, Tel +3130 7440 800, Email
| | - Karin M A Swart
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Emma Y M van der Pal
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Joline W J Beulens
- Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Giel Nijpels
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Ron M C Herings
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
9
|
Bots SH, Riera-Arnau J, Belitser SV, Messina D, Aragón M, Alsina E, Douglas IJ, Durán CE, García-Poza P, Gini R, Herings RMC, Huerta C, Sisay MM, Martín-Pérez M, Martin I, Overbeek JA, Paoletti O, Pallejà-Millán M, Schultze A, Souverein P, Swart KMA, Villalobos F, Klungel OH, Sturkenboom MCJM. Myocarditis and pericarditis associated with SARS-CoV-2 vaccines: A population-based descriptive cohort and a nested self-controlled risk interval study using electronic health care data from four European countries. Front Pharmacol 2022; 13:1038043. [PMID: 36506571 PMCID: PMC9730238 DOI: 10.3389/fphar.2022.1038043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Estimates of the association between COVID-19 vaccines and myo-/pericarditis risk vary widely across studies due to scarcity of events, especially in age- and sex-stratified analyses. Methods: Population-based cohort study with nested self-controlled risk interval (SCRI) using healthcare data from five European databases. Individuals were followed from 01/01/2020 until end of data availability (31/12/2021 latest). Outcome was first myo-/pericarditis diagnosis. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. Baseline incidence rates (IRs), and vaccine- and dose-specific IRs and rate differences were calculated from the cohort The SCRI calculated calendar time-adjusted IR ratios (IRR), using a 60-day pre-vaccination control period and dose-specific 28-day risk windows. IRRs were pooled using random effects meta-analysis. Findings: Over 35 million individuals (49·2% women, median age 39-49 years) were included, of which 57·4% received at least one COVID-19 vaccine dose. Baseline incidence of myocarditis was low. Myocarditis IRRs were elevated after vaccination in those aged < 30 years, after both Pfizer vaccine doses (IRR = 3·3, 95%CI 1·2-9.4; 7·8, 95%CI 2·6-23·5, respectively) and Moderna vaccine dose 2 (IRR = 6·1, 95%CI 1·1-33·5). An effect of AstraZeneca vaccine dose 2 could not be excluded (IRR = 2·42, 95%CI 0·96-6·07). Pericarditis was not associated with vaccination. Interpretation: mRNA-based COVID-19 vaccines and potentially AstraZeneca are associated with increased myocarditis risk in younger individuals, although absolute incidence remains low. More data on children (≤ 11 years) are needed.
Collapse
Affiliation(s)
- Sophie H. Bots
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Svetlana V. Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Maria Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ema Alsina
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian J. Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos E. Durán
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa Gini
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | | | - Consuelo Huerta
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Malede Mequanent Sisay
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Martín-Pérez
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Ivonne Martin
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Olga Paoletti
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | - Meritxell Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anna Schultze
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Felipe Villalobos
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Miriam C. J. M. Sturkenboom
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Miriam C. J. M. Sturkenboom,
| |
Collapse
|
10
|
Holthuis EI, Vondeling GT, Kuiper JG, Dezentjé V, Rosenlund M, Overbeek JA, van Deurzen CH. Real-world data of HER2-low metastatic breast cancer: A population based cohort study. Breast 2022; 66:278-284. [PMID: 36375389 PMCID: PMC9663525 DOI: 10.1016/j.breast.2022.11.003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND With the introduction of investigational human epidermal growth factor receptor 2 (HER2) targeting treatments, thorough understanding of breast cancer with different HER2 expression levels is critical. The aim of this study was to compare clinicopathologic characteristics and survival of patients with metastatic breast cancer according to the level of HER2 expression. METHODS Women with distant metastatic breast cancer during 2008-2016 were selected from PALGA, the Dutch Pathology Registry, and linked to the PHARMO Database Network. Breast cancer samples were categorised as HER2 immunohistochemistry score 0 (IHC0), HER2-low or HER2+. RESULTS Among women with hormone receptor (HR) positive metastatic breast cancer (n = 989), 373 (38%) cancers were HER2 IHC0, 472 (48%) were HER2-low and 144 (15%) were HER2+. Among HR negative patients (n = 272), the proportion of HER2 IHC0, HER2-low and HER2+ was 110 (40%), 104 (38%) and 58 (21%) respectively. Within the HR + cohort, patients with HER2 IHC0 or HER2-low cancer were significantly older compared to HER2+ patients. This age difference was not seen in the HR-cohort. The localisation of distant metastases differed significantly between HER2 IHC0 or HER2-low versus HER2+ cases. Survival rates did not differ markedly by subtypes. CONCLUSION Substantial proportion of patients had a HER2-low breast cancer. No clear differences in survival were found when comparing HER2 and HR status. Getting more granular insights in the level of HER2 expression and addressing HER2-low as a separate category could help to assess the impact of emerging treatment strategies. Therefore, more detailed information on HER2 expression should be routinely reported.
Collapse
Affiliation(s)
- Emily I. Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Corresponding author.PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30AE, Utrecht, the Netherlands.
| | | | | | | | - Mats Rosenlund
- Daiichi-Sankyo Europe GmbH; and Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
11
|
Kuiper JG, Overbeek JA, Foch C, Boutmy E, Sabidó M. Incidence of malignancies in patients with multiple sclerosis versus a healthy matched cohort: A population-based cohort study in the Netherlands using the PHARMO Database Network. J Clin Neurosci 2022; 103:49-55. [PMID: 35810606 DOI: 10.1016/j.jocn.2022.06.025] [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] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/07/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
Abstract
This study estimated the incidence of malignancy in patients with multiple sclerosis (MS) versus a matched general population cohort in the Netherlands. Adults with a diagnosis of MS between 2006 and 2014 in the General Practitioner (GP) Database of the PHARMO Database Network with ≥ 1 year of patient history were matched to four non-MS individuals based on year of birth, sex, and GP practice. Patients were followed-up until the earliest malignancy diagnosis, death, or end of data collection. Age-adjusted incidence rates (IR) were measured overall and by cancer type. Standardized incidence ratios (SIR) were calculated as the ratio of stratification-specific IRs in the MS and non-MS cohorts. A total of 1,692 MS patients were matched to 6,768 non-MS patients. Age-adjusted IR of any malignancy, excluding non-melanoma skin cancer (n = 27), in the MS cohort was 48.3 (95%CI:30.1-66.5) per 10,000 PY. An increased incidence of any malignancy was observed in the MS cohort versus the non-MS cohort (SIR 1.8 [95%CI:1.1-2.5]). The most commonly observed malignancies in the MS cohort were breast cancer (n = 8; IR 20.4 [95%CI:6.3-34.5] per 10,000 PY) and melanoma (n = 6; IR 14.8 [95%CI:3.0-26.7] per 10,000 PY). The corresponding SIR observed between cohorts was 1.4 (95%CI:0.4-2.4) and 3.4 (95%CI:0.7-6.2), respectively. While the small increased incidence of malignancy in the MS cohort could be an artefact created by a different distribution of risk factors, an increased incidence of malignancy in MS patients in the Netherlands cannot be excluded.
Collapse
Affiliation(s)
- Josephina G Kuiper
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
| | - Jetty A Overbeek
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Caroline Foch
- R&D Global Epidemiology, Merck Healthcare KGaA, Darmstadt, Germany
| | | | - Meritxell Sabidó
- R&D Global Epidemiology, Merck Healthcare KGaA, Darmstadt, Germany
| |
Collapse
|
12
|
Overbeek JA, Kuiper JG, Bakker M, van den Bemt BJFB, Herings RMC. Infliximab use in the Netherlands: Uptake and characteristics of originator and biosimilars over time. Br J Clin Pharmacol 2021; 88:1804-1810. [PMID: 34571570 DOI: 10.1111/bcp.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/24/2021] [Accepted: 09/19/2021] [Indexed: 01/11/2023] Open
Abstract
AIMS The objective of this retrospective cohort study was to provide an overview of the utilization of originator and biosimilar infliximab in the Netherlands. METHODS All infliximab dispensings were selected from the PHARMO In-patient Pharmacy Database from 2002-2018. Descriptive analyses were performed in order to characterise initiators and to describe switching patterns over time. RESULTS Overall, 3840 patients with 61 274 infliximab dispensings were identified. 2496 patients initiated an originator infliximab and 777 patients initiated a biosimilar infliximab. Overall, 57% of the patients was female and mean age was 43.2 years. Both originators and biosimilars were mostly prescribed by gastroenterologists, followed by internists and rheumatologists. After market authorisation of the first biosimilar, the proportion of new patients initiating the biosimilar increased from 39% in 2015 to 91% in 2018. Out of 704 patients eligible for switching 34% switched. Among switchers, the proportion of females was 60% and mean age at index was 45.1 years. Among nonswitchers, 55% were female and mean age was 39.8 years. The median time to switch was 1.7 years and switchers were most frequently initiated on infliximab by a rheumatologist (42%), while nonswitchers were most frequently initiated by a gastroenterologist (42%). CONCLUSION The results of this large population-based cohort show an increase in biosimilar initiation in daily clinical practice. The number of switchers remains relatively low as nonmedical switch is not encouraged in the Netherlands.
