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Kampmann JD, Nybo M, Brandt F, Støvring H, Damkier P, Henriksen DP, Lund LC. Statin use before and after the KDIGO Lipids in chronic kidney disease guideline: A population-based interrupted time series analysis. Basic Clin Pharmacol Toxicol 2022; 131:306-310. [PMID: 35762022 PMCID: PMC9795967 DOI: 10.1111/bcpt.13768] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 12/30/2022]
Abstract
In November 2013, the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease was published, recommending statins for all individuals 50 years or older with an estimated glomerular filtration rate below 60 ml/min/1.73 m2 to lower the risk of major cardiovascular events. We quantified the prevalence of statin use among the target population before and after the guideline publication in a large Danish cohort of individuals with an estimated glomerular filtration rate below 60 ml/min/1.73 m2 , to investigate the effect of the guideline, but found no difference in the prevalence of statin use prior to and after the guideline publication.
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Affiliation(s)
- Jan D. Kampmann
- Internal Medicine Research UnitUniversity Hospital of Southern DenmarkOdenseDenmark,Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Mads Nybo
- Department of Clinical BiochemistryOdense University HospitalOdenseDenmark
| | - Frans Brandt
- Internal Medicine Research UnitUniversity Hospital of Southern DenmarkOdenseDenmark,Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Henrik Støvring
- Biostatistics, Department of Public HealthAarhus UniversityAarhusDenmark,Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Per Damkier
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Daniel P. Henriksen
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark,Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Lars C. Lund
- Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
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2
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Madsen H, Mortz CG, Bindslev‐Jensen C, Reilev M, Hallas J, Henriksen DP. High-dose non-sedating antihistamines are used insufficiently in chronic urticaria patients treated with omalizumab. Clin Transl Allergy 2021; 11:e12085. [PMID: 34938439 PMCID: PMC8665689 DOI: 10.1002/clt2.12085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The lifetime prevalence of chronic urticaria (CU) is 0.5%-1%. In some patients with CU, symptomatic control is not achieved with non-sedating second-generation H1 antihistamines (nsAH1) alone, even with quadrupled standard doses as recommended in international guidelines. In these cases, biological treatment with omalizumab can be added. Since omalizumab is expensive compared to antihistamines, lack of adherence to guidelines for high dose nsAH1 (up to four-fold standard dose per day) may be associated with substantial unnecessary costs. The aim was to measure the use nsAH1 before and during omalizumab use for the first time in an omalizumab treated CU population. METHODS We identified all Danish patients with CU who initiated omalizumab from March 2014 to December 2018 and evaluated new and ongoing nsAH1 treatments using the Danish nationwide registries. RESULTS A total of 955 CU patients initiated treatment with omalizumab within the study period (median age 40 years [IQR 28-50], 74.5% females). During the 12 months prior to omalizumab initiation, 95.6% of the patients filled at least one prescription with nsAH1 at some point, while 84.7% filled at least one prescription during the three months before omalizumab. From 3 months before omalizumab initiation till 3 months after, the proportions of users of high-dose nsAH1 was maximum 31.1%. CONCLUSIONS Omalizumab was usually administered before sufficient nsAH1 treatment was tried. In despite of the labelling that omalizumab should be co-administered with high dose nsAH1, this does not happen This may lead to substantial unnecessary costs.
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Affiliation(s)
- Hanne Madsen
- Department of Dermatology and Allergy CenterOdense University HospitalOdenseDenmark
- Department of Internal Medicine & Acute MedicineOdense University HospitalOdenseDenmark
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy CenterOdense University HospitalOdenseDenmark
| | | | - Mette Reilev
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark
| | - Daniel P. Henriksen
- Clinical Pharmacology, Pharmacy and Environmental MedicineDepartment of Public HealthUniversity of Southern DenmarkOdenseDenmark
- Department of Clinical PharmacologyOdense University HospitalOdenseDenmark
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3
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Prætorius K, Henriksen DP, Schmid JM, Printzlau P, Pedersen L, Madsen H, Andersson EA, Madsen LK, Chawes BL. Indirect comparison of efficacy of dupilumab versus mepolizumab and omalizumab for severe type 2 asthma. ERJ Open Res 2021; 7:00306-2021. [PMID: 34476242 PMCID: PMC8405862 DOI: 10.1183/23120541.00306-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
This indirect comparison of dupilumab, mepolizumab and omalizumab for patients with severe type 2 asthma fulfilling start-up criteria for more than one drug shows no significant efficacy differences https://bit.ly/3pK9Nf9.
