1
|
Ruotsalainen J, Lehmus L, Putkonen M, Lievonen J, Kallio A, Raittinen P, Summanen M, Kosunen M, Korhonen MJ. Recent trends in incidence, survival and treatment of multiple myeloma in Finland - a nationwide cohort study. Ann Hematol 2024; 103:1273-1284. [PMID: 38085293 PMCID: PMC10940444 DOI: 10.1007/s00277-023-05571-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/06/2023] [Accepted: 11/28/2023] [Indexed: 03/16/2024]
Abstract
This study aimed to determine the incidence and prevalence of multiple myeloma (MM) in Finland in 2015-2019, to characterize adult patients newly diagnosed with MM, and to follow-up their overall survival (OS) and treatment patterns until the end of 2020. We sourced the data on inpatient and outpatient diagnoses, outpatient medication use, and date of death from comprehensive, nationwide registers. We identified 2037 incident patients with MM in 2015-2019. On average, the annual crude incidence was 8.8 and the age-standardized incidence (World Standard Population) was 3.3 per 100,000. The crude prevalence at the end of 2019 was 32.7 cases per 100,000 inhabitants ≥ 18 years of age. Median age of the patients at first diagnosis (index date) was 71 years, and 48% were female, the median follow-up being 2.4 years. The median OS was estimated at 4.5 years. The proportion of the patients receiving autologous stem cell transplantation (ASCT) within one year since the index date was 24%, with little variation across study years. Conversely, the proportion of all patients receiving lenalidomide within one year since the index date increased from 27 to 48% overall, and from 39 to 81% among ASCT recipients. The estimated median relapse-free survival after ASCT was 2.9 years. Information on in-hospital MM medication administrations was available for a subset of the study cohort. In this subset, 85.8% of the patients received immunomodulatory drugs and/or proteasome inhibitors within the first year after the index date.
Collapse
Affiliation(s)
| | | | - Mervi Putkonen
- Department of Hematology, Turku University Hospital, Turku, Finland
| | - Juha Lievonen
- Department of Hematology, Helsinki University Hospital, Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
2
|
Ogundipe O, Mazidi M, Chin KL, Gor D, McGovern A, Sahle BW, Jermendy G, Korhonen MJ, Appiah B, Ademi Z, De Bruin ML, Liew D, Ofori-Asenso R. Real-world adherence, persistence, and in-class switching during use of dipeptidyl peptidase-4 inhibitors: a systematic review and meta-analysis involving 594,138 patients with type 2 diabetes. Acta Diabetol 2021; 58:39-46. [PMID: 32809070 DOI: 10.1007/s00592-020-01590-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022]
Abstract
AIMS Medication adherence and persistence are important determinants of treatment success in type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis evaluated the real-world adherence, persistence, and in-class switching among patients with T2DM prescribed dipeptidyl peptidase-4 (DPP4) inhibitors. METHODS MEDLINE, EMBASE, Cochrane Library, PsychINFO, and CINAHL were searched for relevant observational studies published in the English language up to 20 December 2019. This was supplemented by manual screening of the references of included papers. Random-effects meta-analysis was performed. RESULTS Thirty-four cohort studies involving 594,138 patients with T2DM prescribed DPP4 inhibitors from ten countries were included. The pooled proportion adherent (proportion of days covered (PDC) or medication possession ratio (MPR) ≥ 0.80) was 56.9% (95% confidence interval [CI] 49.3-64.4) at one year and 44.2% (95% CI 36.4-52.1) at two years. The proportion persistent with treatment decreased from 75.6% (95% CI 71.5-79.5) at six months to 52.8% (95% CI 51.6-59.8) at two years. No significant differences in adherence and persistence were observed between individual DPP4 inhibitors. At one year, just 3.2% (95% CI 3.1-3.3) of patients switched from one DPP4 inhibitor to another. Switching from saxagliptin and alogliptin to others was commonest. CONCLUSIONS Adherence to and persistence with DPP4 inhibitors is suboptimal but similar across all medications within the class. While in-class switching is uncommon, saxagliptin and alogliptin are the DPP4 inhibitors most commonly switched. Interventions to improve treatment adherence and persistence among patients with T2DM prescribed DPP4 inhibitors may be warranted.
Collapse
Affiliation(s)
| | - Mohsen Mazidi
- Department of Twin Research and Genetic Epidemiology, Kings College London, London, UK
| | - Ken Lee Chin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
| | - Deval Gor
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois At Chicago, Chicago, USA
| | - Andrew McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
- Exeter Medical School, The Institute of Biomedical and Clinical Science,, Exeter, UK
| | - Berhe W Sahle
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Maarit Jaana Korhonen
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland
| | - Bernard Appiah
- School of Public Health, Texas A&M University Health Science Center, TAMU, College Station, TX, USA
- Centre for Science and Health Communication, Accra, Ghana
| | - Zanfina Ademi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Richard Ofori-Asenso
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
3
|
Picton L, Bell JS, George J, Korhonen MJ, Ilomäki J. The changing pattern of statin use in people with dementia: A population-based study. J Clin Lipidol 2020; 15:192-201. [PMID: 33309941 DOI: 10.1016/j.jacl.2020.11.008] [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: 07/13/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND After a dementia diagnosis, goals of care are often reassessed, including the use of preventive medications like statins. OBJECTIVE To examine changes in statin use after initiating medication for managing dementia. METHODS A case-crossover study utilizing medication dispensing data from the Australian Pharmaceutical Benefits Scheme (PBS) 10% random sample was conducted. Use of statins was compared in the 12 months pre- and post-initiation (pre-period and post-period) of anti-dementia medications or risperidone for behavioural symptoms of dementia. Individuals aged ≥65 years who had their first dispensing of anti-dementia medication or risperidone between July 2006 and June 2017 and survived ≥12 months after their first supply were included. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for change in statin use in the discordant pairs. RESULTS The cohort (n = 19,809) had a median age of 81 years and 61% were female. Statins were less likely to be used after initiating anti-dementia medication or risperidone (OR 0.50; 95%CI 0.45-0.55). The OR for statin use in the post-period versus the pre-period decreased annually over the 11 years from 1.21; 95%CI 0.84-1.75 in 2006-7 to 0.31; 95%CI 0.24-0.41 in 2016-17 (p for interaction <0.05). CONCLUSION Statins are more likely to be ceased than started after initiating medication for dementia. This may reflect changes in goals of care, or changes in the interpretation of the available evidence for the safety and efficacy of statins in older people living with dementia.
Collapse
Affiliation(s)
- Leonie Picton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | | | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| |
Collapse
|
4
|
Ofori-Asenso R, Ilomaki J, Tacey M, Zomer E, Curtis AJ, Si S, Zullo AR, Korhonen MJ, Bell JS, Zoungas S, Liew D. Switching, Discontinuation, and Reinitiation of Statins Among Older Adults. J Am Coll Cardiol 2019; 72:2675-2677. [PMID: 30466527 DOI: 10.1016/j.jacc.2018.08.2191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/03/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022]
|
5
|
Ofori-Asenso R, Jakhu A, Curtis AJ, Zomer E, Gambhir M, Jaana Korhonen M, Nelson M, Tonkin A, Liew D, Zoungas S. A Systematic Review and Meta-analysis of the Factors Associated With Nonadherence and Discontinuation of Statins Among People Aged ≥65 Years. J Gerontol A Biol Sci Med Sci 2019; 73:798-805. [PMID: 29360935 DOI: 10.1093/gerona/glx256] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/01/2018] [Indexed: 02/02/2023] Open
Abstract
Background Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed. Methods We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques. Results Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15). Conclusion Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Division of Metabolism, Genomics and Ageing, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
6
|
Ofori-Asenso R, Jakhu A, Zomer E, Curtis AJ, Korhonen MJ, Nelson M, Gambhir M, Tonkin A, Liew D, Zoungas S. Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci 2019; 73:813-819. [PMID: 28958039 DOI: 10.1093/gerona/glx169] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/30/2017] [Indexed: 12/31/2022] Open
Abstract
Background Older people (aged ≥ 65 years) have distinctive challenges with medication adherence. However, adherence and persistence patterns among older statin users have not been comprehensively reviewed. Methods As part of a broader systematic review, we searched Medline, Embase, PsycINFO, CINAHL, Database of Abstracts of Reviews of Effects, CENTRAL, and the National Health Service Economic Evaluation Database through December 2016 for English articles reporting adherence and/or persistence among older statin users. Data were analyzed via descriptive methods and meta-analysis using random-effect modeling. Results Data from more than 3 million older statin users in 82 studies conducted in over 40 countries were analyzed. At 1-year follow-up, 59.7% (primary prevention 47.9%; secondary prevention 62.3%) of users were adherent (medication possession ratio [MPR] or proportion of days covered [PDC] ≥ 80%). For both primary and secondary prevention subjects, 1-year adherence was worse among individuals aged more than 75 years than those aged 65-75 years. At 3 and ≥10 years, 55.3% and 28.4% of users were adherent, respectively. The proportion of users persistent at 1-year was 76.7% (primary prevention 76.0%; secondary prevention 82.6%). Additionally, 68.1% and 61.2% of users were persistent at 2 and 4 years, respectively. Among new statin users, 48.2% were nonadherent and 23.9% discontinued within the first year. The proportion of statin users who were adherent based on self-report was 85.5%. Conclusions There is poor short and long term adherence and persistence among older statin users. Strategies to improve adherence and reduce discontinuation are needed if the intended cardiovascular benefits of statin treatment are to be realized.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Avtar Jakhu
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrea J Curtis
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Manoj Gambhir
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Andrew Tonkin
- Cardiovascular Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - Sophia Zoungas
- STAREE, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.,Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| |
Collapse
|
7
|
Lalic S, Ilomäki J, Bell JS, Korhonen MJ, Gisev N. Prevalence and incidence of prescription opioid analgesic use in Australia. Br J Clin Pharmacol 2019; 85:202-215. [PMID: 30338545 PMCID: PMC6303244 DOI: 10.1111/bcp.13792] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [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: 07/24/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 12/30/2022] Open
Abstract
AIMS The aims of the current study were to determine the prevalence and incidence of prescription opioid analgesic use in Australia and compare the characteristics of people with and without cancer initiating prescription opioid analgesics. METHODS A retrospective population-based study was conducted using the random 10% sample of adults who were dispensed prescription opioid analgesics in Australia between July 2013 and June 2017 through the Pharmaceutical Benefits Scheme. Poisson regression was used to calculate rate ratios (RR) for opioid prevalence and incidence. The characteristics of people initiating opioids, including type of opioid initiated, total oral morphine equivalents dispensed, prescriber speciality, medical comorbidities, and past analgesic and benzodiazepine use, were compared for people with and without cancer. RESULTS Opioid prevalence increased {RR = 1.006 [95% confidence interval (CI) 1.004, 1.008]}, while incidence decreased [RR = 0.977 (95% CI 0.975,0.979)] from 2013/2014 to 2016/2017. There were between 287 677 and 307 772 prevalent users each year. In total, 769 334 adults initiated opioids between 2013/2014 and 2016/2017, and half of these initiations were by general practitioners. Initiation with a strong opioid occurred in 55.8% of those with cancer and 28.2% of those without cancer. CONCLUSION Rates of opioid use have remained high since 2013, with approximately 3 million adults using opioids and over 1.9 million adults initiating opioids each year. Between 2013 and 2017, opioid prevalence has slightly increased but incidence has decreased. People without cancer account for the majority of opioid use and are more likely to be initiated on short-acting and weak opioids. Initiation of strong opioids has increased over time, reinforcing concerns about increased use and the harms associated with strong opioids in the community.