Collapse
Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marina Bakker
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Zilveren Kruis, Utrecht, Netherlands
| | - B J F Bart van den Bemt
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, Netherlands.,Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,Department of Epidemiology and Data Science, VU University Medical Center, Amsterdam, Netherlands
| |
Collapse
|
13
|
Morales DR, Macfarlane T, MacDonald TM, Hallas J, Ernst MT, Herings RMC, Smits E, Overbeek JA, Mitchell L, Morant S, Mackenzie I, Doney ASF, Robertson C, Bennie M, Wei L, Nicholson L, Morris C, Flynn RWF. Impact of EMA regulatory label changes on hydroxyzine initiation, discontinuation and switching to other medicines in Denmark, Scotland, England and the Netherlands: An interrupted time series regression analysis. Pharmacoepidemiol Drug Saf 2021; 30:482-491. [PMID: 33386650 DOI: 10.1002/pds.5191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hydroxyzine is indicated for the management of anxiety, skin and sleep disorders. In 2015, the European Medicines Agency (EMA) concluded that hydroxyzine was pro-arrhythmogenic and changes to the product information were implemented in Europe. This study aimed to evaluate their impact in Denmark, Scotland, England and the Netherlands. METHOD Quarterly time series analyses measuring hydroxyzine initiation, discontinuation, and switching to other antihistamines, benzodiazepines and antidepressants in Denmark, England, Scotland and the Netherlands from 2009 to 2018. Data were analysed using interrupted time series regression. RESULTS Hydroxyzine initiation in quarter one 2010 in Denmark, Scotland, England and the Netherlands per 100 000 was: 23.5, 91.5, 35.9 and 34.4 respectively. Regulatory action was associated with a significant: immediate fall in hydroxyzine initiation per 100 000 in England (-12.05, 95%CI -18.47 to -5.63) and Scotland (-19.01, 95%CI -26.99 to -11.02); change to a negative trend in hydroxyzine initiation per 100 000/quarter in England (-1.72, 95%CI -2.69 to -0.75) and Scotland (-2.38, 95%CI -3.32 to -1.44). Regulatory action was associated with a significant: immediate rise in hydroxyzine discontinuation per 100 000 in England (3850, 95%CI 440-7240). No consistent changes were observed in the Netherlands or Denmark. Regulatory action was associated with no switching to other antihistamines, benzodiazepines or antidepressants following hydroxyzine discontinuation in any country. CONCLUSION The 2015 EMA regulatory action was associated with heterogeneous impact with reductions in hydroxyzine initiation varying by country. There was limited impact on discontinuation with no strong evidence suggesting unintended consequences of major switching to other antihistamines, benzodiazepines or antidepressants.
Collapse
Affiliation(s)
- Daniel R Morales
- MEMO Research, University of Dundee, Dundee, UK.,Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | | | | | - Jesper Hallas
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Department of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | | |
Collapse
|
14
|
Morales DR, Morant SV, MacDonald TM, Hallas J, Ernst MT, Pottegard A, Herings RMC, Smits E, Overbeek JA, Mackenzie IS, Doney ASF, Mitchell L, Bennie M, Robertson C, Wei L, Nicholson L, Morris C, Flynn RWV. Impact of EU regulatory label changes for diclofenac in people with cardiovascular disease in four countries: Interrupted time series regression analysis. Br J Clin Pharmacol 2020; 87:1129-1140. [PMID: 32668021 DOI: 10.1111/bcp.14478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. METHOD Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. RESULTS The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark -0.08%, 95%CI -0.13, -0.03; England -0.09%, 95%CI -0.13 to -0.06%; the Netherlands -1.84%, 95%CI -2.51 to -1.17%; Scotland -0.34%, 95%CI -0.38 to -0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post-intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (-0.12%, 95%CI -0.19 to -0.04), PAD (-0.13%, 95%CI -0.22 to -0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (-0.01%, 95%CI -0.02 to -0.007%), IHD (-0.017, 95%CI -0.02, -0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. CONCLUSION Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam UMC
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, The Netherlands
| | | | | | | | | | - Marion Bennie
- University of Strathclyde, UK.,NHS National Services, Scotland, UK
| | | | - Li Wei
- University College London, UK
| | | | | | | |
Collapse
|
15
|
Rebordosa C, Houben E, Laugesen K, Bothner U, Montonen J, Aguado J, Overbeek JA, Ehrenstein V, Asmar J, Wallace L, Gilsenan AW. No Evidence of Off-label Use of Olodaterol and Indacaterol in Denmark, France, and the Netherlands: A Drug Utilization Study. Sci Rep 2020; 10:586. [PMID: 31953521 PMCID: PMC6968970 DOI: 10.1038/s41598-019-57397-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
To characterize the use of olodaterol and indacaterol in clinical practice and to quantify the off-label use in asthma. Drug utilization study of new users of olodaterol or indacaterol between 2014 and 2017 in the PHARMO Database Network in the Netherlands, the Danish population registers, and the IMS Real-World Evidence Longitudinal Patient Database panels in France. On-label use was defined as use among adults with a recorded diagnosis of COPD. Off-label use was defined as use among adults with a recorded diagnosis of asthma without a recorded diagnosis of COPD or as use among patients aged ≤18 years. Potential off-label use was defined as no recorded diagnosis of either COPD or asthma. The study included 4,158 new users of olodaterol and 9,966 new users of indacaterol. Prevalence of off-label use ranged from 3.5% for both drugs to 12.4% for olodaterol and 11.9% for indacaterol. Prevalence of on-label use ranged from 47.8% to 77.7% for olodaterol and from 28.7% to 70.1% for indacaterol. The remaining new users of olodaterol and indacaterol were classified as potential off-label users, with prevalence ranging from 17.3% to 48.6% for olodaterol and from 20.5% to 66.6% for indacaterol. This study provides no evidence of a major concern in Europe for olodaterol or indacaterol for off-label use in asthma or for pediatric use.
Collapse
Affiliation(s)
- Cristina Rebordosa
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain. .,Research Triangle Park, NC, North Carolina, USA.
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40 3528 AE, Utrecht, Netherlands
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Ulrich Bothner
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jukka Montonen
- Boehringer Ingelheim International GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany
| | - Jaume Aguado
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.,Research Triangle Park, NC, North Carolina, USA
| | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Joelle Asmar
- IQVIA, RWI, Tour D2, 17 Bis Place des Reflets, TSA 64567, 92099, La Défense Cedex, France
| | - Laura Wallace
- Boehringer Ingelheim International GmbH, 900 Ridgebury Road, Ridgefield, CT, 06877, USA
| | - Alicia W Gilsenan
- RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.,Research Triangle Park, NC, North Carolina, USA
| |
Collapse
|
16
|
Morales DR, Morant SV, MacDonald TM, Mackenzie IS, Doney ASF, Mitchell L, Bennie M, Robertson C, Hallas J, Pottegard A, Ernst MT, Wei L, Nicholson L, Morris C, Herings RMC, Overbeek JA, Smits E, Flynn RWV. Impact of EMA regulatory label changes on systemic diclofenac initiation, discontinuation, and switching to other pain medicines in Scotland, England, Denmark, and The Netherlands. Pharmacoepidemiol Drug Saf 2020; 29:296-305. [PMID: 31899936 PMCID: PMC7079064 DOI: 10.1002/pds.4955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/15/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 01/29/2023]
Abstract
Purpose In June 2013 a European Medicines Agency referral procedure concluded that diclofenac was associated with an elevated risk of acute cardiovascular events and contraindications, warnings, and changes to the product information were implemented across the European Union. This study measured the impact of the regulatory action on the prescribing of systemic diclofenac in Denmark, The Netherlands, England, and Scotland. Methods Quarterly time series analyses measuring diclofenac prescription initiation, discontinuation and switching to other systemic nonsteroidal anti‐inflammatory (NSAIDs), topical NSAIDs, paracetamol, opioids, and other chronic pain medication in those who discontinued diclofenac. Absolute effects were estimated using interrupted time series regression. Results Overall, diclofenac prescription initiations fell during the observation periods of all countries. Compared with Denmark where there appeared to be a more limited effect, the regulatory action was associated with significant immediate reductions in diclofenac initiation in The Netherlands (−0.42%, 95% CI, −0.66% to −0.18%), England (−0.09%, 95% CI, −0.11% to −0.08%), and Scotland (−0.67%, 95% CI, −0.79% to −0.55%); and falling trends in diclofenac initiation in the Netherlands (−0.03%, 95% CI, −0.06% to −0.01% per quarter) and Scotland (−0.04%, 95% CI, −0.05% to −0.02% per quarter). There was no significant impact on diclofenac discontinuation in any country. The regulatory action was associated with modest differences in switching to other pain medicines following diclofenac discontinuation. Conclusions The regulatory action was associated with significant reductions in overall diclofenac initiation which varied by country and type of exposure. There was no impact on discontinuation and variable impact on switching.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marion Bennie
- Strathclyde Onstitute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Chris Robertson
- Dept of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Jesper Hallas
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegard
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Martin Thomsen Ernst
- Dept of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Li Wei
- School of Pharmacy, University College London, London, UK
| | - Lizzie Nicholson
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Carole Morris
- Electronic Data Research and Innovation Service, NHS National Services Scotland, Edinburgh, UK
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | |
Collapse
|
17
|
de Bruin IJA, Klop C, Wyers CE, Overbeek JA, Geusens PPMM, van den Bergh JPW, Driessen JHM, de Vries F. All-cause mortality with current and past use of antidepressants or benzodiazepines after major osteoporotic and hip fracture. Osteoporos Int 2019; 30:573-581. [PMID: 30737577 PMCID: PMC6422967 DOI: 10.1007/s00198-019-04851-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/10/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED In the first year, after an osteoporotic fracture of a hip, forearm, upper arm, or spine, the dispensing rates of antidepressants and benzodiazepines increased significantly. After those fractures, recent and past use of antidepressants and benzodiazepines was associated with increased all-cause mortality; current use was not associated with mortality risk. INTRODUCTION It remains unclear to what extent use of antidepressants and benzodiazepines is associated with mortality risk after a major osteoporotic fracture (MOF). We aimed to study the cumulative use of antidepressants and benzodiazepines during the year after MOF or hip fracture (HF) and whether the use was associated with mortality. METHODS A cohort study was performed within the Dutch PHARMO Database Network including all patients aged 65+ with a first record of MOF (hip, humerus, forearm, and clinical vertebral fracture) between 2002 and 2011. Data were analyzed using Cox regression models, adjusted for comorbidities, and concomitant medication use and broken down to index fracture type. RESULTS A total of 4854 patients sustained a first MOF, of whom 1766 patients sustained a HF. Mean follow-up was 4.6 years, divided in 30-day periods. The cumulative antidepressant and benzodiazepine use during the first year after MOF increased from 10.6 to 14.7% and from 24.0 to 31.4%, respectively. Recent (31-92 days before each follow-up period) and past use (> 92 days before) of antidepressants and benzodiazepines after MOF or HF was associated with an increased all-cause mortality risk but current use (< 30 days before) was not. CONCLUSION There is a considerable increase in dispensing rate of antidepressants and benzodiazepines in the first year after a MOF. Recent and past use of these medications was associated with all-cause mortality. The finding that current use was not associated with mortality should be further explored and may probably be explained by the healthy survivor's bias.