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Affiliation(s)
- Katrine Prætorius
- Dept of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Daniel P Henriksen
- Dept of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Johannes M Schmid
- Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lars Pedersen
- Dept of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Madsen
- Dept of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ehm A Andersson
- The Danish Medicines Council Secretariat, Copenhagen, Denmark
| | | | - Bo L Chawes
- Dept of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, Copenhagen, Denmark.,COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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4
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Kristensen KB, Henriksen DP, Hallas J, Pottegård A, Lund LC. Sodium-glucose cotransporter 2 inhibitors and risk of nephrolithiasis. Diabetologia 2021; 64:1563-1571. [PMID: 33715024 DOI: 10.1007/s00125-021-05424-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/19/2020] [Accepted: 01/05/2021] [Indexed: 10/21/2022]
Abstract
AIMS/HYPOTHESIS Sodium-glucose cotransporter 2 inhibitors (SGLT2Is) may reduce nephrolithiasis risk by increasing urine flow. We aimed to investigate whether initiation of SGLT2I was associated with reduced nephrolithiasis risk. METHODS We conducted an active-comparator new-user cohort study using the Danish health registries in the period 11 November 2012 to 31 December 2018. Individuals aged ≥40 years initiating SGLT2Is or glucagon-like peptide-1 receptor agonists (GLP1 RAs) were followed from treatment initiation until an inpatient or outpatient diagnosis of nephrolithiasis, death, emigration or end of study. New users of SGLT2Is were matched 1:1 on propensity scores to new users of GLP1 RAs. In supplementary analyses, risk of recurrent nephrolithiasis was assessed in individuals with a history of nephrolithiasis before treatment initiation. RESULTS We identified 24,290 and 19,576 eligible users of SGLT2Is and GLP1 RAs, respectively. After matching, 12,325 patient pairs remained. The median age was 61 years and median follow-up was 2.0 years. The nephrolithiasis rate was 2.0 per 1000 person-years in SGLT2I initiators compared with 4.0 per 1000 person-years in GLP1 RA initiators, with a rate difference of -1.9 per 1000 person-years (95% CI -2.8, -1.0) and an HR of 0.51 (95% CI 0.37, 0.71). For recurrent nephrolithiasis (n = 731 patient pairs), the rate difference was -17 per 1000 person-years (95% CI -33, -1.5) and the HR was 0.68 (95% CI 0.48, 0.97). CONCLUSIONS/INTERPRETATION Initiation of treatment with SGLT2Is was associated with a clinically significant reduced risk of incident and recurrent nephrolithiasis.
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Affiliation(s)
- Kasper B Kristensen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Daniel P Henriksen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars C Lund
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
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5
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Hansen RS, Revsholm J, Henriksen DP, Lund LC, Nybo M. Diagnoses and mortality in a population without acute myocardial infarction, but with elevated high-sensitive troponin I - a retrospective register-based single center study. Acute Med 2021; 20:18-24. [PMID: 33749691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
AIM To explore, which differential diagnoses to consider in individuals with elevated troponins without acute myocardial infarction (AMI), and the mortality for those individuals. METHODS Retrospective, register-based study on a representative sample of the Danish population with the following inclusion criteria: High-sensitive troponin I (hs-TnI) ⋝25 ng/L, age ⋝18 years, and exclusion of AMI. RESULTS 3067 individuals without AMI but increased hs-TnI were included. Most frequent discharge diagnoses: Pneumonia (12.8%), Aortic valve disorder (11.3%), Medical observation (10.9%) and Heart failure (8.9%). The 30-days and one-year mortality was 15.8% and 32.0%, respectively. CONCLUSIONS A selected number of alternative diagnoses must be considered in individuals with increased hs-TnI. Due to high mortality it is crucial to carefully evaluate these individuals despite the absence of AMI.