Collapse
Affiliation(s)
- Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Pharmacy DepartmentAustin HealthMelbourneVICAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Institute of BiomedicineUniversity of TurkuTurkuFinland
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
| |
Collapse
|
8
|
Lalic S, Gisev N, Bell JS, Korhonen MJ, Ilomäki J. Predictors of persistent prescription opioid analgesic use among people without cancer in Australia. Br J Clin Pharmacol 2018; 84:1267-1278. [PMID: 29451672 PMCID: PMC5980567 DOI: 10.1111/bcp.13556] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 10/11/2017] [Revised: 01/10/2018] [Accepted: 02/05/2018] [Indexed: 12/26/2022] Open
Abstract
AIMS To identify patterns of opioid analgesic use and determine predictors of persistent opioid use among people without cancer. METHODS A population-based cohort study of Australians initiating prescription opioids from July 2013 to December 2015 was conducted using data from a random 10% sample of people who accessed medicines through Australia's Pharmaceutical Benefits Scheme. A 12-month retrospective period was used to define opioid initiation, exclude people with cancer and determine comorbidities. Persistent use over 12 months since initiation was identified through group-based trajectory modelling. Odds ratios (OR) and 95% confidence intervals (CIs) for predictors of opioid persistence were estimated using logistic regression. RESULTS The cohort consisted of 431 963 people without cancer who initiated opioids. A total of 11 323 (2.6%) persistent opioid users were identified. Predictors of persistence included initiation with transdermal formulations (OR 4.2, 95% CI 3.9-4.5), or initiation with total oral morphine equivalents (OME) ≥ 750 mg (3.7, 3.3-4.1), having depression (1.6, 1.5-1.7) or psychotic illness (2.0, 1.9-2.2). Previous dispensing of paracetamol (2.0, 1.9-2.1), pregabalin (2.0, 1.8-2.1) and benzodiazepines (1.53, 1.4-1.6) predicted persistence. Compared to people aged 18-44 years, those ≥75 years were 2.5 (2.3-2.6) times more likely to be persistent users. CONCLUSIONS Patient-specific characteristics (older age, prior history of mental health comorbidities and use of non-opioid analgesics) and prescriber choice of initial opioid (transdermal formulation and higher total OMEs) were found to strongly predict persistent use. This information may help prescribers target monitoring and early intervention efforts in order to prevent harms associated with the long-term use of opioids.
Collapse
Affiliation(s)
- Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Pharmacy DepartmentAustin HealthMelbourneAustralia
| | - Natasa Gisev
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| |
Collapse
|
9
|
Korhonen MJ, Tiittanen P, Kastarinen H, Helin-Salmivaara A, Hauta-aho M, Rikala M, Huupponen R. Statins do not Increase the Rate of Bleeding Among Warfarin Users. Basic Clin Pharmacol Toxicol 2018; 123:195-201. [DOI: 10.1111/bcpt.12998] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/15/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Maarit Jaana Korhonen
- Institute of Biomedicine; University of Turku; Turku Finland
- Centre for Medicine Use and Safety; Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Melbourne VIC Australia
| | - Pekka Tiittanen
- Institute of Biomedicine; University of Turku; Turku Finland
- National Institute of Health and Welfare, Environmental Unit; Kuopio Finland
| | - Helena Kastarinen
- Institute of Biomedicine; University of Turku; Turku Finland
- Social Insurance Institution; Regional Office for Eastern Finland; Kuopio Finland
| | - Arja Helin-Salmivaara
- Institute of Biomedicine; University of Turku; Turku Finland
- Unit of Primary Health Care; Hospital District of Helsinki and Uusimaa; Helsinki Finland
| | - Milka Hauta-aho
- Institute of Biomedicine; University of Turku; Turku Finland
- Clinical Pharmacology Unit; Turku University Hospital; Turku Finland
| | - Maria Rikala
- Institute of Biomedicine; University of Turku; Turku Finland
| | - Risto Huupponen
- Institute of Biomedicine; University of Turku; Turku Finland
- Clinical Pharmacology Unit; Turku University Hospital; Turku Finland
| |
Collapse
|
10
|
Affiliation(s)
- E Aarnio
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - R Huupponen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - M J Korhonen
- Institute of Biomedicine, University of Turku, Turku, Finland.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Vic., Australia
| |
Collapse
|
11
|
Hickson RP, Robinson JG, Annis IE, Killeya-Jones LA, Korhonen MJ, Cole AL, Fang G. Changes in Statin Adherence Following an Acute Myocardial Infarction Among Older Adults: Patient Predictors and the Association With Follow-Up With Primary Care Providers and/or Cardiologists. J Am Heart Assoc 2017; 6:e007106. [PMID: 29051213 PMCID: PMC5721894 DOI: 10.1161/jaha.117.007106] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change. METHODS AND RESULTS This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI. Multivariable multinomial logistic regression models (odds ratio [OR] and 99% confidence interval [CI]) were applied to assess associations between both patient characteristics and follow-up with a primary care provider and/or cardiologist with the outcome of statin adherence change (increase or decrease) from the 6-month pre- to 6-month post-AMI periods. Of 113 296 patients, 64.0% had no change in adherence, while 19.7% had increased and 16.3% had decreased adherence after AMI hospitalization. Black and Hispanic patients were more likely to have either increased or decreased adherence than white patients. Patients who required coronary artery bypass graft surgery (OR, 1.34; 99% CI, 1.21-1.49) or percutaneous transluminal coronary angioplasty/stent procedure (OR, 1.25; 99% CI, 1.17-1.32) during their index hospitalization were more likely to have increased adherence. Follow-up with a primary care provider was only mildly associated with increased adherence (OR, 1.08; 99% CI, 1.00-1.16), while follow-up with a cardiologist (OR, 1.15; 99% CI, 1.05-1.25) or both provider types (OR, 1.21; 99% CI, 1.12-1.30) had stronger associations with increased adherence. CONCLUSIONS Post-AMI changes in statin adherence varied by patient characteristics, and improved adherence was associated with post-discharge follow-up care, particularly with a cardiologist or both a primary care provider and a cardiologist.