Collapse
Affiliation(s)
- I J A de Bruin
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcome Research, Utrecht, Netherlands
| | - P P M M Geusens
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
- CAPHRI, Department of Internal Medicine, Subdivision Rheumatology, Maastricht University Medical Center +, Maastricht, Netherlands
| | - J P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, Netherlands
- NUTRIM, Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, Netherlands
- Biomedical Research Center, Hasselt University, Diepenbeek, Belgium
| | - J H M Driessen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
- NUTRIM/CAPHRI, Maastricht University Medical Center +, Maastricht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands
| | - F de Vries
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +, P Debyelaan 25, Maastricht, Netherlands.
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
| |
Collapse
|
18
|
Overbeek JA, van Herk-Sukel MPP, Vissers PAJ, van der Heijden AAWA, Bronsveld HK, Herings RMC, Schmidt MK, Nijpels G. Type 2 Diabetes, but Not Insulin (Analog) Treatment, Is Associated With More Advanced Stages of Breast Cancer: A National Linkage of Cancer and Pharmacy Registries. Diabetes Care 2019; 42:434-442. [PMID: 30679303 DOI: 10.2337/dc18-2146] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/12/2018] [Accepted: 12/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether women with type 2 diabetes (T2D) develop a more advanced stage of breast cancer and whether treatment with insulin (analogs) is associated with specific breast cancer characteristics. RESEARCH DESIGN AND METHODS For this nested case-control study, women with breast cancer diagnosed in 2002-2014 were selected from the linked Netherlands Cancer Registry-PHARMO Database Network (N = 33,377). T2D was defined as receiving two or more dispensings of noninsulin blood glucose-lowering drugs prior to breast cancer diagnosis. Women with T2D were matched to women without diabetes. Among women with T2D, insulin users and nonusers were compared. Multivariable ordinal logistic regression was used to investigate the association between T2D/insulin and breast cancer characteristics, including TNM classification (tumor size, lymph node status, metastasis), morphology, grade, estrogen receptor and progesterone receptor (PR), human epidermal growth factor receptor 2, and molecular subtype. RESULTS Women with T2D (n = 1,567) were more often diagnosed with a more advanced tumor stage (odds ratio 1.28 [95% CI 13-1.44]) and a higher grade (1.22 [1.08-1.39]) though less often with a PR-negative breast tumor (0.77 [0.67-0.89]) than women without diabetes (n = 6,267). No associations were found for the other breast cancer characteristics. Women with T2D using insulin (n = 388) were not diagnosed with different breast cancer characteristics compared with women with T2D not using insulin (n = 1,179). CONCLUSIONS Our study suggests that women with T2D are at increased risk to be diagnosed with a more aggressive type of breast cancer than women without diabetes. No evidence was found that the use of insulin (analogs) is associated with developing more advanced breast cancer tumors.
Collapse
Affiliation(s)
- Jetty A Overbeek
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands .,PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pauline A J Vissers
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Heleen K Bronsveld
- Department of Acute Care and Oncology, Nestlé Health Science, Lausanne, Switzerland
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
19
|
van de Ven LI, Klop C, Overbeek JA, de Vries F, Burden AM, Janssen PK. Association between use of antidepressants or benzodiazepines and the risk of subsequent fracture among those aged 65+ in the Netherlands. Osteoporos Int 2018; 29:2477-2485. [PMID: 30112636 PMCID: PMC6208956 DOI: 10.1007/s00198-018-4632-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED This is the first study to examine the association between antidepressant and benzodiazepine use following a MOF and risk of subsequent fracture in those 65+. Using national data, drug use following MOF showed that the 1-year fully adjusted risk of subsequent MOF in those on antidepressants was more than doubled. INTRODUCTION We evaluated the association between the use of antidepressants or benzodiazepines and the risk of a subsequent major osteoporotic fracture. METHODS A cohort study was performed using the Dutch PHARMO Database Network. Between 2002 and 2011, a total of 4854 patients sustained a first major osteoporotic fracture after the age of 65 years, of which 1766 sustained a hip fracture. Incidence rates and adjusted hazard ratios were calculated using Cox proportional hazards models. RESULTS Within 1 year following a major osteoporotic fracture, 15% (95% CI 13.7-15.7) and 31% (95% CI 30.1-32.8) of patients were dispensed an antidepressant or benzodiazepine, respectively. Current use of antidepressants in the first year following a major osteoporotic fracture was associated with subsequent fracture (adjusted HR 2.17 (95% CI 1.37-3.43)). Recent and past use of antidepressants were also associated with an increased risk of subsequent fracture. When the complete follow-up period was included, only the current use of antidepressants was associated with subsequent fracture following a major osteoporotic fracture (adjusted HR 1.48; 95% CI 1.06-2.06). Current benzodiazepine use was not associated with an increased risk of fracture within 1 year following a major osteoporotic fracture (adjusted HR 1.18; 95% CI 0.76-1.81) or during the complete follow-up period (adjusted HR 1.18; 95% CI 0.90-1.55). CONCLUSION This study provides evidence that antidepressants should be used with caution following a major osteoporotic fracture. It provides needed insights that can be used to inform clinicians when assessing subsequent fracture risk in patients.
Collapse
Affiliation(s)
- L I van de Ven
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C Klop
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - F de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - A M Burden
- Department of Chemistry and Applied Biosciences, Institute of Pharmaceutical Sciences, ETH Zürich, Zürich, Switzerland
| | - P K Janssen
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Departments of Hospital Pharmacy and Intensive Care, VieCuri Medical Center, Venlo, The Netherlands
| |
Collapse
|
20
|
Overbeek JA, Heintjes EM, Huisman EL, Tikkanen CK, van Diermen AW, Penning‐van Beest FJ, Herings RM. Clinical effectiveness of liraglutide vs basal insulin in a real-world setting: Evidence of improved glycaemic and weight control in obese people with type 2 diabetes. Diabetes Obes Metab 2018; 20:2093-2102. [PMID: 29726082 PMCID: PMC6099315 DOI: 10.1111/dom.13335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 12/19/2022]
Abstract
AIMS To compare real-world antidiabetic treatment outcomes over 12 months in obese people with type 2 diabetes mellitus (T2DM) who previously received oral antidiabetic therapy and then initiated a first injectable therapy with liraglutide or basal insulin. PATIENTS AND METHODS This was a retrospective, propensity score-matched, longitudinal cohort study using real-world data (January 2010 to December 2015) from the Dutch PHARMO Database Network. Adult obese (body mass index [BMI] ≥35 kg/m2 ) patients with T2DM with ≥2 dispensing dates for liraglutide or basal insulin supported oral therapy (BOT) were selected. The primary endpoint was the change in glycated haemoglobin (HbA1c) from baseline during 12 months of follow-up. The secondary endpoints were the changes in weight, BMI and cardiovascular risk factors from baseline. Clinical data were analysed using descriptive statistics and compared using mixed models for repeated measures. RESULTS Obese patients with T2DM (N = 1157) in each treatment group were matched (liraglutide cohort, n = 544; BOT cohort, n = 613). From 3 months onwards, glycaemic control improved in both cohorts but improved significantly more with liraglutide than with BOT (12 months: -12.2 mmol/mol vs -8.8 mmol/mol; P = .0053). In addition, weight and BMI were significantly lower for treatments with liraglutide vs BOT (12 months: -6.0 kg vs -1.6 kg and - 2.1 kg/m2 vs -0.5 kg/m2 , respectively; P < .0001 for both). No significant differences were seen in changes in cardiovascular risk factors. CONCLUSIONS The results of this real-world study in matched obese patients with T2DM showed that liraglutide was more effective than BOT for HbA1c control and weight/BMI reductions. Patients were more likely to maintain glycaemic control over time after initiating liraglutide than after initiating BOT.