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Affiliation(s)
- R S Hansen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - J Revsholm
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - D P Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | - L C Lund
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern, Denmark
| | - M Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
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6
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Henriksen DP, Bodtger U, Sidenius K, Maltbaek N, Pedersen L, Madsen H, Andersson EA, Norgaard O, Madsen LK, Chawes BL. Efficacy of omalizumab in children, adolescents, and adults with severe allergic asthma: a systematic review, meta-analysis, and call for new trials using current guidelines for assessment of severe asthma. Allergy Asthma Clin Immunol 2020; 16:49. [PMID: 32565844 PMCID: PMC7302157 DOI: 10.1186/s13223-020-00442-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 05/23/2020] [Indexed: 12/14/2022] Open
Abstract
Background Omalizumab is approved for treating severe allergic asthma from age 6, but the definition of severe asthma including a systematic assessment to rule out difficult-to-treat asthma has changed since the drug was approved in 2003. Methods We conducted a systematic review and meta-analysis of two critical (exacerbation rate, oral corticosteroid (OCS) treatment) and eight important clinical outcomes in children, adolescents and adults, and specifically searched papers for systematic assessment of severe asthma. Results Adults: seven studies (n = 2159) ascertaining exacerbation rate showing a 37% (95% CI 21–50) reduction in favor of omalizumab, larger than the pre-specified minimal clinically important difference (MCID) of 25%. Only one open-label study (n = 82) was identified assessing the percentage of patients experiencing reduction of OCS-maintenance treatment showing a significantly greater decrease in the omalizumab group (− 45% vs. + 18.3%, p = 0.002). Children and adolescents: four studies (n = 1551) reported data on exacerbations (no meta-analysis conducted), showed overall improvements in exacerbation rate and some passed MCID. No OCS studies were identified. No included studies provided systematic assessment of severe asthma according to current guidelines. Conclusions Omalizumab provides clinically relevant improvements in exacerbation rate among children, adolescents, and adults and in OCS-reduction among adults. New studies incorporating a guideline-approached definition of severe asthma are warranted.
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Affiliation(s)
- Daniel P Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.,Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | - Niels Maltbaek
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Madsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ehm A Andersson
- The Danish Medicines Council Secretariat, Copenhagen, Denmark
| | - Ole Norgaard
- The Danish Medicines Council Secretariat, Copenhagen, Denmark
| | - Louise K Madsen
- The Danish Medicines Council Secretariat, Copenhagen, Denmark
| | - Bo L Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte University Hospital, University of Copenhagen, Ledreborg Allé 34, Gentofte, 2820 Copenhagen, Denmark
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7
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Brix TH, Lund LC, Henriksen DP, Folkestad L, Bonnema SJ, Hallas J, Hegedüs L. Methimazole and risk of acute pancreatitis. Lancet Diabetes Endocrinol 2020; 8:187-189. [PMID: 32035032 DOI: 10.1016/s2213-8587(20)30025-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Thomas H Brix
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark.