Collapse
Affiliation(s)
- Ryan P Hickson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Ley A Killeya-Jones
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Ashley L Cole
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Gang Fang
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| |
Collapse
|
12
|
Kinjo M, Chia-Cheng Lai E, Korhonen MJ, McGill RL, Setoguchi S. Potential contribution of lifestyle and socioeconomic factors to healthy user bias in antihypertensives and lipid-lowering drugs. Open Heart 2017; 4:e000417. [PMID: 28761670 PMCID: PMC5515136 DOI: 10.1136/openhrt-2016-000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 01/11/2023] Open
Abstract
Objectives Healthy user bias arises when users of preventive medications such as lipid-lowering drugs (LLDs), hormone replacement therapy and antihypertensive (AH) medications are healthier than non-users due to factors other than medication effects, making the medications appear more beneficial in observational studies of effectiveness and safety. The purpose of the study is to examine factors contributing to healthy user effect in patients taking AHs or LLDs. Methods Among patients with hypertension or hyperlipidaemia in a population-based sample from the National Health and Nutrition Examination Survey (1999–2010), we assessed the association between socioeconomic and lifestyle factors and the use of AHs/LLDs by logistic regression with adjustment for demographics and comorbidities in a cross-sectional study. Results When 9715 AH/LLD users were compared with 3725 non-users, AH/LLD users were more likely to be: highly educated (OR 1.2, 95% CI 1.2 to 1.3), non-impoverished (OR 1.3, 95% CI 1.2 to 1.4), current non-smokers (OR 1.2, 95% CI 1.1 to 1.4), physically active (OR 1.1, 95% CI 1.0 to 1.2) and consume more calcium (OR 1.1, 95% CI 1.0 to 1.3) but less likely to have normal body mass index (OR 0.6, 95% CI 0.6 to 0.7) or to meet dietary sodium recommendations (OR 0.8, 95% CI 0.7 to 0.9). Conclusions We identified several salutary lifestyle factors associated with AH/LLD use in a representative US population. Healthy user effect may be partly explained by better socioeconomic profiles and lifestyles in AH/LLD users compared with non-users.
Collapse
Affiliation(s)
- Mitsuyo Kinjo
- Department of Medicine, Rheumatology, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Rita L McGill
- Department of Medicine, Nephrology, The University of Chicago, Chicago, USA
| | - Soko Setoguchi
- Department of Epidemiology, Rutgers School of Public Health, New Brunswick, USA
| |
Collapse
|
13
|
Korhonen MJ, Pentti J, Hartikainen J, Kivimäki M, Vahtera J. Somatic symptoms of anxiety and nonadherence to statin therapy. Int J Cardiol 2016; 214:493-9. [DOI: 10.1016/j.ijcard.2016.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/02/2016] [Indexed: 12/22/2022]
|
14
|
Lavikainen P, Helin-Salmivaara A, Eerola M, Fang G, Hartikainen J, Huupponen R, Korhonen MJ. Statin adherence and risk of acute cardiovascular events among women: a cohort study accounting for time-dependent confounding affected by previous adherence. BMJ Open 2016; 6:e011306. [PMID: 27259530 PMCID: PMC4893857 DOI: 10.1136/bmjopen-2016-011306] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Previous studies on the effect of statin adherence on cardiovascular events in the primary prevention of cardiovascular disease have adjusted for time-dependent confounding, but potentially introduced bias into their estimates as adherence and confounders were measured simultaneously. We aimed to evaluate the effect when accounting for time-dependent confounding affected by previous adherence as well as time sequence between factors. DESIGN Retrospective cohort study. SETTING Finnish healthcare registers. PARTICIPANTS Women aged 45-64 years initiating statin use for primary prevention of cardiovascular disease in 2001-2004 (n=42 807). OUTCOMES Acute cardiovascular event defined as a composite of acute coronary syndrome and acute ischaemic stroke was our primary outcome. Low-energy fractures were used as a negative control outcome to evaluate the healthy-adherer effect. RESULTS During the 3-year follow-up, 474 women experienced the primary outcome event and 557 suffered a low-energy fracture. The causal HR estimated with marginal structural model for acute cardiovascular events for all the women who remained adherent (proportion of days covered ≥80%) to statin therapy during the previous adherence assessment year was 0.78 (95% CI: 0.65 to 0.94) when compared with everybody remaining non-adherent (proportion of days covered <80%). The result was robust against alternative model specifications. Statin adherers had a potentially reduced risk of experiencing low-energy fractures compared with non-adherers (HR 0.90, 95% CI 0.76 to 1.07). CONCLUSIONS Our study, which took into account the time dependence of adherence and confounders, as well as temporal order between these factors, is support for the concept that adherence to statins in women in primary prevention decreases the risk of acute cardiovascular events by about one-fifth in comparison to non-adherence. However, part of the observed effect of statin adherence on acute cardiovascular events may be due to the healthy-adherer effect.
Collapse
Affiliation(s)
- Piia Lavikainen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Drug Research Doctoral Programme, University of Turku, Turku, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Mervi Eerola
- The Center of Statistics, University of Turku, Turku, Finland
| | - Gang Fang
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
15
|
Abstract
BACKGROUND Adverse effects of antidepressants are most common at the beginning of the treatment, but possible also later. We examined the association between antidepressant use and work-related injuries taking into account the duration of antidepressant use. METHOD Antidepressant use and work-related injuries between 2000 and 2011 were measured among 66 238 employees (mean age 43.8 years, 80% female) using linkage to national records (the Finnish Public Sector study). We analysed data using time-dependent modelling with individuals as their own controls (self-controlled case-series design). RESULTS In 2238 individuals who had used antidepressants and had a work-related injury during a mean follow-up of 7.8 years, no increase in the risk of injury was observed in the beginning of antidepressant treatment. However, an increased injury risk was seen after 3 months of treatment (rate ratio, compared with no recent antidepressant use, 1.27, 95% confidence interval 1.10-1.48). This was also the case among those who had used only selective serotonin reuptake inhibitors (n = 714; rate ratio 1.41, 95% confidence interval 1.08-1.83). CONCLUSIONS Antidepressant use was not associated with an increased risk of work-related injury at the beginning of treatment. Post-hoc analyses of antidepressant trials are needed to determine whether long-term use of antidepressants increases the risk of work-related injury.
Collapse
Affiliation(s)
- A Kouvonen
- Department of Social Research,University of Helsinki,Helsinki,Finland
| | - J Vahtera
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - J Pentti
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M J Korhonen
- Department of Pharmacology, Drug Development and Therapeutics,University of Turku,Turku,Finland
| | - T Oksanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - P Salo
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Virtanen
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| | - M Kivimäki
- Finnish Institute of Occupational Health,Turku and Helsinki,Finland
| |
Collapse
|
16
|
Upmeier E, Vire J, Korhonen MJ, Isoaho H, Lehtonen A, Arve S, Wuorela M, Viitanen M. Corrigendum to 'Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart'. Age Ageing 2016; 45:323. [PMID: 26941354 DOI: 10.1093/ageing/afw016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eveliina Upmeier
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Jenni Vire
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Finland
| | | | - Aapo Lehtonen
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Seija Arve
- Department of Nursing Science, Turku City Hospital and University of Turku, Turku, Finland
| | - Maarit Wuorela
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Matti Viitanen
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland Division of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| |
Collapse
|
17
|
Rikala M, Kastarinen H, Tiittanen P, Huupponen R, Korhonen MJ. Natural history of bleeding and characteristics of early bleeders among warfarin initiators - a cohort study in Finland. Clin Epidemiol 2016; 8:23-35. [PMID: 26917975 PMCID: PMC4751892 DOI: 10.2147/clep.s91379] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aims The demand for oral anticoagulant therapy will continue to increase in the future along with the aging of the population. This study aimed to determine the rate of bleeding requiring hospitalization and to characterize early bleeders among persons initiating warfarin therapy. Characterization of those most susceptible to early bleeding is important in order to increase the safety of warfarin initiation. Patients and methods Using data from nationwide health registers, we identified persons initiating warfarin therapy between January 1, 2009 and June 30, 2012, n=101,588, and followed them until hospitalization for bleeding, death, or administrative end of the study (December 31, 2012). We defined early bleeders as persons with a bleeding requiring hospitalization within 30 days since warfarin initiation. Results The rate of hospitalization for bleeding during a median follow-up of 1.9 years was 2.6% per person-year (95% confidence interval [CI] 2.5%–2.7%), with a peak within the first 30 days of warfarin initiation (6.5% per person-year, 95% CI 6.0%–7.1%). In a multivariable Cox proportional hazards regression analysis, early bleeders were characterized by prior bleeding (<180 days before initiation, hazard ratio [HR] =13.7, 95% CI 10.9–17.1; during 180 days–7 years before initiation, HR =1.48, 95% CI 1.15–1.90), male sex (HR =1.32, 95% CI 1.10–1.57), older age (HR =1.13, 95% CI 1.04–1.22, per 10-year increase), venous thrombosis (HR =1.83, 95% CI 1.44–2.34), pulmonary embolism (HR =1.46, 95% CI 1.11–1.91), alcohol abuse (HR =1.59, 95% CI 1.08–2.35), rheumatic disease (HR =1.40, 95% CI 1.07–1.83), and exposure to drugs with dynamic interaction mechanism with warfarin (HR =1.43, 95% CI 1.20–1.71). In age-adjusted models, Charlson comorbidity index and number of drugs predicted a graded increase in the hazard of early bleeding. Conclusion The rate of hospitalizations for bleeding peaked in the beginning of warfarin therapy. Early bleeders were characterized by venous thrombosis, pulmonary embolism, and factors that increase bleeding risk without affecting the international normalized ratio.