Collapse
Affiliation(s)
- Jetty A. Overbeek
- PHARMO Institute for Drug Outcomes ResearchUtrechtthe Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research InstituteVU University Medical CentreAmsterdamthe Netherlands
| | | | | | | | | | | | - Ron M.C. Herings
- PHARMO Institute for Drug Outcomes ResearchUtrechtthe Netherlands
- Department of Epidemiology and BiostatisticsVU University Medical CenterAmsterdamthe Netherlands
| |
Collapse
|
21
|
Overbeek JA, Bakker M, van der Heijden AAWA, van Herk-Sukel MPP, Herings RMC, Nijpels G. Risk of dipeptidyl peptidase-4 (DPP-4) inhibitors on site-specific cancer: A systematic review and meta-analysis. Diabetes Metab Res Rev 2018; 34:e3004. [PMID: 29573125 DOI: 10.1002/dmrr.3004] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 05/23/2017] [Revised: 01/03/2018] [Accepted: 03/12/2018] [Indexed: 12/19/2022]
Abstract
The long-term impact of dipeptidyl peptidase-4 (DPP-4) inhibition is unknown, and there are concerns about the influence of DPP-4 inhibition on carcinogenesis of the pancreas and thyroid. As DPP-4 is a rather unselective enzyme present in many tissues, we focused on all specific cancer types. PubMed and EMBASE were searched between January 2005 and April 2017 to identify studies comparing DPP-4 inhibitors with either placebo or active drugs on cancer risk. Studies were included if they reported on at least one specific cancer outcome and had a follow-up of at least 1 year after start of drug use. Methodological quality of the studies was assessed by the Cochrane Collaboration's tool and the Newcastle-Ottawa Scale. Twenty-five studies met the inclusion criteria (12 randomized controlled trials and 13 observational studies). Sample sizes of the DPP-4 inhibitor groups ranged from 29 to 8212 patients for randomized controlled trials and from 2422 to 71 137 patients for observational studies. Mean age ranged from 51 to 76 years, and mean follow-up was 1.5 years. None of the pooled (sensitivity) analyses, except the observational studies studying breast cancer (hazard ratio [95% CI]: 0.76 [0.60-0.96]), showed evidence for an association between DPP-4 inhibitors and site-specific cancer. Also for pancreatic and thyroid cancer, no statistically significant risk was found. Based on the current literature, it is not possible to conclude whether DPP-4 inhibitors were associated with an increased risk of site-specific cancer. Future studies should address the methodological limitations and follow patients for a longer period to determine the long-term cancer risk of DPP-4 inhibitors.
Collapse
Affiliation(s)
- Jetty A Overbeek
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Marina Bakker
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Amber A W A van der Heijden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
22
|
Engelkes M, van Blijderveen JC, Overbeek JA, Kuiper J, Herings RCM, Sturkenboom MCJM, de Jongste JC, Verhamme KMC, Janssens HM. Brand and generic use of inhalation medication and frequency of switching in children and adults: A population-based cohort study. J Asthma 2017; 55:1086-1094. [PMID: 29185812 DOI: 10.1080/02770903.2017.1396468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The expiration of patents of brand inhalation medications and the ongoing pressure on healthcare budgets resulted in a growing market for generics. AIM To study the use of brand and generic inhalation medication and the frequency of switching between brand and generic and between devices. In addition, we investigated whether switching affected adherence. METHODS From dispensing data from the Dutch PHARMO Database Network a cohort aged ≥ 5 years, using ≥ 1 year of inhalation medication between 2003 and 2012 was selected. Switching was defined as changing from brand to generic or vice versa. In addition, we studied change in aerosol delivery device type (e.g., DPI, pMDI, and nebulizers). Adherence was calculated using the medication possession ratio (MPR). RESULTS The total cohort comprised 70,053 patients with 1,604,488 dispensations. Per calendar year, 5% switched between brand and generic inhalation medication and 5% switched between devices. Median MPRs over the first 12 months ranged between 33 and 55%. Median MPR over the total period was lower after switch from brand to generic and vice versa for formoterol (44.5 vs. 42.1 and 63.5 vs. 53.8) and beclomethasone (93.8 vs. 59.8 and 81.3 vs. 55.9). CONCLUSION Per year, switching between brand and generic inhalation medication was limited to 5% of the patients, switching between device types was observed in 5% as well. Adherence to both generic and brand inhalation medication was low. Effect of switching on adherence was contradictory; depending on time period, medication and type, and direction of switching. Further research on reasons for switching and potential impact on clinical outcomes is warranted.
Collapse
Affiliation(s)
- Marjolein Engelkes
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands
| | | | - Jetty A Overbeek
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Josephine Kuiper
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | - Ron C M Herings
- b PHARMO , Institute for Drug Outcomes Research , Utrecht , the Netherlands
| | | | - Johan C de Jongste
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
| | - Katia M C Verhamme
- a Department of Medical Informatics , Erasmus MC , Rotterdam , the Netherlands.,d Department of Bioanalysis, Faculty of Pharmaceutical Sciences , Ghent University , Belgium
| | - Hettie M Janssens
- c Department of Pediatrics, Division of Respiratory Medicine and Allergology , Erasmus MC Sophia , Rotterdam , the Netherlands
| |
Collapse
|
23
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
24
|
Houben E, Smits E, Overbeek JA, Penning-van Beest FJA, Herings RMC, van Herk-Sukel MPP, Teichert M, de Smet PAGM. No Evidence for an Association Between Renal Function and Serious Bleeding Events in Patients Treated With Coumarins: A Population-Based Study. Ann Pharmacother 2017; 52:221-234. [PMID: 28985682 DOI: 10.1177/1060028017735340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 Although anticoagulation therapy is closely monitored in the Netherlands, coumarin-induced serious bleeding events are still observed. Current literature suggests that renal impairment may contribute to this. OBJECTIVE To explore the association between renal function and bleeding events during coumarin treatment. METHODS A nested case-control study was conducted using data from the PHARMO Database Network. Patients hospitalized for a bleeding event during coumarin treatment were selected as cases and matched on sex, birth year, and geographic region to up to 2 controls using coumarins without hospitalization for bleeding. All values of estimated glomerular filtration rates (eGFRs) were selected in the year before index date (case hospitalization date) and compared between cases and controls using logistic regression analyses. RESULTS In total, 2224 cases were matched to 4398 controls (61% male; mean ± SD age 75 ± 11 and 78 ± 11 years among cases and controls, respectively). Availability of eGFR values was higher among cases compared with controls (mean ± SD eGFR values 4.5 ± 7.1 vs 3.2 ± 5.5), reflected in the significantly shorter time since last eGFR value (at index date, mean ± SD = 2.7 ± 3.0 vs 3.8 ± 3.1 months; odds ratio [OR] = 0.91, 95%CI = 0.89-0.92). No statistically significant difference was found for the mean eGFR value in the year before index date (mean ± SD 65.7 ± 22.8 vs 64.6 ± 20.9 mL/min/1.73 m2; OR per 10 units [95%CI] = 0.99 [0.96-1.02]). CONCLUSIONS No association between renal function and serious bleeding events during coumarin treatment was observed.
Collapse
Affiliation(s)
- Eline Houben
- 1 PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Elisabeth Smits
- 1 PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Jetty A Overbeek
- 1 PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands.,2 Amsterdam Public Health Research Institute, Netherlands
| | | | - Ron M C Herings
- 1 PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | | | - Martina Teichert
- 3 Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands.,4 Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands.,5 Leiden University Medical Center, Netherlands
| | - Peter A G M de Smet
- 3 Royal Dutch Pharmacists Association (KNMP), The Hague, Netherlands.,4 Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| |
Collapse
|
25
|
van Wijngaarden RPT, Overbeek JA, Heintjes EM, Schubert A, Diels J, Straatman H, Steyerberg EW, Herings RMC. Relation Between Different Measures of Glycemic Exposure and Microvascular and Macrovascular Complications in Patients with Type 2 Diabetes Mellitus: An Observational Cohort Study. Diabetes Ther 2017; 8:1097-1109. [PMID: 28921256 PMCID: PMC5630557 DOI: 10.1007/s13300-017-0301-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION This retrospective cohort study investigated the relation between different measures of glycemic exposure and micro- and macrovascular complications among patients with type 2 diabetes. METHODS The analysis included patients receiving oral antihyperglycemic agents between 1 January 2006 and 31 December 2014 from the General Practitioner Database from the PHARMO Database Network. All recorded HbA1c levels during follow-up were used to express glycemic exposure in four ways: index HbA1c, time-dependent HbA1c, exponential moving average (EMA) and glycemic burden. Association between glycemic exposure and micro-/macrovascular complications was analyzed by estimating hazard ratios and 95% confidence intervals using an adjusted (time-dependent) Cox proportional hazards model. RESULTS The analysis included 32,725 patients (median age, 65 years; 47% female). Median follow-up was 5.4 years; median number of HbA1c measurements per patient was 18.0. From all measures, HbA1c at index showed the weakest relation between all micro-/macrovascular complications, with coronary artery disease (CAD) having the highest HR (95% CI): 1.18 (1.04-1.34) for HbA1c ≥64 mmol/mol (8%). The time-dependent HbA1c model showed a significant association only for microvascular complications, with retinopathy having the highest HR (95% CI): 1.55 (1.40-1.73) for HbA1c ≥64 mmol/mol (8%). EMA-defined exposure showed similar findings, although the effect of retinopathy was more pronounced [HR (95% CI): 1.81 (1.63-2.02) for HbA1c ≥64 mmol/mol (8%)] and was also predictive for CAD [HR (95% CI): 1.29 (1.10-1.50) for HbA1c ≥64 mmol/mol (8%)]. A statistically significant relation with glycemic burden was found for all selected micro-/macrovascular complications, with retinopathy having the highest HR (95%): 2.60 (2.19-3.07) for glycemic burden years >3. CONCLUSION This study shows that greater and more prolonged exposure to hyperglycemia increases the risk of micro- and macrovascular complications. FUNDING Janssen Pharmaceutica NV.