| | - Lars C Lund
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Daniel P Henriksen
- Department of Clinical Biochemistry, Odense University Hospital, 5000 Odense, Denmark; Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark
| | - Steen J Bonnema
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark
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8
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Bergmann TK, Christensen MMH, Henriksen DP, Haastrup MB, Damkier P. Progression-free survival in oncology: Caveat emptor! Basic Clin Pharmacol Toxicol 2018; 124:240-244. [PMID: 30417586 DOI: 10.1111/bcpt.13168] [Citation(s) in RCA: 3] [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] [Indexed: 01/29/2023]
Abstract
Overall survival (OS) is the undisputed gold standard efficacy end-point in cancer drug trials. It is with growing concern that we observe how progression-free survival (PFS) gains ground as surrogate end-point in its place. PFS has appeal because it is resource-efficient, but it has severe shortcomings. Our concern is that uncritical use of PFS will harm the evidence-based evaluation of cancer drugs when considering them for standard use in publicly financed health care systems. PFS is only valid as a surrogate end-point for OS if it correlates strongly with OS and if the cancer drug being investigated has the same effect on PFS and OS such that effects on one predict effects on the other. The latter might be less obvious than the former but is no less critical. Research indicates that in a majority of cases, correlation between surrogate end-points and OS is of medium strength or lower. PFS is therefore unreliable as a surrogate for OS. We do not find it justified to use PFS as surrogate for OS without first having assessed its validity. Stakeholders who take part in evaluating cancer drugs considered for standard use in a health care system must be particularly vigilant about this issue to minimize the risk of introducing cancer drugs that have an unacceptable cost-risk-benefit profile.
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Affiliation(s)
- Troels K Bergmann
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark
| | - Mette Marie H Christensen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Hospital Pharmacy, Hospital of South West Denmark, Esbjerg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Daniel P Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maija Bruun Haastrup
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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9
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Henriksen DP, Bodtger U, Sidenius K, Maltbaek N, Pedersen L, Madsen H, Andersson EA, Norgaard O, Madsen LK, Chawes BL. Efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab anti-IL-5 treatments of severe asthma - a systematic review and meta-analysis. Eur Clin Respir J 2018; 5:1536097. [PMID: 30533206 PMCID: PMC6282428 DOI: 10.1080/20018525.2018.1536097] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/28/2018] [Accepted: 10/06/2018] [Indexed: 12/25/2022] Open
Abstract
Background: New, complex, and expensive therapies targeting Interleukin-5 (IL-5) to treat severe eosinophilic asthma are emerging. Objective: To assess efficacy, adverse events, and inter-drug comparison of mepolizumab and reslizumab for treating severe eosinophilic asthma. Design: A systematic review and meta-analysis on randomized, placebo-controlled, clinical trials elucidating two critical (exacerbation rate and oral corticosteroid (OCS) use) and six important clinical outcomes on the efficacy and safety of mepolizumab and reslizumab. Results: Five studies (N = 2197) contributed with data for exacerbation rate, showing a reduction of 53% (95% CI 46; 59) in favour of anti-IL-5, corresponding to -0.94 annual exacerbations (95% CI -1.08;-0.82), thus exceeding the predefined minimal clinical important difference (MCID) of 25% reduction of the estimated ≥2 annual exacerbations. Quality of evidence was considered moderate, with low heterogeneity in study findings (I2 = 0%). One study (N = 135) contributed with data on percentage of patients experiencing ≥50% reduction inoral corticosteroid treatment, showing an effect of 20% (95% CI 2.3;47) in favour of anti-IL-5 treatment (mepolizumab), thus exceeding the predefined MCID of 10%. Quality of evidence was considered low. Compared to placebo, anti-IL-5 showed significant improvements in lung function, asthma control, and asthma-related quality of life, but below the MCIDs. No differences were observed for serious adverse events and number of patients, who dropped out. No studies evaluating sickleave or head-to-head comparisons were identified. By indirect comparison, we found no significant difference between mepolizumab and reslizumab in any ofthe predefined clinical outcomes. OCS treatment reduction could not be compared due to lack of reslizumab studies investigating this outcome. Conclusions: Mepolizumab and reslizumab provide significant and clinically relevant improvements in exacerbation rate and OCS reduction. Indirect, inter-study comparisons revealed no differences between the anti-IL-5 drugs in efficacy or safety measures.