Collapse
Affiliation(s)
- Maria Rikala
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Helena Kastarinen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Social Insurance Institution, Regional Office for Eastern and Northern Finland, Kuopio, Finland
| | - Pekka Tiittanen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Department of Public Health, University of Turku, Turku, Finland; Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
18
|
Upmeier E, Vire J, Korhonen MJ, Isoaho H, Lehtonen A, Arve S, Wuorela M, Viitanen M. Cardiovascular risk profile and use of statins at the age of 70 years: a comparison of two Finnish birth cohorts born 20 years apart. Age Ageing 2016; 45:84-90. [PMID: 26764397 DOI: 10.1093/ageing/afv187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to compare cardiovascular morbidity and risk factor profiles of two 70-year-old cohorts of Finns examined in 1991 and 2011 and to describe prevalence of statin use according to cardiovascular risk in the later cohort. METHODS 1920-born cohort of community-dwelling 70-year-old persons (n = 1032) participated in comprehensive health surveys, physical and laboratory examinations in the Turku Elderly Study (TUVA) during 1991-92. In 2011, identical examination pattern was performed, in a 1940-born cohort of 70-year-old persons (n = 956) from the same area. Prevalence of cardiovascular diseases (CVD) and risk factors in the two cohorts was compared. Further, each cohort was divided into three cardiovascular risk groups (high, moderate and low) based on their estimated risk. Prevalence of statin use was calculated among each risk group in the 1940 cohort. RESULTS coronary heart disease (25 versus 11%) and peripheral artery disease (9 versus 2%) were more common in the 1920 than 1940 cohort, respectively. Lipid profile was worse and blood pressure higher in the earlier cohort, whereas use of statins and antihypertensives was more common in the later cohort. Forty-two per cent of the 1920 cohort and 29% of the 1940 cohort were estimated to have high cardiovascular risk. In the 1940 cohort, a total of 36% used statins. Statin use was most common among high-risk persons. CONCLUSIONS seventy-year olds examined in 2011 had less CVD morbidity than their counterparts 20 years earlier, and their cardiovascular risk factors were better controlled which is reflected in higher use of preventive medications, such as statins and antihypertensives.
Collapse
Affiliation(s)
- Eveliina Upmeier
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Jenni Vire
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Finland
| | | | - Aapo Lehtonen
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Seija Arve
- Department of Nursing Science, Turku City Hospital and University of Turku, Turku, Finland
| | - Maarit Wuorela
- Department of Geriatrics, Turku City Hospital and University of Turku, Turku FIN-20700, Finland
| | - Matti Viitanen
- Statcon Ltd, Salo, Finland Division of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Huddinge, Sweden
| |
Collapse
|
19
|
Korhonen MJ, Ruokoniemi P, Ilomäki J, Meretoja A, Helin-Salmivaara A, Huupponen R. Adherence to statin therapy and the incidence of ischemic stroke in patients with diabetes. Pharmacoepidemiol Drug Saf 2015; 25:161-9. [PMID: 26687512 DOI: 10.1002/pds.3936] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 05/26/2015] [Revised: 11/11/2015] [Accepted: 11/23/2015] [Indexed: 01/06/2023]
Abstract
PURPOSE We aimed to quantify for the first time the relationship between statin adherence and ischemic stroke (IS) in patients with diabetes. METHODS Using Finnish health registers, we assembled a cohort of 52 868 statin initiators with diabetes in 1995-2006. We conducted a nested case-control analysis matching cases with IS with up to four controls for age, sex, date of statin initiation and follow-up duration. Adjusted rate ratios for IS were estimated with conditional logistic regression. Additional potential confounders were considered with inverse probability weighting and the role of unmeasured confounding using external adjustment. Statin adherence was measured as the proportion of days covered (PDC). RESULTS Among 1703 cases and 6799 controls, good adherence to statins (PDC ≥ 80%) was associated with a 23% decreased incidence of IS (95%CI 14-32%) compared with poor adherence (PDC < 80%). This association remained broadly unchanged when stratified by sex, age, history of atherosclerotic cardiovascular disease or IS. There was a dose-response relationship between adherence level and the risk of IS (RR 0.63 [0.53-0.75] for PDC ≥ 80% versus PDC < 20%, P for trend <0.0001). Among patients with good adherence, those initiating with low intensity statin therapy had a 15% lower incidence (95%CI 2-27%) and those initiating with moderate intensity therapy a 29% lower incidence (16-41%) of IS compared with those with poor adherence who initiated with low intensity therapy. Our sensitivity analyses supported the robustness of the results. CONCLUSIONS In diabetes, poor statin adherence may considerably increase the risk of IS both in primary and secondary prevention of IS.
Collapse
Affiliation(s)
- Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Public Health, University of Turku, Turku, Finland
| | - Päivi Ruokoniemi
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Atte Meretoja
- Departments of Medicine and the Florey, University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| |
Collapse
|
20
|
Rannanheimo PK, Tiittanen P, Hartikainen J, Helin-Salmivaara A, Huupponen R, Vahtera J, Korhonen MJ. Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland. Value Health 2015; 18:896-905. [PMID: 26409618 DOI: 10.1016/j.jval.2015.06.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/15/2015] [Accepted: 06/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To assess the extent to which adherence to statins is associated with the incidence of cardiovascular (CV) events and all-cause mortality in the primary prevention of CV diseases and whether different analytical approaches influence the observed associations. METHODS This population-based cohort study used data from Finnish registers. The cohort included 97,575 new statin users aged 45 to 75 years in 2001 to 2004 with no CV diseases at baseline. Exposure was defined as adherence to statins (proportion of days covered [PDC]). The primary outcome was any CV event or death during a 3-year follow-up. Different analytical approaches, including multivariable-adjusted Cox regression, inverse probability weighting with time-varying adherence, and propensity score calibration, were used. RESULTS During the first year of follow-up, 53% displayed good (PDC ≥80%), 26% had intermediate (PDC 40%-79%), and 21% exhibited poor (PDC <40%) adherence. After adjustment for sociodemographic and clinical covariates, a 25% relative risk reduction (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71-0.79) was observed in the rate of any CV event or death among good versus poor adherers. Good adherers also had a lower incidence than poor adherers of acute coronary syndrome (HR 0.56; 95% CI 0.49-0.65) and acute cerebrovascular disease events (HR 0.67; 95% CI 0.60-0.76). The different analytical approaches achieved comparable results for all the outcomes. CONCLUSIONS The incidence of CV events and mortality was higher in poor versus good adherers. Different analytical methods that took into account changes in adherence and confounding at baseline did not appreciably affect the results.
Collapse
Affiliation(s)
- Piia K Rannanheimo
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Finnish Medicines Agency, Kuopio, Finland
| | - Pekka Tiittanen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Juha Hartikainen
- Heart Center, Kuopio University Hospital, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland; Clinical Pharmacology Unit, Tykslab, Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.
| |
Collapse
|
21
|
Lavikainen P, Korhonen MJ, Huupponen R, Helin-Salmivaara A. Accumulation of cardiovascular and diabetes medication among apparently healthy statin initiators. PLoS One 2015; 10:e0117182. [PMID: 25658919 PMCID: PMC4319777 DOI: 10.1371/journal.pone.0117182] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To characterize accumulation of drug-modifiable cardiovascular (CV) risk factors in statin initiators who had no prior medication or hospitalizations for CV disease or diabetes. Methods A cohort of 45-75-year-old statin initiators in Finland with no prior CV diseases, diabetes or medication for these conditions was followed up for 24 months after statin initiation for accumulation of CV and diabetes drugs. The number of drugs was measured semi-annually since the first statin purchase and analyzed by growth mixture modeling. Results Of the 11 948 apparently healthy statin initiators, 34% purchased at least one additional CV or diabetes drug during the subsequent 24 months. Of those, 20% redeemed no other CV or diabetes drugs at statin initiation but started to accumulate them after 18 months of follow-up, receiving on average 1.3 other drugs at 24 months. The majority, 59%, redeemed on average 0.5 drugs at statin initiation and accumulated 1.5 drugs by the end of 24-month follow-up. Seventeen percent received 1 additional drug at statin initiation, accumulating on average 3 drugs. The remaining 4% with an average of 2 CV or diabetes drugs at statin initiation redeemed 3.5 additional drugs during the follow-up. Conclusions Two years after statin initiation, 2 in 3 apparently healthy initiators could still be defined as such as reflected by CV and diabetes medication use.