Collapse
Affiliation(s)
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, Netherlands
| | - Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | | | - Joris Diels
- Janssen Research and Development, Beerse, Belgium
| | - Huub Straatman
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Department of Epidemiology & Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
26
|
Margulis AV, Houben E, Hallas J, Overbeek JA, Pottegård A, Torp-Pedersen T, Perez-Gutthann S, Arana A. Ophthalmic nepafenac use in the Netherlands and Denmark. Acta Ophthalmol 2017; 95:509-517. [PMID: 28493461 PMCID: PMC5518196 DOI: 10.1111/aos.13468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 12/06/2016] [Accepted: 03/24/2017] [Indexed: 02/01/2023]
Abstract
Purpose To describe nepafenac use in the Netherlands and Denmark with reference to its approved indications. For context, we also describe the use of ketorolac and diclofenac. Methods We identified users in the PHARMO Database Network (the Netherlands, 2008–2013) and the Danish national health registers (Denmark, 1994–2014). We described prevalence of cataract surgery and duration of use in patients with cataract surgery with and without diabetes. Results In the Netherlands, 9530 nepafenac users (mean age, 71 years; 60% women) contributed 12 691 therapy episodes, of which 21% had a recently recorded cataract surgery. Of 2266 episodes in adult non‐diabetic patients with cataract surgery, 60% had one bottle dispensed (treatment duration ≤21 days). Of 441 episodes in adult diabetic patients with cataract surgery, 90% had up to two bottles dispensed (≤60 days). Denmark had 60 403 nepafenac users (mean age, 72 years; 58% women) and 73 648 episodes (41% had recorded cataract surgery). Of 26 649 nepafenac episodes in adult non‐diabetic patients with cataract surgery, 92% had one bottle dispensed. Of 3801 episodes in adult diabetic patients with cataract surgery, 99.8% had up to two bottles dispensed. Use patterns of nepafenac, ketorolac and diclofenac were roughly similar in the Netherlands, but not in Denmark. Conclusion Less than half of therapy episodes were related to cataract surgery; around 90% of episodes with surgery were within the approved duration. Underrecording of ophthalmic conditions and procedures was a challenge in this study.
Collapse
Affiliation(s)
| | - Eline Houben
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
| | | | | | | |
Collapse
|
27
|
Overbeek JA, Heintjes EM, Prieto-Alhambra D, Blin P, Lassalle R, Hall GC, Lapi F, Bianchini E, Hammar N, Bezemer ID, Herings RMC. Type 2 Diabetes Mellitus Treatment Patterns Across Europe: A Population-based Multi-database Study. Clin Ther 2017; 39:759-770. [PMID: 28342563 DOI: 10.1016/j.clinthera.2017.02.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/03/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to determine the similarities and differences of type 2 diabetes mellitus (T2DM) treatment patterns in daily practice in 5 European countries and whether these reflect differences in guidelines. METHODS Prescriptions for drugs used in diabetes treatment during a 5-year study period were obtained from electronic databases. Patients initiating T2DM treatment during the study period were included. An SAS analysis tool was developed to create episodes of use of drug classes, which resulted in treatment patterns. FINDINGS A total of 253,530 patients initiating T2DM treatment during the study period were included; 52% to 55% were male, and the mean age ranged from 62 to 67 years. Metformin was the most common initial treatment in all countries. After initial therapy, most patients in the Netherlands, Spain, and the United Kingdom switched to a combination of metformin + a sulfonylurea derivative (SU). In Italy, metformin in combination with an SU was outnumbered by "other treatment," mainly because of repaglinide use. In France, treatments including dipeptidyl peptidase-4 inhibitors were most frequent as second- and fourth-line treatment. Metformin monotherapy was again most commonly observed as the third line of treatment in all countries. Fourth treatment was a combination of metformin + an SU in the Netherlands and Spain; in the United Kingdom and France, dipeptidyl peptidase-4 inhibitors were the most frequently used fourth line of treatment. IMPLICATIONS This study provides a comprehensive overview of T2DM treatment patterns among patients initiating T2DM treatment in 5 European countries. There were differences, especially regarding the uptake of newer incretin-based treatments, which are usually prescribed as a second and/or third treatment in agreement with local guidelines. These variations reflect the differences between the national guidelines of these countries.
Collapse
Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
| | - Edith M Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Daniel Prieto-Alhambra
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain; Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Patrick Blin
- Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, CIC Bordeaux CIC 1401, Bordeaux, France
| | | | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Elisa Bianchini
- 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
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands; EMGO Institute for Health and Care research, Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| |
Collapse
|
28
|
Burden A, Roche N, Miglio C, Hillyer EV, Postma DS, Herings RM, Overbeek JA, Khalid JM, van Eickels D, Price DB. An evaluation of exact matching and propensity score methods as applied in a comparative effectiveness study of inhaled corticosteroids in asthma. Pragmat Obs Res 2017; 8:15-30. [PMID: 28356782 PMCID: PMC5367458 DOI: 10.2147/por.s122563] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Cohort matching and regression modeling are used in observational studies to control for confounding factors when estimating treatment effects. Our objective was to evaluate exact matching and propensity score methods by applying them in a 1-year pre–post historical database study to investigate asthma-related outcomes by treatment. Methods We drew on longitudinal medical record data in the PHARMO database for asthma patients prescribed the treatments to be compared (ciclesonide and fine-particle inhaled corticosteroid [ICS]). Propensity score methods that we evaluated were propensity score matching (PSM) using two different algorithms, the inverse probability of treatment weighting (IPTW), covariate adjustment using the propensity score, and propensity score stratification. We defined balance, using standardized differences, as differences of <10% between cohorts. Results Of 4064 eligible patients, 1382 (34%) were prescribed ciclesonide and 2682 (66%) fine-particle ICS. The IPTW and propensity score-based methods retained more patients (96%–100%) than exact matching (90%); exact matching selected less severe patients. Standardized differences were >10% for four variables in the exact-matched dataset and <10% for both PSM algorithms and the weighted pseudo-dataset used in the IPTW method. With all methods, ciclesonide was associated with better 1-year asthma-related outcomes, at one-third the prescribed dose, than fine-particle ICS; results varied slightly by method, but direction and statistical significance remained the same. Conclusion We found that each method has its particular strengths, and we recommend at least two methods be applied for each matched cohort study to evaluate the robustness of the findings. Balance diagnostics should be applied with all methods to check the balance of confounders between treatment cohorts. If exact matching is used, the calculation of a propensity score could be useful to identify variables that require balancing, thereby informing the choice of matching criteria together with clinical considerations.
Collapse
Affiliation(s)
- Anne Burden
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Nicolas Roche
- University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France
| | - Cristiana Miglio
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | | | - Dirkje S Postma
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen
| | - Ron Mc Herings
- PHARMO Institute for Drug Outcomes Research, Utrech, the Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrech, the Netherlands
| | | | | | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore; Academic Primary Care, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
29
|
Houben E, van Haalen HGM, Sparreboom W, Overbeek JA, Ezendam NPM, Pijnenborg JMA, Severens JL, van Herk-Sukel MPP. Chemotherapy for ovarian cancer in the Netherlands: a population-based study on treatment patterns and outcomes. Med Oncol 2017; 34:50. [PMID: 28224447 DOI: 10.1007/s12032-017-0901-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/06/2017] [Indexed: 12/28/2022]
Abstract
Information on treatment patterns for ovarian cancer (OC) is limited. The aim of this study was to describe current patterns of chemotherapy and other systemic treatments for OC in the Netherlands and evaluate survival outcomes following subsequent lines of treatment. Data from the Eindhoven Cancer Registry, including on newly diagnosed cancer patients, were linked to the PHARMO Database Network, including information on in- and out-patient drug use. Patients diagnosed with OC between January 2000 and December 2010 were selected. An algorithm was used to identify separate lines of treatment. Data were studied descriptively. Detailed data on systemic drug use were available for 261 patients (17%) with OC. In first-line treatment, 87% of the patients (227/261) received platinum-based chemotherapy. Of the 161 patients receiving second-line treatment, 101 patients (63%) received platinum-based chemotherapy. In third line, this was 51% (53/103). The median number of treatment lines received by patients was two (interquartile range 1-3), and eight or more lines of chemotherapy were identified for 12 patients. Median survival from diagnosis onwards was 47 months from the end of first-line treatment, median survival was 32 months, and from the end of second-line treatment, it was 14 months. Predominantly beyond second-line treatment, there is much variety in treatment patterns with chemotherapy for OC. Although uncertainty remains regarding the desirability of this observed treatment variation, there seems a need for detailed clinical guidance, assuring that physicians can properly choose the most suitable treatment for each patient.
Collapse
Affiliation(s)
- E Houben
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands.
| | - H G M van Haalen
- AstraZeneca BV, Zoetermeer, The Netherlands.,Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| | - N P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - J M A Pijnenborg
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J L Severens
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - M P P van Herk-Sukel
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, The Netherlands
| |
Collapse
|
30
|
Overbeek JA, van der Heijden AWA, Herings RMC, Nijpels G. [Prevalence of diabetes mellitus in the Netherlands more than doubled in the period 1999-2014]. Ned Tijdschr Geneeskd 2017; 160:D673. [PMID: 28098041] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the trend in the prevalence of diabetes in the Netherlands during the period 1999-2014. DESIGN Descriptive study of prevalence. METHODS The prevalence of diabetes during the period 1999-2014 was calculated on the basis of data from the PHARMO Database Network, a network of electronic databases that includes data from public pharmacies for 3.8 million residents of the Netherlands. A person with diabetes was defined as someone with at least two dispensings for a glucose lowering-drug within six months. Prevalence was adjusted for variation in age demographics per sex to investigate the influence of these variations on population demographics. RESULTS The prevalence of diabetes in the Netherlands increased from 1.8% in 1999 to 4.9% in 2014. The increase was more pronounced among men as age increased. Only half of the increase was explained by changes in age demographics per sex. CONCLUSION The study showed that the prevalence of diabetes more than doubled during the period 1999-2014. This trend can only be partly explained by changes in age demographics per sex.