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Affiliation(s)
- Daniel P. Henriksen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark
| | | | - Niels Maltbaek
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Madsen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | | | - Ole Norgaard
- The Danish Medicines Council Secretariat, Copenhagen, Denmark
| | | | - Bo L. Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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10
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Andersen RM, Henriksen DP, Mafi HM, Langfeldt S, Budtz-Lilly J, Graumann O. A Long-Time Follow-Up Study of a Single-Center Endovascular Aneurysm Repair (Evar) Endoleak Outcomes. Vasc Endovascular Surg 2018; 52:505-511. [DOI: 10.1177/1538574418779667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The aim of this study was to evaluate the incidence, risk factors, and outcome of endoleaks related to endovascular aneurysm repair (EVAR) procedure at a single center with up to 10 years’ surveillance. Materials and Methods: All patients treated with EVAR for an abdominal aorta or iliac aneurysm in a 10-year period at a single cardiovascular center in Denmark were included. Data were collected from a national database and patient journals. Follow-up computed tomography angiography and plain abdominal X-ray reports were reviewed. Results: A total of 421 patients were included. There were 125 endoleaks observed in 117 (27.8%) patients after a median 95 days (interquartile range: 90-106 days). There were 16 type I, 107 type II, 1 type III, and 1 type V endoleaks. A total of 33 (7.8%) patients had at least 1 reintervention. Patients with type II endoleaks had significantly fewer active smokers and lower plasma creatinine at baseline. They also more often had one, or both, internal iliac arteries embolized as well as an identified endoleak at the procedural completion angiogram. Non-type II endoleaks were associated with internal iliac artery embolization. There was no association between the occurrence of endoleaks and increased mortality. Conclusion: Type II endoleaks are common after EVAR, yet few lead to reintervention. Absence of smoking, low plasma creatinine, embolized iliac arteries, and endoleak on completion angiogram were associated with type II endoleaks, whereas only embolized iliac arteries were associated with non-type II endoleaks. Overall, endoleaks are not associated with increased mortality.
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Affiliation(s)
- Rosa Marie Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel P. Henriksen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | - Sten Langfeldt
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
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11
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Farah RI, Damkier P, Christiansen A, Henriksen DP. Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study. Basic Clin Pharmacol Toxicol 2018; 123:78-83. [PMID: 29438596 DOI: 10.1111/bcpt.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
Montelukast, a leukotriene receptor antagonist, was marketed in 1998 as an oral supplementary treatment to patients with mild to moderate asthma. The aim of this study was to describe the early discontinuation pattern among montelukast users in Denmark in the period of 1 March 1998 to 31 December 2016, and to identify demographic characteristics possibly associated with early discontinuation. This nationwide drug utilization study was based on data collected from three nationwide Danish registers. All montelukast users who redeemed at least one prescription in the study period were identified. Early discontinuation was defined as failing to fill a second prescription for montelukast within at least a year after the initial montelukast prescription. Among 135,271 included montelukast users, 47,480 (35%) discontinued the use of montelukast after a single redeemed prescription. The trend in early discontinuation increased throughout the years. The most predominant demographic risk factors for early discontinuation were prescription for only nasal topical anti-allergic treatment up to a year prior to montelukast initiation [adjusted odds ratio (OR) 2.25; 95% confidence interval (CI) 2.13-2.38], as well as suspected off-label use (adjusted OR 2.02; 95% CI 1.97-2.08). Several risk factors were associated with a decreased risk of early discontinuation; most pronounced was a prescription of inhaled corticosteroids within a year up to montelukast initiation [adjusted OR 0.47 (95% CI 0.46-0.49)]. Early discontinuation was more pronounced after patent expiry in 2012 [adjusted OR 1.42 (95% CI 1.38-1.45)]. In conclusion, we found that early montelukast discontinuation increased during the last 19 years. Appropriateness of the treatment indication as estimated by concomitant prescription of adequate inhalation therapy was associated with a low risk of early discontinuation. A more pronounced early discontinuation was observed after patent expiry in 2012, which could reflect a more liberal approach to montelukast prescription.