Collapse
Affiliation(s)
- Piia Lavikainen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Drug Research Doctoral Programme, University of Turku, Turku, Finland
- * E-mail:
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| |
Collapse
|
22
|
Rikala M, Hauta-Aho M, Helin-Salmivaara A, Lassila R, Korhonen MJ, Huupponen R. Co-Prescribing of Potentially Interacting Drugs during Warfarin Therapy - A Population-Based Register Study. Basic Clin Pharmacol Toxicol 2015; 117:126-32. [PMID: 25537751 DOI: 10.1111/bcpt.12373] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/16/2014] [Indexed: 11/29/2022]
Abstract
We analysed the occurrence of co-prescribing of potentially interacting drugs during warfarin therapy in the community-dwelling population of Finland. We identified drugs having interaction potential with warfarin using the Swedish Finnish INteraction X-referencing drug-drug interaction database (SFINX) and obtained data on drug purchases from the nationwide Prescription Register. We defined warfarin users as persons purchasing warfarin in 2010 (n = 148,536) and followed them from their first prescription in 2010 until the end of the calendar year. Co-prescribing was defined as at least 1-day overlap between warfarin and interacting drug episodes. In addition, we identified persons who initiated warfarin therapy between 1 January 2007 and 30 September 2010 (n = 110,299) and followed these incident users for a 3-month period since warfarin initiation. Overall, 74.4% of warfarin users were co-prescribed interacting drugs. Co-prescribing covered 46.4% of the total person-years of warfarin exposure. Interacting drugs that should be avoided with warfarin were co-prescribed for 13.4% of warfarin users. The majority of the co-prescriptions were for drugs that are not contraindicated during warfarin therapy but require special consideration. Among incident users, 57.1% purchased potentially interacting drugs during the 3-month period after initiation, while 9.0% purchased interacting drugs that should be avoided with warfarin. To conclude, the occurrence of co-prescribing of potentially interacting drugs was high during warfarin therapy. Our findings highlight the importance of close monitoring of warfarin therapy and the need for further studies on the clinical consequences of co-prescribing of interacting drugs with warfarin.
Collapse
Affiliation(s)
- Maria Rikala
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Milka Hauta-Aho
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Riitta Lassila
- Coagulation Disorders Unit, Hematology, Cancer Center and Laboratory Services HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Department of Public Health, University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| |
Collapse
|
23
|
Romppainen T, Rikala M, Aarnio E, Korhonen MJ, Saastamoinen LK, Huupponen R. Measurement of statin exposure in the absence of information on prescribed doses. Eur J Clin Pharmacol 2014; 70:1275-6. [PMID: 25146693 DOI: 10.1007/s00228-014-1737-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Tomi Romppainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | | | | | | | | | | |
Collapse
|
24
|
Halava H, Korhonen MJ, Huupponen R, Setoguchi S, Pentti J, Kivimäki M, Vahtera J. Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities. CMAJ 2014; 186:E449-56. [PMID: 24958839 DOI: 10.1503/cmaj.131807] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Easily detectable predictors of nonadherence to long-term drug treatment are lacking. We investigated the association between lifestyle factors and nonadherence to statin therapy among patients with and without cardiovascular comorbidities. METHODS We included 9285 participants from the Finnish Public Sector Study who began statin therapy after completing the survey. We linked their survey data with data in national health registers. We used prescription dispensing data to determine participants' nonadherence to statin therapy during the first year of treatment (defined as < 80% of days covered by filled prescriptions). We used logistic regression to estimate the association of several lifestyle factors with nonadherence, after adjusting for sex, age and year of statin initiation. RESULTS Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Obesity (adjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.74-0.99), overweight (adjusted OR 0.88, 95% CI 0.79-0.98) and former smoking (adjusted OR 0.82, 95% CI 0.74-0.92) predicted a reduced risk of nonadherence in this group after adjustment for sex, age and year of statin initiation. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent. In this group, high alcohol consumption (adjusted OR 1.55, 95% CI 1.12-2.15), extreme drinking occasions (adjusted OR 1.48, 95% CI 1.11-1.97) and a cluster of 3-4 lifestyle risks (adjusted OR 1.61, 95% CI 1.15-2.27) predicted increased odds of nonadherence after adjustment for sex, age and year of statin initiation. INTERPRETATION People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence. Among individuals without cardiovascular comorbidities, information on lifestyle factors was unhelpful in identifying those at increased risk of nonadherence; that overweight, obesity and former smoking were predictors of better adherence in this group provides insight into mechanisms of adherence to preventive medication that deserve further study.
Collapse
Affiliation(s)
- Heli Halava
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Maarit Jaana Korhonen
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Risto Huupponen
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Soko Setoguchi
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Jaana Pentti
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Mika Kivimäki
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| | - Jussi Vahtera
- Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
| |
Collapse
|
25
|
Ruokoniemi P, Sund R, Arffman M, Helin-Salmivaara A, Huupponen R, Keskimäki I, Vehko T, Korhonen MJ. Are statin trials in diabetes representative of real-world diabetes care: a population-based study on statin initiators in Finland. BMJ Open 2014; 4:e005402. [PMID: 24948750 PMCID: PMC4067810 DOI: 10.1136/bmjopen-2014-005402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 04/04/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the representativeness of the Heart Protection Study (HPS) and the Collaborative Atorvastatin Diabetes Study (CARDS) for incident statin users. DESIGN A population-based analysis with linked register data. SETTING Finland. POPULATION 56 963 patients with diabetes initiating statin use from 2005 to 2008. MAIN OUTCOME MEASURES We determined the proportions of real-world patients who fulfilled the eligibility criteria for HPS and CARDS trials and assessed the cardiovascular disease (CVD) event rates, assumed to reflect the background CVD risk, for those eligible and ineligible. We used descriptive statistics to identify the patient characteristics, lipid-lowering interventions and adherence to statin therapy. RESULTS Of the real-world patients, 57% (N=32 582) fulfilled the eligibility criteria for HPS (DM) and 49% (N=20 499) of those without CVD for CARDS. The patients ineligible for HPS (DM) had a higher cumulative risk for CVD events than those eligible, whereas regarding CARDS the cumulative risks were of similar magnitude. The overall CVD event rates seemed to be comparable to those in the reviewed trials. Both trials were under-representative of women and users of antihypertensive agents and metformin. 27% and 29% of real-world patients had an initial statin dose corresponding to <20 mg of simvastatin. The proportions of patients who were deemed adherent were 57% in the real world and 85% in both trials. CONCLUSIONS Only half of the real-world patients would have qualified for the HPS (DM) and CARDS, limiting their representativeness for clinical practice. Women and users of antihypertensive agents and metformin were under-represented in both trials. These deviations reflect the changes in diabetes treatment over the years and are not expected to modify the average treatment effects of statins on CVD. Prescribing of lower statin doses in clinical practice than used in the trials and lower adherence may, however, attenuate the benefits in the real world.
Collapse
Affiliation(s)
- Päivi Ruokoniemi
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| | - Reijo Sund
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Martti Arffman
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
- Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| | - Ilmo Keskimäki
- Social and Health Services, National Institute for Health and Welfare, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Tuulikki Vehko
- Service Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, FI-20014 University of Turku, Turku, Finland
| |
Collapse
|
26
|
Upmeier E, Korhonen MJ, Rikala M, Helin-Salmivaara A, Huupponen R. Older Statin Initiators in Finland—Cardiovascular Risk Profiles and Persistence of Use. Cardiovasc Drugs Ther 2014; 28:263-72. [DOI: 10.1007/s10557-014-6517-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
27
|
Helin-Salmivaara A, Lavikainen P, Aarnio E, Huupponen R, Korhonen MJ. Sequential cohort design applying propensity score matching to analyze the comparative effectiveness of atorvastatin and simvastatin in preventing cardiovascular events. PLoS One 2014; 9:e90325. [PMID: 24614626 PMCID: PMC3948677 DOI: 10.1371/journal.pone.0090325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 10/17/2013] [Accepted: 01/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background Sequential cohort design (SCD) applying matching for propensity scores (PS) in accrual periods has been proposed to mitigate bias caused by channeling when calendar time is a proxy for strong confounders. We studied the channeling of patients according to atorvastatin and simvastatin initiation in Finland, starting from the market introduction of atorvastatin in 1998, and explored the SCD PS approach to analyzing the comparative effectiveness of atorvastatin versus simvastatin in the prevention of cardiovascular events (CVE). Methods Initiators of atorvastatin or simvastatin use in the 45–75-year age range in 1998–2006 were characterized by their propensity of receiving atorvastatin over simvastatin, as estimated for 17 six-month periods. Atorvastatin (10 mg) and simvastatin (20 mg) initiators were matched 1∶1 on the PS, as estimated for the whole cohort and within each period. Cox regression models were fitted conventionally, and also for the PS matched cohort and the periodically PS matched cohort, to estimate the hazard ratios (HR) for CVEs. Findings Atorvastatin (10 mg) was associated with a 11%–12% lower incidence of CVE in comparison with simvastatin (20 mg). The HR estimates were the same for a conventional Cox model (0.88, 95% confidence interval 0.85–0.91), for the analysis in which the PS was used to match across all periods and the Cox model was adjusted for strong confounders (0.89, 0.85–0.92), and for the analysis in which PS matching was applied within sequential periods (0.88, 0.84–0.92). The HR from a traditional PS matched analysis was 0.80 (0.77–0.83). Conclusions The SCD PS approach produced effect estimates similar to those obtained in matching for PS within the whole cohort and adjusting the outcome model for strong confounders, but at the cost of efficiency. A traditional PS matched analysis without further adjustment in the outcome model produced estimates further away from unity.