Collapse
Affiliation(s)
- J A Overbeek
- VU medisch centrum, EMGO Instituut, afd. Huisartsgeneeskunde en ouderengeneeskunde, Amsterdam
| | | | | | | |
Collapse
|
31
|
Postma DS, Dekhuijzen R, van der Molen T, Martin RJ, van Aalderen W, Roche N, Guilbert TW, Israel E, van Eickels D, Khalid JM, Herings RMC, Overbeek JA, Miglio C, Thomas V, Hutton C, Hillyer EV, Price DB. Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids. Allergy Asthma Immunol Res 2017; 9:116-125. [PMID: 28102056 PMCID: PMC5266109 DOI: 10.4168/aair.2017.9.2.116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/04/2016] [Indexed: 11/20/2022]
Abstract
Purpose Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). Methods This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. Results Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. Conclusions In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.
Collapse
Affiliation(s)
- Dirkje S Postma
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Thys van der Molen
- University of Groningen, Department of Pulmonology, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard J Martin
- Department of Medicine, National Jewish Health, and University of Colorado Denver, Denver, CO, USA
| | | | - Nicolas Roche
- University Paris Descartes (EA2511), Cochin Hospital Group (AP-HP), Paris, France
| | | | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, The Netherlands
| | | | | | | | | | | | - David B Price
- Research in Real Life, Cambridge, UK.,Academic Primary Care, University of Aberdeen, Aberdeen, UK.
| |
Collapse
|
32
|
van der Molen T, Postma DS, Martin RJ, Herings RMC, Overbeek JA, Thomas V, Miglio C, Dekhuijzen R, Roche N, Guilbert T, Israel E, van Aalderen W, Hillyer EV, van Rysewyk S, Price DB. Erratum to: Effectiveness of initiating extrafine-particle versus fine-particle inhaled corticosteroids as asthma therapy in the Netherlands. BMC Pulm Med 2016; 16:105. [PMID: 27450521 PMCID: PMC4958282 DOI: 10.1186/s12890-016-0270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Dirkje S Postma
- University of Groningen, University Medical Center Groningen, Department Pulmonary Medicine and Tuberculosis, Groningen, The Netherlands
| | - Richard J Martin
- National Jewish Health and the University of Colorado, Denver, USA
| | - Ron M C Herings
- PHARMO Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- PHARMO Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | | | | | | | - Nicolas Roche
- Groupe Hospitalier Cochin, AP-HP and University Paris Descartes (EA2511), Paris, France
| | - Theresa Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wim van Aalderen
- Emma's Children Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Simon van Rysewyk
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore
| | - David B Price
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore. .,Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| |
Collapse
|
33
|
Heintjes EM, Overbeek JA, Penning-van Beest FJA, Brobert G, Herings RMC. Post authorization safety study comparing quetiapine to risperidone and olanzapine. Hum Psychopharmacol 2016; 31:304-12. [PMID: 27297785 DOI: 10.1002/hup.2539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/01/2015] [Revised: 03/26/2016] [Accepted: 04/15/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To compare rates of specific adverse outcomes between patients starting quetiapine, olanzapine, or risperidone use in the Netherlands. METHODS Observational study using the PHARMO Database Network, including patients starting quetiapine (4658), olanzapine (5856), or risperidone (7229) in 2000-2009, comparing rates of all-cause mortality, failed suicide attempts, extrapyrimidal symptoms (EPS), diabetes mellitus (DM), hypothyroidism, and acute myocardial infarction (AMI). KEY FINDINGS Median follow-up until discontinuation/end of follow-up was 0.6 years. Prescribed doses were generally lower than the approved defined daily doses, especially for quetiapine. Quetiapine was significantly associated with lower EPS rates (HR 0.18; 95% CI 0.13-0.24), but higher failed suicide attempt rates (HR 2.07; 95% CI 1.35-3.16) compared to risperidone. Quetiapine was significantly associated with lower EPS rates (HR 0.59; 95% CI 0.42-0.84) and DM rates (HR 0.66; 95% CI 0.44-0.97) compared to olanzapine. Rates for all-cause mortality, hypothyroidism, and stroke were similar between groups. AMI events were too infrequent to draw conclusions. CONCLUSIONS Quetiapine was associated with lower EPS, but higher failed suicide attempt rates compared to risperidone. Quetiapine was associated with lower EPS and DM rates compared to olanzapine. The results should be interpreted with caution because of possible channelling and residual confounding. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
|
34
|
van der Molen T, Postma DS, Martin RJ, Herings RMC, Overbeek JA, Thomas V, Miglio C, Dekhuijzen R, Roche N, Guilbert T, Israel E, van Aalderen W, Hillyer EV, van Rysewyk S, Price DB. Effectiveness of initiating extrafine-particle versus fine-particle inhaled corticosteroids as asthma therapy in the Netherlands. BMC Pulm Med 2016; 16:80. [PMID: 27184175 PMCID: PMC4869182 DOI: 10.1186/s12890-016-0234-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/27/2016] [Indexed: 11/25/2022] Open
Abstract
Background Most randomised clinical trials typically exclude a significant proportion of asthma patients, including those at higher risk of adverse events, with comorbidities, obesity, poor inhaler technique and adherence, or smokers. However, these patients might differentially benefit from extrafine-particle inhaled corticosteroids (ICS). This matched cohort, database study, compared the effectiveness of extrafine-particle with fine-particle ICS in a real-life population initiating ICS therapy in the Netherlands. Methods Data were from the Pharmo Database Network, comprising pharmacy and hospital discharge records, representative of 20 % of the Dutch population. The study population included patients aged 12 − 60, with a General Practice-recorded diagnosis for asthma (International Classification of Primary Care code R96), when available, ≥2 prescriptions for asthma therapy at any time in their recorded history, and receiving first prescription of ICS therapy as either extrafine-particle (ciclesonide or hydrofluoroalkane beclomethasone dipropionate [BDP]) or fine-particle ICS (fluticasone propionate or non-extrafine-particle-BDP). Patients were matched (1:1) on relevant demographic and clinical characteristics over 1-year baseline. Primary outcomes were severe exacerbation rates, risk domain asthma control and overall asthma control during the year following first ICS prescription. Secondary outcomes, treatment stability and being prescribed higher versus lower category of short-acting β2 agonists (SABA) dose, were compared over a 1-year outcome period using conditional logistic regression models. Results Following matching, 1399 patients were selected in each treatment cohort (median age: 43 years; males: 34 %). Median (interquartile range) initial ICS doses (fluticasone-equivalents in μg) were 160 (160 − 320) for extrafine-particle versus 500 (250 − 500) for fine-particle ICS (p < 0.001). Following adjustment for residual confounders, matched patients prescribed extrafine-particle ICS had significantly lower rates of exacerbations (adjusted rate ratio [95 % CI], 0.59 [0.47–0.73]), and significantly higher odds of achieving asthma control and treatment stability in the year following initiation than those prescribed fine-particle ICS, and this occurred at lower prescribed doses. Patients prescribed extrafine-particle ICS had lower odds of being prescribed higher doses of SABA (0.50 [0.44–0.57]). Conclusion In this historical, matched study, extrafine-particle ICS was associated with better odds of asthma control than fine-particle ICS in patients prescribed their first ICS therapy in the Netherlands. Of importance, this was reached at significantly lower prescribed dose. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0234-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Thys van der Molen
- Department of General Practice, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Dirkje S Postma
- Department of Pulmonary Medicine, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Ron M C Herings
- Pharmo Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | - Jetty A Overbeek
- Pharmo Institute for Drugs Outcome Research, Utrecht, The Netherlands
| | | | | | | | - Nicolas Roche
- Groupe Hospitalier Cochin, AP-HP and University Paris Descartes, Paris, France
| | - Theresa Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, USA
| | - Elliot Israel
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wim van Aalderen
- Emma's Children Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Simon van Rysewyk
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore
| | - David B Price
- Observational & Pragmatic Research Institute Pte, Ltd, Singapore, Singapore. .,Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, AB25 2ZD, Aberdeen, UK.
| |
Collapse
|
35
|
Klop C, Welsing PMJ, Leufkens HGM, Elders PJM, Overbeek JA, van den Bergh JP, Bijlsma JWJ, de Vries F. The Epidemiology of Hip and Major Osteoporotic Fractures in a Dutch Population of Community-Dwelling Elderly: Implications for the Dutch FRAX® Algorithm. PLoS One 2015; 10:e0143800. [PMID: 26633011 PMCID: PMC4669166 DOI: 10.1371/journal.pone.0143800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Incidence rates of non-hip major osteoporotic fractures (MOF) remain poorly characterized in the Netherlands. The Dutch FRAX® algorithm, which predicts 10-year probabilities of hip fracture and MOF (first of hip, humerus, forearm, clinical vertebral), therefore incorporates imputed MOF rates. Swedish incidence rate ratios for hip fracture to MOF (Malmo 1987–1996) were used to perform this imputation. However, equality of these ratios between countries is uncertain and recent evidence is scarce. Aims were to estimate incidence rates of hip fracture and MOF and to compare observed MOF rates to those predicted by the imputation method for the Netherlands. Methods Using hospitalisation and general practitioner records from the Dutch PHARMO Database Network (2002–2011) we calculated age-and-sex-specific and age-standardized incidence rates (IRs) of hip and other MOFs (humerus, forearm, clinical vertebral) and as used in FRAX®. Observed MOF rates were compared to those predicted among community-dwelling individuals ≥50 years by the standardized incidence ratio (SIR; 95% CI). Results Age-standardized IRs (per 10,000 person-years) of MOF among men and women ≥50 years were 25.9 and 77.0, respectively. These numbers were 9.3 and 24.0 for hip fracture. Among women 55–84 years, observed MOF rates were significantly higher than predicted (SIR ranged between 1.12–1.50, depending on age). In men, the imputation method performed reasonable. Conclusion Observed MOF incidence was higher than predicted for community-dwelling women over a wide age-range, while it agreed reasonable for men. As miscalibration may influence treatment decisions, there is a need for confirmation of results in another data source. Until then, the Dutch FRAX® output should be interpreted with caution.