Collapse
Affiliation(s)
- Arja Helin-Salmivaara
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Unit of Primary Health Care, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
- * E-mail:
| | - Piia Lavikainen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
| | - Emma Aarnio
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Risto Huupponen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Clinical Pharmacology, Tykslab, Turku University Hospital, Turku, Finland
| | - Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland
- Department of Public Health, University of Turku, Turku, Finland
| |
Collapse
|
28
|
Aarnio EJ, Martikainen JA, Helin-Salmivaara A, Huupponen RK, Hartikainen JE, Peura PK, Korhonen MJ. Register-based predictors of adherence among new statin users in Finland. J Clin Lipidol 2014; 8:117-25. [DOI: 10.1016/j.jacl.2013.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/12/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
|
29
|
Rikala M, Hartikainen S, Saastamoinen LK, Korhonen MJ. Measuring psychotropic drug exposures in register-based studies--validity of a dosage assumption of one unit per day in older Finns. Int J Methods Psychiatr Res 2013; 22:155-65. [PMID: 23682009 PMCID: PMC6878353 DOI: 10.1002/mpr.1384] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 10/28/2011] [Accepted: 01/17/2012] [Indexed: 11/07/2022] Open
Abstract
Pharmacoepidemiological studies provide valuable information on the relationships between psychotropic drug use and adverse outcomes in older people. To minimize the influence of misclassification bias in pharmacoepidemiological studies, more emphasis should be given to methodological aspects of exposure assessment. This study evaluated the validity of a dosage assumption of one unit per day for measuring legend duration of psychotropic drug exposures among older people. Using data from the Finnish Prescription Register, the study analysed 62,320 psychotropic drug prescriptions dispensed for people aged ≥ 75 years (n = 52,729) in September 2009. The proportions of prescriptions in which the prescribed dose deviated from one unit per day were assessed for categories and subcategories of psychotropic drugs. The prescription was considered misclassified (a) if the prescribed drug was intended for "as needed" use, (b) if the prescription included a dose range, or (c) if the prescribed dose was below or above one unit per day. Among antidepressants, less than every fourth (23.7%) prescription was misclassified. The proportions of misclassification varied substantially across subcategories, being 13.1% for selective serotonin reuptake inhibitors (SSRIs), 25.3% for other antidepressants and 53.8% for tricyclic antidepressants. Of the benzodiazepine and antipsychotic prescriptions, 79.9% and 57.6%, respectively, were misclassified. In conclusion, the dosage assumption of one unit per day is valid for measuring the legend duration of SSRI and other antidepressant exposures among older people. Among other psychotropic drugs, the dosage assumption is likely to lead to severe exposure misclassification.
Collapse
Affiliation(s)
- Maria Rikala
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
| | | | | | | |
Collapse
|
30
|
Rikala M, Huupponen R, Helin-Salmivaara A, Korhonen MJ. Channelling of Statin Use towards Low-Risk Population and Patients with Diabetes. Basic Clin Pharmacol Toxicol 2013; 113:173-8. [DOI: 10.1111/bcpt.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Rikala
- Department of Pharmacology, Drug Development and Therapeutics; University of Turku; Turku; Finland
| | | | | | | |
Collapse
|
31
|
Onyeka IN, Beynon CM, Uosukainen H, Korhonen MJ, Ilomäki J, Bell JS, Paasolainen M, Tasa N, Tiihonen J, Kauhanen J. Coexisting social conditions and health problems among clients seeking treatment for illicit drug use in Finland: the HUUTI study. BMC Public Health 2013; 13:380. [PMID: 23617549 PMCID: PMC3639872 DOI: 10.1186/1471-2458-13-380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use. METHODS We carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients' first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems. RESULTS The mean age of the clients was 25 years, 21% (n = 519) were homeless, 54% (n = 1363) were unemployed and 7% (n = 183) had experienced threats of violence. Half of the clients (50%, n = 1258) were self-referred and 31% (n = 788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n = 630) was more prevalent than other infectious diseases and depressive symptoms (59%, n = 1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR = 1.86; 95% CI = 1.50-2.30) and psychological problems (AOR = 1.51; 95% CI = 1.23-1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR = 3.89; 95% CI = 1.32-11.46) and for reporting a combination of social and health problems (AOR = 3.24; 95% CI = 1.58-6.65). CONCLUSION The existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients' treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.
Collapse
Affiliation(s)
- Ifeoma N Onyeka
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, P,O,Box 1627, Kuopio, FI, 70211, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Ilomäki J, Paljärvi T, Korhonen MJ, Enlund H, Alderman CP, Kauhanen J, Bell JS. Prevalence of concomitant use of alcohol and sedative-hypnotic drugs in middle and older aged persons: a systematic review. Ann Pharmacother 2013; 47:257-68. [PMID: 23362039 DOI: 10.1345/aph.1r449] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To systematically review the prevalence of concomitant alcohol and sedative-hypnotic use among middle-aged and older persons. DATA SOURCES A bibliographic search of English-language literature was performed using MEDLINE, EMBASE, and PsycINFO (January 1990-August 2012). The reference lists of all included articles were screened for additional relevant articles not identified by any of the bibliographic searches. STUDY SELECTION AND DATA EXTRACTION Population-based studies in which the mean age of participants was 40 years or older were included. For a study to be included in the review, alcohol use had to be reported in terms of the quantity or frequency consumed. Data from included articles were extracted using a standardized data extraction tool. DATA SYNTHESIS Five population-based studies conducted in North America, 10 in Europe, and 1 in Australia were included in the review. Up to 88% of men and 79% of women who used sedative-hypnotics also consumed alcohol. Up to 28% of those who consumed alcohol were concomitant users of sedative-hypnotics. Alcohol was consumed at higher levels among middle-aged than older persons. Risky drinking (eg, binge drinking, heavy drinking) was more prevalent among middle-aged than older persons. In contrast, sedative-hypnotic use was more prevalent among older persons. CONCLUSIONS Our review identified a higher prevalence of alcohol consumption among middle-aged than older persons. However, middle-aged persons may experience harm from alcohol/sedative-hypnotic drug interactions due to risky drinking behavior. Despite lower levels of alcohol consumption, older persons may be more susceptible to addictive central nervous system effects than younger persons because of physiologic changes in psychotropic drug and alcohol metabolism. Clinicians should consider patients' alcohol consumption patterns before prescribing sedative-hypnotic drugs.
Collapse
Affiliation(s)
- Jenni Ilomäki
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
| | | | | | | | | | | | | |
Collapse
|
33
|
Onyeka IN, Uosukainen H, Korhonen MJ, Beynon C, Bell JS, Ronkainen K, Föhr J, Tiihonen J, Kauhanen J. Sociodemographic Characteristics and Drug Abuse Patterns of Treatment-Seeking Illicit Drug Abusers in Finland, 1997–2008: The Huuti Study. J Addict Dis 2012; 31:350-62. [DOI: 10.1080/10550887.2012.735563] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ifeoma N. Onyeka
- a Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - Hanna Uosukainen
- b School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - Maarit Jaana Korhonen
- a Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
- c Department of Pharmacology, Drug Development and Therapeutics , University of Turku , Turku , Finland
| | - Caryl Beynon
- d Centre for Public Health, Faculty of Health and Applied Social Sciences , Liverpool John Moores University , Liverpool , United Kingdom
| | - J. Simon Bell
- b School of Pharmacy, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
- e Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute , University of South Australia , Adelaide , Australia
| | - Kimmo Ronkainen
- f Research Institute of Public Health, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| | - Jaana Föhr
- g Helsinki Deaconess Institute , Helsinki , Finland
| | - Jari Tiihonen
- h Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; National Institute for Health and Welfare, Helsinki, Finland; and Karolinska Institute, Department of Clinical Neuroscience , Stockholm , Sweden
| | - Jussi Kauhanen
- a Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences , University of Eastern Finland , Kuopio , Finland
| |
Collapse
|
34
|
Sipilä R, Helin-Salmivaara A, Korhonen MJ, Ketola E. Change in antihypertensive drug prescribing after guideline implementation: a controlled before and after study. BMC Fam Pract 2011; 12:87. [PMID: 21849037 PMCID: PMC3176159 DOI: 10.1186/1471-2296-12-87] [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] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 08/17/2011] [Indexed: 11/30/2022]
Abstract
Background Antihypertensive drug choices and treatment levels are not in accordance with the existing guidelines. We aimed to assess the impact of a guideline implementation intervention on antihypertensive drug prescribing. Methods In this controlled before and after study, the effects of a multifaceted (education, audit and feedback, local care pathway) quality programme was evaluated. The intervention was carried out in a health centre between 2002 and 2003. From each health care unit (n = 31), a doctor-nurse pair was trained to act as peer facilitators in the intervention. All antihypertensive drugs prescribed by 25 facilitator general practitioners (intervention GPs) and 53 control GPs were retrieved from the nationwide Prescription Register for three-month periods in 2001 and 2003. The proportions of patients receiving specific antihypertensive drugs and multiple antihypertensive drugs were measured before and after the intervention for three subgroups of hypertension patients: hypertension only, with coronary heart disease, and with diabetes. Results In all subgroups, the use of multiple concurrent medications increased. For intervention patients with hypertension only, the odds ratio (OR) was 1.12 (95% CI 0.99, 1.25; p = 0.06) and for controls 1.13 (1.05, 1.21; p = 0.002). We observed no statistically significant differences in the change in the prescribing of specific antihypertensive agents between the intervention and control groups. The use of agents acting on the renin-angiotensin-aldosterone system increased in all subgroups (hypertension only intervention patients OR 1.19 (1.06, 1.34; p = 0.004) and controls OR 1.24 (1.15, 1.34; p < 0.0001). Conclusions A multifaceted guideline implementation intervention does not necessarily lead to significant changes in prescribing performance. Rigorous planning of the interventions and quality projects and their evaluation are essential.
Collapse
Affiliation(s)
- Raija Sipilä
- Current Care, Finnish Medical Society Duodecim, Helsinki.
| | | | | | | |
Collapse
|
35
|
Abstract
PURPOSE Knowledge of the different usage patterns that emerge during a long-term statin therapy is limited. The aim of this study was to characterize statin use, including the rates of reinitiation after extended periods of non-use, transitions between good and poor adherence, and the effect of the length of a drug-free period on the identification of new users. METHODS The study cohort comprised individuals aged 45-84 years who were identified in the Finnish prescription register as having purchased statins between 1997 and 2007. New users in 1997, including those with no statin purchases during the preceding 3 years, were followed-up until institutionalization, death, or 31 December 2007. Reinitiation rates after ≥180 days with no refill for statins were analyzed using survival analysis. Annual adherence levels and the prevalences of good (proportion of days covered ≥0.80) and poor (<0.80) adherence were calculated for ten 1-year periods following initiation. For statin users in 2007, purchases were captured over the previous 10 years. RESULTS Based on the data extracted from the Finnish prescription register, 32,760 persons initiated statin treatment in 1997, of whom 48.1% had discontinued it for at least 180 days by the end of the follow-up period. Of the discontinuers, 46.7% restarted the treatment within 1 year and 88.7% by the end of the follow-up. Of those followed up for ≥10 years, 51.8% had ≥6 years of treatment with good adherence. In 2007, 27.7% of the initiators having no statin purchases within the previous year had refills during the preceding 10 years. CONCLUSION Statin use is dynamic. This should be taken into consideration in clinical practice and when studying the incidence, patterns, and health outcomes of statin use.
Collapse
Affiliation(s)
- Maarit Jaana Korhonen
- Department of Pharmacology, Drug Development and Therapeutics, University of Turku, 20014, Turun yliopisto, Finland.
| | | | | |
Collapse
|
36
|
Ilomäki J, Hajat A, Kauhanen J, Kurl S, Kaufman JS, Tuomainen TP, Korhonen MJ. Relationship between alcohol consumption and myocardial infarction among ageing men using a marginal structural model. Eur J Public Health 2011; 22:825-30. [PMID: 21398379 DOI: 10.1093/eurpub/ckr013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies on the association between alcohol consumption and myocardial infarction (MI) have typically used baseline data on alcohol consumption and potential confounders. This study aimed at investigating the association between alcohol consumption and MI considering time-varying alcohol consumption and time-varying confounders. METHODS Data were available for 1030 males participating in the Kuopio Ischaemic Heart Disease Risk Factor Study (Finland). Baseline data for the present study were collected in 1991-93. MIs were ascertained from national registries until December 2005. Alcohol consumption was categorized into four groups. Data were analysed using conventional discrete-time hazard and marginal structural models (MSMs). Time-invariant covariates were age, working status, diabetes and cigarette-years. Time-varying covariates in the MSM were prior alcohol consumption, smoking, history of cardiovascular diseases, body mass index, high-density lipoprotein cholesterol, systolic blood pressure, insulin and fibrinogen. RESULTS An insignificant increase of MI risk among the heaviest alcohol consumers (≥168 g week(-1)) compared with the reference group (12-83 g week(-1)) was observed when using a conventional model including baseline alcohol consumption and confounders measured prior to baseline [relative risk (RR) = 1.20, 95% confidence interval (95% CI) = 0.68-2.12]. When using a conventional model with time-varying alcohol consumption and adjusting for prior confounders, an increased risk of MI among the heaviest alcohol consumers was revealed (RR = 1.71, 95% CI = 1.03-2.85). There was also a trend towards increased risk among the heaviest consumers using the MSM (RR = 1.59, 95% CI = 0.93-2.72). CONCLUSION Our findings suggest that standard methods using only baseline data on alcohol consumption and confounders may lead to biased estimates on the association between alcohol consumption and MI.
Collapse
Affiliation(s)
- Jenni Ilomäki
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
| | | | | | | | | | | | | |
Collapse
|
37
|
Rikala M, Korhonen MJ, Sulkava R, Hartikainen S. Psychotropic drug use in community-dwelling elderly people—characteristics of persistent and incident users. Eur J Clin Pharmacol 2011; 67:731-9. [DOI: 10.1007/s00228-011-0996-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/10/2011] [Indexed: 11/29/2022]
|
38
|
Rikala M, Hartikainen S, Sulkava R, Korhonen MJ. Validity of the Finnish Prescription Register for Measuring Psychotropic Drug Exposures among Elderly Finns. Drugs Aging 2010; 27:337-49. [DOI: 10.2165/11315960-000000000-00000] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
39
|
Lindell-Osuagwu L, Korhonen MJ, Saano S, Helin-Tanninen M, Naaranlahti T, Kokki H. Off-label and unlicensed drug prescribing in three paediatric wards in Finland and review of the international literature. J Clin Pharm Ther 2009; 34:277-87. [PMID: 19650250 DOI: 10.1111/j.1365-2710.2008.01005.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In paediatric pharmacotherapy, many drugs are prescribed to be given in ways and for conditions not approved in the marketing authorization (MA). Thus, off-label prescribing of drugs with no MA is widespread in paediatric wards. However, drug MA status and clinical practices differ across countries. In this prospective study, we studied the prescribing of off-label and unlicensed drugs in three paediatric wards in a tertiary hospital in Finland. Furthermore, we reviewed previous published studies to provide an up-to-date international perspective on prescribing of off-label and unlicensed drugs for hospitalized children. METHODS During a 2-week period, prescriptions for patients under 18 years of age (median age 1*6 years) in three wards; neonatal intensive care unit (NICU), general paediatric ward and paediatric surgical ward were recorded daily and drug-licensing status of all prescriptions was determined according to the approved summary of product characteristics. Published studies were retrieved through electronic searches, including MEDLINE (PubMed). RESULTS Of the 141 children, 108 received 629 prescriptions. Of the 108 children with a prescription, 82 (76%) had at least one off-label or unlicensed drug prescribed; 79% in the NICU, 63% in the general ward and 91% in the surgical ward (P = 0*014). Of the 108 children with a prescription, 26 (24%) received prescriptions for licensed drugs, 71 (66%) received prescriptions off-label and 36 (33%) for unlicensed drugs. Of all 629 prescriptions, 321 (51%) were for licensed drugs, 226 (36%) for off-label and 82 (13%) for unlicensed drugs. International studies showed similar extents of off-label and unlicensed-drug prescribing. CONCLUSION This study indicates that the use of off-label and unlicensed drugs is widespread in all the different paediatric wards surveyed and was as extensive as those reported for other countries.
Collapse
Affiliation(s)
- L Lindell-Osuagwu
- Department of Social Pharmacy, University of Kuopio, Kuopio, Finland.
| | | | | | | | | | | |
Collapse
|
40
|
Korhonen MJ, Huupponen R, Ruokoniemi P, Helin-Salmivaara A. Protopathic bias in observational studies on statin effectiveness. Eur J Clin Pharmacol 2009; 65:1167-8. [DOI: 10.1007/s00228-009-0701-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 07/03/2009] [Indexed: 10/20/2022]
|
41
|
Ilomäki J, Korhonen MJ, Lavikainen P, Lipton R, Enlund H, Kauhanen J. Changes in alcohol consumption and drinking patterns during 11 years of follow-up among ageing men: the FinDrink study. Eur J Public Health 2009; 20:133-8. [PMID: 19561173 DOI: 10.1093/eurpub/ckp079] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol consumption is often reported to decrease with ageing. We investigated alcohol consumption and drinking patterns in an ageing population-based male sample during an 11-year follow-up period. METHODS This study with baseline and two follow-up examinations (at 4 and 11 years) included 1516 randomly selected participants, aged 42, 48, 54 and 60 years from Eastern Finland. Alcohol consumption and drinking patterns during the year preceding the examination were assessed. Data were analysed using Generalized Estimating Equations and Mixed Models. RESULTS Over the 11-year study period, the amount of alcohol consumed weekly increased among the 42-year-olds (P < 0.001) and remained constant among the older cohorts. The risk of frequent drinking (alcohol consumption at least twice weekly) increased among all cohorts (OR = 2.04, 95% CI = 1.50-2.79 for 42-year-olds; OR = 1.71, 95% CI = 1.13-2.58 for 48-year-olds; OR = 1.67, 95% CI = 1.16-2.39 for 54-year-olds and OR = 1.67, 95% CI = 1.21-2.29 for 60-year-olds). There was also an increasing probability of heavy consumption (more than 14 weekly drinks) among the 42-year-olds (OR = 1.47, 95% CI = 1.09-2.00). The risk of binging (six-plus drinks at one occasion) decreased among the older participants (OR = 0.65, 95% CI = 0.47-0.89 for 54-year-olds, and OR = 0.56, 95% CI = 0.39-0.81 for 60-year-olds). CONCLUSION Finnish men born in 1926-1946 do not seem to decrease drinking while ageing. In contrast those born in 1944-1946 increase drinking until their 60's. This should be taken into consideration in planning health services for aged men in the near future.