Collapse
Affiliation(s)
- Corinne Klop
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - Paco M. J. Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
| | - Hubert G. M. Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - Petra J. M. Elders
- Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, Netherlands
| | | | - Joop P. van den Bergh
- Department of Internal Medicine, Viecuri Medical Centre, Venlo, Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, Netherlands
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
| | - Frank de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, United Kingdom
- * E-mail:
| |
Collapse
|
36
|
Klop C, Welsing PMJ, Elders PJM, Overbeek JA, Souverein PC, Burden AM, van Onzenoort HAW, Leufkens HGM, Bijlsma JWJ, de Vries F. Long-term persistence with anti-osteoporosis drugs after fracture. Osteoporos Int 2015; 26:1831-40. [PMID: 25822104 PMCID: PMC4469296 DOI: 10.1007/s00198-015-3084-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/19/2015] [Indexed: 11/07/2022]
Abstract
UNLABELLED Long-term persistence with anti-osteoporosis drugs and determinants for discontinuation among fracture patients were examined. Persistence was 75.0 and 45.3 % after 1 and 5 years, respectively. Those aged ≥80 years were at increased risk of early discontinuation. Within 1 year after discontinuation, 24.3 % restarted therapy, yet 47.0 % persisted for 1 year. INTRODUCTION The risk of osteoporotic fracture can effectively be reduced with use of anti-osteoporosis drugs. However, little is known about persistence with these drugs after fracture where subsequent fracture risk is high. The aims were to determine long-term persistence with anti-osteoporosis drugs among fracture patients, including its determinants, and to describe restart and subsequent persistence. METHODS A cohort study was conducted within the Dutch PHARMO Database Network. Patients aged ≥50 years (n = 961) who received anti-osteoporosis drugs within 1 year after fracture, but not in the preceding year, were included (2002-2011). Persistence (defined as the proportion on treatment) and the proportion restarting after discontinuation were estimated using Kaplan-Meier analyses. Time-dependent Cox regression was used to identify determinants of non-persistence including age, sex, initial dosage regime, fracture type, comorbidities, and drug use. RESULTS Persistence with anti-osteoporosis drugs was 75.0 % (95 % confidence interval (CI) 72.0-77.7) and 45.3 % (95 % CI 40.4-50.0) after 1 and 5 years, respectively. A significant determinant of non-persistence was age ≥80 years (reference 50-59 years: adjusted hazard ratio [adj. HR] 1.65; 95 % CI 1.15-2.38). This effect was not constant over time (≤360 days following initiation: adj. HR 2.07; 95 % CI 1.27-3.37; >360 days: adj. HR 1.08; 95 % CI 0.62-1.88). Within 1 year after discontinuation, 24.3 % (95 % CI 20.1-29.2) restarted therapy, yet 47.0 % persisted for 1 year. CONCLUSIONS This study identified suboptimal persistence with anti-osteoporosis drugs among fracture patients. Major target groups for measures aimed to improve persistence may be those aged >80 years and those restarting therapy.
Collapse
Affiliation(s)
- C Klop
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - P M J Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
| | - P J M Elders
- Department of General Practice and Elderly Care, VU University Medical Centre, Amsterdam, Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - P C Souverein
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - A M Burden
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - H A W van Onzenoort
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands
- Department of Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - H G M Leufkens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands
| | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, Netherlands
| | - F de Vries
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, Netherlands.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Netherlands.
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
| |
Collapse
|
37
|
Fazeli Farsani S, Souverein PC, Overbeek JA, van der Vorst MMJ, Knibbe CAJ, Herings RMC, de Boer A, Mantel-Teeuwisse AK. Long term trends in oral antidiabetic drug use among children and adolescents in the Netherlands. Br J Clin Pharmacol 2015; 80:294-303. [PMID: 25683632 DOI: 10.1111/bcp.12608] [Citation(s) in RCA: 8] [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] [Received: 11/23/2014] [Revised: 02/07/2015] [Accepted: 02/10/2015] [Indexed: 12/18/2022] Open
Abstract
AIM The aim of the study was to document long term trends in oral antidiabetic drug (OAD) use among children and adolescents in the Netherlands. METHODS A population-based cohort study was conducted using the Dutch PHARMO Database Network. All patients younger than 20 years old with at least one OAD dispensing were identified. Age-adjusted and age-specific incidence (1999-2011) and prevalence (1998-2011) rates of OAD use were calculated. Trends over time were assessed using joinpoint regression software. A subset of PHARMO Database Network (including community pharmacy dispensing records linked to general practitioner data (OPD-GP database)) was used to assess indications for OADs. RESULTS In 2011, the overall age-adjusted incidence and prevalence rates of OAD use were 20.7/100 000 (95% CI 19.2, 22.1) person-years (PY) and 53.8/100 000 (95% CI 51.5, 56.1) persons, respectively. The average annual percentage change (AAPC) in the overall age-adjusted incidence rates from 1999 to 2011 was 18.9% (95% CI 4.5, 35.2). The incidence and prevalence rates of OAD use were higher among females and older age categories. The increases in rates of OAD use were mainly driven by metformin. For only 50% of the 98 patients in the OPD-GP database, indications for OAD prescriptions were reported with type 1 diabetes (n = 20), type 2 diabetes (n = 16), and overweight/obesity (n = 10). CONCLUSIONS Incidence and prevalence rates of OAD use in children and adolescents substantially increased in the Netherlands, especially among older age categories (10-14 and 15-19 years) and females. The main indications for use of OADs were type 1 and 2 diabetes and overweight/obesity.
Collapse
Affiliation(s)
- S Fazeli Farsani
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - P C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - M M J van der Vorst
- Department of Paediatrics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - C A J Knibbe
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands.,Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - R M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.,Department of Medical Informatics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - A K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
38
|
Overbeek JA, Penning FJA, van Dongen E, Herings RMC. Trend in Prevalence and Distribution of Diabetes Mellitus Type I and Type II in the Netherlands. Value Health 2014; 17:A337. [PMID: 27200604 DOI: 10.1016/j.jval.2014.08.652] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - F J A Penning
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - E van Dongen
- Novo Nordisk B. V., Alphen a/d Rijn, The Netherlands
| | - R M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| |
Collapse
|
39
|
Van den Berg EJ, Overbeek JA, Penning-van Beest FJA, Khalid JM, Dekhuijzen PNR, Herings R. Incidence and Prevalence of COPD By Gold 2013 Classification in the Netherlands. Value Health 2014; 17:A590. [PMID: 27202015 DOI: 10.1016/j.jval.2014.08.2020] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- E J Van den Berg
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | - J M Khalid
- Takeda Development Centre Europe, Ltd., London, UK
| | - P N R Dekhuijzen
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| |
Collapse
|
40
|
Houben E, van Haalen HGM, Sparreboom W, Overbeek JA, Ezendam N, Pijnenborg H, van Herk-Sukel MPP. Treatment Patterns And Outcomes Of Patients Diagnosed With Ovarian Cancer In The Netherlands: A Registry Study. Value Health 2014; 17:A655. [PMID: 27202372 DOI: 10.1016/j.jval.2014.08.2391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- E Houben
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - N Ezendam
- Comprehensive Cancer Centre the Netherlands, Eindhoven, The Netherlands
| | | | | |
Collapse
|
41
|
Heintjes E, Overbeek JA, Blin P, Hall GC, Lapi F, Prieto AD, Bezemer ID. Type 2 Diabetes Treatment Patterns Across Europe. Value Health 2014; 17:A359. [PMID: 27200724 DOI: 10.1016/j.jval.2014.08.779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- E Heintjes
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - J A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P Blin
- INSERM CIC Bordeaux CIC1401, Univ. Bordeaux, Bordeaux, France
| | | | - F Lapi
- Genomedics SRL, Firenze, Italy
| | | | - I D Bezemer
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| |
Collapse
|
42
|
Overbeek JA, Penning-van Beest FJA, Balp MM, Dekhuijzen PNR, Herings RMC. Burden of Exacerbations in Patients with Moderate to Very Severe COPD in the Netherlands: A Real-life Study. COPD 2014; 12:132-43. [PMID: 24960237 DOI: 10.3109/15412555.2014.898053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to compare rates of different types of acute exacerbations of COPD (AECOPDs) and healthcare utilization among patients with different severities of COPD. METHODS Data for this study was obtained from the PHARMO Database Network, which includes drug dispensing records from pharmacies, hospitalization records and information from general practitioners. Patients with moderate to very severe COPD (GOLD II-III-IV) and a moderate or severe AECOPD between 2000 and 2010 were included in the study. Moderate and severe AECOPDs were defined by drug use and hospitalizations respectively. Study patients were followed from the first AECOPD to end of registration in PHARMO, death or end of study period, whichever occurred first. During follow-up, all recurrent AECOPDs were characterized and healthcare utilization was assessed. RESULTS Of 886 patients in the study, 52% had GOLD-II, 34% GOLD-III and 14% had GOLD-IV. The overall AECOPD recurrence rate per person year (PY) increased from 0.63 for patients with GOLD-II to 1.09 for patients with GOLD-III and 1.33 for patients with GOLD-IV. The rate of severe AECOPD was 0.06, 0.14 and 0.17 per PY, respectively. CONCLUSION AECOPD recurrence rates and healthcare utilization are significantly higher among patients with more severe COPD.