Collapse
Affiliation(s)
- Jenni Ilomäki
- School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland.
| | | | | | | | | | | |
Collapse
|
42
|
Ilomäki J, Korhonen MJ, Enlund H, Hartzema AG, Kauhanen J. Risk drinking behavior among psychotropic drug users in an aging Finnish population: the FinDrink study. Alcohol 2008; 42:261-7. [PMID: 18400450 DOI: 10.1016/j.alcohol.2008.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 02/08/2008] [Accepted: 02/09/2008] [Indexed: 11/19/2022]
Abstract
Psychotropic drug use and alcohol consumption is increasing among aging Finns. Alcohol use is not recommended with benzodiazepines and some other psychotropic medicines. Concomitant use may lead to accidents and other serious consequences. The aim of this study was to analyze the drinking behavior of psychotropic drug users in an aging Finnish population. This study is part of the ongoing epidemiologic FinDrink study. Self-reported data on alcohol consumption and psychotropic drug use were collected from the Kuopio Ischaemic Heart Disease Risk Factor Study examinations conducted in 1998-2001. Overall, 854 men and 920 women participated in the study. A total of 204 (11.5%) individuals used psychotropic drugs regularly (14.2% of women and 8.5% of men; P<.001). Three quarters of the study population had used alcohol weekly during the preceding year (68.9% of women and 87.5% of men; P<.001). Men who use anxiolytics and sedatives were more likely to drink alcohol at least twice a week (odds ratio=2.42; 95% confidence interval=1.30-4.51), to be binge drinkers (odds ratio=1.86; 95% confidence interval=1.01-3.43) and to be heavy alcohol consumers (odds ratio=2.22; 95% confidence interval= 1.13-4.39) than men not using psychotropics. In women, alcohol consumption and drinking patterns were same between the groups. Our results indicate the potential for alcohol-related health risks among aging Finnish men and women using psychotropic drugs.
Collapse
Affiliation(s)
- Jenni Ilomäki
- School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio 70211, Finland.
| | | | | | | | | |
Collapse
|
43
|
Virtanen JK, Voutilainen S, Alfthan G, Korhonen MJ, Rissanen TH, Mursu J, Kaplan GA, Salonen JT. Homocysteine as a risk factor for CVD mortality in men with other CVD risk factors: the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. J Intern Med 2005; 257:255-62. [PMID: 15715682 DOI: 10.1111/j.1365-2796.2005.01450.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Based on case-control and prospective studies elevated blood total homocysteine (tHcy) has been suggested to be an independent risk factor for cardiovascular diseases (CVD). The purpose of the study was to explore the joint effect of increased serum tHcy concentration and other risk factors on the risk of CVD mortality in middle-aged men without a history of heart disease or stroke. DESIGN A prospective, population-based Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. SETTING Eastern Finland. Subjects. A total of 802 men aged 46-64 years, examined in 1991-93. MAIN OUTCOME MEASURES CVD mortality event. RESULTS The mean serum tHcy concentration was 10.8 micromol L(-1) (SD 3.3). During the average follow-up time of 10.8 years 50 men experienced a CVD death. The hazard rate ratio for CVD mortality was 1.80 (95% confidence interval: 1.02-3.19) in men in the highest serum tHcy third versus lower thirds after adjustment for cardiovascular risk factors. Furthermore, elevated serum tHcy concentration appeared to increase the risk of CVD death in men who smoke or who have high circulating concentrations of serum total or LDL cholesterol, apo-B apolipoprotein or plasma fibrinogen. CONCLUSION We conclude that homocysteine may increase the risk of CVD mortality in middle-aged men from Eastern Finland, and it may especially increase the risk when present with other risk factors for CVD.
Collapse
Affiliation(s)
- J K Virtanen
- Research Institute of Public Health, University of Kuopio, Kuopio, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Preterm labour (PTL) is a major contributor to preterm delivery (PTD) but delivery is often not preventable by current therapies. We conducted this study to determine the proportion of women with PTL who were and who were not candidates for tocolytic therapy. The cohort comprised residents of Olmsted County, Minnesota who delivered at >20 weeks' gestation in 1985--94 and who experienced PTL. Medical records were abstracted to identify episodes of PTL, its treatment and outcome. We developed an algorithm that accounted for gestation at delivery and pregnancy complications to determine the proportion of pregnancies complicated by PTL that were candidates for tocolytic therapy. Of 651 pregnancies complicated by PTL, a 50% probability sample, stratified by delivery year, were selected and abstracted. The cumulative incidence of PTL ranged from 3.6 to 6.4 per 100 deliveries of live or stillborn infants. Tocolysis was not contraindicated for 49.4% of all women with PTL and for a third of women with only one PTL episode. Delivery was delayed to >35 weeks in 53.8% of candidates for tocolysis. Only an additional 11.7% of women with one or more PTL episodes could have had their PTD delayed beyond 35 weeks if a perfect tocolytic therapy had been available. Many pregnancies complicated by PTL occurred at > or =35 weeks or involved maternal or obstetric factors that contraindicated tocolytic medications. The maximum incremental benefit that could be expected of a new safe and efficacious tocolytic therapy would be to reduce current PTD rates resulting from PTL by about 12%.
Collapse
Affiliation(s)
- S L West
- Research Triangle Institute, Research Triangle Park, NC, USA
| | | | | | | | | | | |
Collapse
|
45
|
Vainio KK, Korhonen MJ, Hirvonen AM, Enlund KH. The perceived role and skills of pharmacists in asthma management after in-house training. Pharm World Sci 2001; 23:6-12. [PMID: 11344591 DOI: 10.1023/a:1011296628830] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate perceived roles and skills of pharmacists in asthma management before and after a training intervention that consisted of six in-house training sessions. METHOD Altogether 315 pharmacists in the intervention group and 121 pharmacists in the control group participated in the study. The data on study variables were collected by a questionnaire during the first and last training sessions. MAIN OUTCOME MEASURES Pharmacists' perceptions of their role, perceived skills, estimates of patients receiving counselling and experienced problems. RESULTS Based on their ratings for 16 topics, the pharmacists' perceptions about their role in counselling asthma patients remained rather stable. Handling of the inhalers and inhalation technique were considered as the most important aspects of counselling and issues dealing with the disease were regarded as the least important. Using a self-rated scale (4-10 scale), pharmacists' perceived counselling skills improved in the intervention group (6.5 vs 7.6), but not in the control group (6.5 vs 6.4). In the intervention group, the pharmacists' estimates of the proportion of new users of asthma medicines receiving counselling increased from 48% to 61% and that of old users from 18% to 26%. Before the training, the most commonly experienced problem in counselling was the pharmacists' lack of knowledge and skills. After the training, pharmacists experienced problems mainly with communication. CONCLUSION When pharmacists are included in the support system for any patients group, their capabilities of fulfilling their role have to be assessed. In particular, communication skills and outcome-oriented counselling require attention.
Collapse
Affiliation(s)
- K K Vainio
- Department of Social Pharmacy, University of Kuopio, P.O.B. 1627, FIN-70211 Kuopio, Finland.
| | | | | | | |
Collapse
|
46
|
Wallenius SH, Vainio KK, Korhonen MJ, Hartzema AG, Enlund HK. Self-initiated modification of hypertension treatment in response to perceived problems. Ann Pharmacother 1995; 29:1213-17. [PMID: 8672823 DOI: 10.1177/106002809502901204] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To assess the prevalence of patient-initiated modification of drug instructions and the association between different classes of problems and the modification of hypertension therapy. DESIGN AND METHODS In this cross-sectional study, all patients (n = 1215) who had been examined at a hypertension clinic during a 1-year period were surveyed. The response rate to the questionnaire was 85%. Of the 1035 respondents, 623 currently taking antihypertensive medication (self-report) were included in the study. RESULTS Of the patients taking antihypertensive drugs, 36% admitted that they had tried to manage their condition with a lower dosage and/or fewer drugs than prescribed. The percentage of patients who modified their drug regimen decreased with increasing age. One or more problems with the treatment of hypertension were reported by 79% of the respondents. The odds ratio (95% confidence interval) for modification among patients who reported 1 or more problems compared with those not reporting any problem was 3.5 (2.12 to 5.67). The prevalence of modification increased with the number of problems; this was seen in all age groups and among men and women. CONCLUSIONS Perceived problems in drug taking in the treatment of hypertension have an important impact on the prevalence of modifying drug instructions.
Collapse
Affiliation(s)
- S H Wallenius
- Department of Social Pharmacy, University of Kuopio, Finland
| | | | | | | | | |
Collapse
|