Collapse
|
43
|
Hoogendoorn M, Kappelhoff BS, Overbeek JA, Wouters EFM, Rutten-van Mölken MPMH. Which long-acting bronchodilator is most cost-effective for the treatment of COPD? Neth J Med 2012; 70:357-364. [PMID: 23065983] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The aim of this study was to estimate the cost-effectiveness of tiotropium versus salmeterol to inform decision making within the Dutch healthcare setting. METHODS A previously published, validated COPD progression model was updated with new exacerbation data and adapted to the Dutch setting by including Dutch estimates of healthcare use for COPD maintenance treatment and Dutch unit costs. Exacerbation data from the POET-COPD trial were combined with evidence from earlier tiotropium studies using Bayesian meta-analysis. The model-based analysis was performed using a one- and five-year time horizon. Main health outcomes were the number of exacerbations and quality-adjusted life years (QALYs). RESULTS One-year costs per patient from the healthcare perspective were v1370 for tiotropium and v1359 for salmeterol; a difference of v11 (95% uncertainty interval (UI): -198-212). The annual number of exacerbations was 0.068 (-0.005-0.140) lower in the tiotropium group. The number of QALYs in the tiotropium group was 0.011 (-0.019-0.049) higher, resulting in an incremental cost-effectiveness ratio (ICER) of v1015 per QALY. After five years, the difference in exacerbations, QALYs and costs between the tiotropium and salmeterol group were -0.435 (-0.915-0.107), 0.079 (-0.272-0.520) and v-277 (-1586-1074), respectively, indicating that tiotropium was more effective and less costly. Using a societal perspective, tiotropium dominated salmeterol both after one and five years. CONCLUSION Tiotropium reduced exacerbations and exacerbation-related costs. After one year the cost per QALY of tiotropium compared with salmeterol was very low, while after five years tiotropium was found to dominate salmeterol.
Collapse
Affiliation(s)
- M Hoogendoorn
- Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
44
|
Overbeek JA, Zhao Z, Herk-Sukel MPPV, Barber BL, Herings RMC. Cardiovascular comorbidities among patients with metastatic colorectal cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.7243/2049-7962-1-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
45
|
Overbeek JA, Penning-van Beest FJ, Heintjes EM, Gerber RA, Cappelleri JC, Hovius SE, Herings RM. Dupuytren's contracture: a retrospective database analysis to determine hospitalizations in the Netherlands. BMC Res Notes 2011; 4:402. [PMID: 21992150 PMCID: PMC3203074 DOI: 10.1186/1756-0500-4-402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 10/12/2011] [Indexed: 11/24/2022] Open
Abstract
Background Dupuytren's contracture is a condition of the palmar fascia involving contractures of the fascia and skin in the hand. Current treatment for Dupuytren's contracture is mainly limited to surgery. In the Netherlands, little is known about the prevalence of Dupuytren's contracture. In this study we determined the prevalence of patients with a hospitalization for Dupuytren's contracture in the Netherlands and characterized their (re)hospitalizations. Methods From the PHARMO database, which consists of multiple observational databases linked on a patient level, all patients hospitalized for Dupuytren's contracture between 2004 and 2007 were included in the source population (ICD-9-CM code 728.6). Numbers from this source population were used to provide estimates of hospitalizations for Dupuytren's contracture in the Netherlands. Patients with a medical history in the PHARMO database of at least 12 months before their hospitalization were included in the study cohort and followed until end of data collection, death, or end of study period, whichever occurred first. Type of admission, length of stay, recorded procedures, treating specialty, number of rehospitalizations for Dupuytren's contracture, and time to first rehospitalization were assessed. Results Of 3, 126 patients included in the source population, 3, 040 were included in the study population. The overall prevalence of patients with a hospitalization for Dupuytren's contracture was 0.04%, with the highest prevalence (0.25%) among 60-79 year old males. The majority (85%) of all hospitalizations were day-case admissions. Of the admitted inpatients (15%) the majority (81%) had one overnight stay in the hospital. The most common recorded procedure was fasciectomy (87%) and 78% of patients was treated by a plastic surgeon. During a median (IQR) follow-up of 2.9 (1.8-4.0) years, 523 patients were rehospitalized for Dupuytren's contracture. The median (IQR) time to first rehospitalization was 0.8 (0.4-1.9) years. Conclusions This study is a first exploration of Dupuytren's contracture in the Netherlands based on hospitalizations, showing a prevalence of 0.25% among 60-79 year old males. Future studies should also address outpatient procedures to get a complete picture of the treatment of Dupuytren's contracture. In addition, patients not yet treated should be included to be able to estimate the prevalence of Dupuytren's contracture.
Collapse
|
46
|
Penning-van Beest FJA, Overbeek JA, Meijer WM, Woodruff K, Jackson J, van der Vis H, van der Linden P, Herings RMC. Venous thromboembolism prophylaxis after total knee or hip replacement: treatment pattern and outcomes. Pharmacoepidemiol Drug Saf 2011; 20:972-8. [DOI: 10.1002/pds.2187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 04/11/2011] [Accepted: 05/12/2011] [Indexed: 11/05/2022]
Affiliation(s)
| | - Jetty A. Overbeek
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
| | | | | | | | | | | | - Ron M. C. Herings
- PHARMO Institute for Drug Outcomes Research; Utrecht the Netherlands
- Department of Health Policy & Management, Erasmus MC; Rotterdam the Netherlands
| |
Collapse
|
47
|
Abstract
BACKGROUND In the last decade, the number of new agents, including monoclonal antibodies, being developed to treat metastatic colorectal cancer (mCRC) increased rapidly. While improving outcomes, these new treatments also have distinct and known safety profiles with toxicities that may require hospitalizations. However, patterns and costs of hospitalizations of toxicities of these new 'targeted' drugs are often unknown. OBJECTIVE This study aimed to estimate the costs of hospital events associated with adverse events specified in the 'Special Warnings and Precautions for Use' section of the European Medicinal Agency Summary of Product Characteristics for bevacizumab, cetuximab, and panitumumab, in patients with mCRC. METHODS From the PHARMO Record Linkage System (RLS), patients with a primary or secondary hospital discharge code for CRC and distant metastasis between 2000-2008 were selected and defined as patients with mCRC. The first discharge diagnosis defining metastases served as the index date. Patients were followed from index date until end of data collection, death, or end of study period, whichever occurred first. Hospital events during follow-up were identified through primary hospital discharge codes. Main outcomes for each event were length of stay and costs per hospital admission. RESULTS Among 2964 mCRC patients, 271 hospital events occurred in 210 patients (mean [SD] duration of follow-up: 34 [31] months). The longest mean (SD) length of stay per hospital admission were for stroke (16 [33] days), arterial thromboembolism (ATE) (14 [21] days), wound-healing complications (WHC), acute myocardial infarction (AMI), congestive heart failure (CHF), and neutropenia (all 9 days; SD 5-15). Highest mean (SD) costs per admission were for stroke (€13,500 [€28,800]), ATE (€13,300 [€18,800]), WHC (€10,800 [€20,500]). LIMITATIONS Although no causal link could be identified between any specific event and any specific treatment, data from this study are valuable for pharmacoeconomic evaluations of newer treatments in mCRC patients. CONCLUSIONS Inpatient costs for events in mCRC patients are considerable and vary greatly.
Collapse
Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVE Several pharmacological therapies are available to help smokers quit. The aim was to investigate the utilisation and effectiveness of smoking cessation drugs in daily practice in the Netherlands. METHODS Subjects aged ≥18 years with a pharmacy prescription of varenicline, bupropion, nicotine replacement therapy (NRT) or nortriptyline between March 2007 and September 2008 were identified from the PHARMO data warehouse, which includes drug dispensing, hospitalisation and other data from approximately 2.5 million residents in the Netherlands. Using an encrypted methodology, corresponding non-person-identifiable dispensing IDs were linked to a web-based system for patient-reported data collection. Corresponding pharmacists asked the subjects to participate in the study and complete a web-based questionnaire on smoking history and cessation, including utilisation of (pharmaco) therapies. RESULTS Of 2,684 invited subjects, 698 responded (26%), of whom 612 were included in the analyses. Bupropion was the most frequently used smoking cessation drug (35% of patients), followed by varenicline (28%), bupropion + NRT (12%) and varenicline + NRT (9%). Overall, 51% of patients also reported behavioural therapy. A total of 53% of bupropion users, 51% of varenicline users, 42% of NRT users and 20-40% of patients using multiple drugs reported to not smoke at the time of questionnaire. Median (interquartile range) number of days between time of questionnaire and start date of last quit attempt ranged from 271 (104-432) for varenicline + bupropion to 356 (205-518) for bupropion. Mean duration of drug use ranged from 42 to 53 days among quitters and from 19 to 42 days among relapsers. CONCLUSION In this study up to 50% of patients who obtained smoking cessation drugs at the pharmacy stopped smoking. Better access to smoking cessation drugs as recommended in guidelines will help to further decrease smoking prevalence.
Collapse
|