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Affiliation(s)
- Rahmo I Farah
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Christiansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Daniel P Henriksen
- Department of Clinical Biochemistry & Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
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12
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Davidsen JR, Bendstrup E, Henriksen DP, Graumann O, Laursen CB. Lung ultrasound has limited diagnostic value in rare cystic lung diseases: a cross-sectional study. Eur Clin Respir J 2017; 4:1330111. [PMID: 28649310 PMCID: PMC5475293 DOI: 10.1080/20018525.2017.1330111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/08/2017] [Indexed: 01/30/2023] Open
Abstract
Background: Lung ultrasound (LUS) used to identify interstitial syndrome (IS) and pleural thickening related to diffuse parenchymal lung disease (DPLD) has shown significant correlations with ground glass opacity (GGO) on high-resolution computed tomography (HRCT). However, the applicability of LUS in patients with DPLD subtypes as rare cystic lung diseases has not previously been investigated. This study aimed to observe if distinctive LUS findings could be found in patients with lymphangioleiomyomatosis (LAM), pulmonary Langerhans cell histiocytosis (PLCH), and Birt-Hogg-Dubé syndrome (BHDS). Methods: This single centre case-based cross-sectional study of patients diagnosed with LAM, PCLH and BHDS was conducted at a Danish DPLD specialist centre. Patients underwent clinical examination including LUS. LUS findings were compared to findings scored according to a modified Belmaati score on HRCT and reviewed in consensus between two pulmonologists and one radiologist. Results: Twelve patients with HRCT proven cystic lung disease were included, six with LAM, three with PLCH, two with BHDS, and one with uncharacteristic cystic lung disease. The mean age was 48.7 years (SD ± 15.8). In general all had normal LUS findings. IS could not be found in any patients despite GGO presentation on HRCT among 75% of the patients with a Belmaati in the highest category of 0.76-1.00. Pleural thickening on LUS was present in three patients, but with inconsistent findings. Conclusion: This study indicates that LUS has limited value as a diagnostic tool in patients with LAM, PLCH, and BHDS as normal LUS findings did not rule out severe cystic lung disease.
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Affiliation(s)
- Jesper Rømhild Davidsen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
- Research Unit of Respiratory Medicine, Clinical Institute, University of Southern Denmark, Odense C, Denmark
- South Danish Center for Interstitial Lung Diseases (SCILS), Odense University Hospital, Odense C
| | - Elisabeth Bendstrup
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel P. Henriksen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
- Research Unit of Respiratory Medicine, Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense C, Denmark
- Center of Clinical Ultrasound (CECLUS), Aarhus University, Aarhus N, Denmark
| | - Christian B. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C, Denmark
- Research Unit of Respiratory Medicine, Clinical Institute, University of Southern Denmark, Odense C, Denmark
- Center for Thoracic Oncology, Odense University Hospital, Odense C, Denmark
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Henriksen DP, Havshøj U, Pedersen PB, Laursen CB, Jensen HK, Brabrand M, Lassen AT. Hospitalized acute patients with fever and severe infection have lower mortality than patients with hypo- or normothermia: a follow-up study. QJM 2016; 109:473-479. [PMID: 26961550 DOI: 10.1093/qjmed/hcw022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Severe infection is a frequent cause of admission to an acute medical unit (AMU). However, not all infected patients present with fever. The aim was to assess differences in 30-day mortality among patients hospitalized with community-acquired severe infection presenting with hypothermia, normothermia or fever. METHODS A retrospective single-center follow-up at an AMU from August 1, 2009 to August 31, 2011. Patients were included the first time they presented with severe infection within the study period. Temperature was categorized into hypothermia (<36.0ºC), normothermia (36.0ºC-38.0ºC) and fever (>38.0ºC). Severe infection was defined as a discharge diagnosis indicating infection combined with organ failure within the first 24 h after arrival. Multivariable Cox regression analysis was computed to assess the association between temperature and 30-day mortality. RESULTS A total of 2128 patients with severe infection were included. 3.0% (N = 64) were hypothermic, 57.1% (N = 1216) normothermic and 39.9% (N = 848) had fever at arrival. Crude 30-day mortality was 16.1% (N = 342, 95%CI 14.5-17.7%); 37.5% (N = 24, 95% CI 25.7-50.5%) for hypothermic patients, 18.3% (N = 223, 95%CI 16.2-20.6%) for normothermic patients and 11.2% (N = 95, 95%CI 9.2-13.5%) for patients with fever. Compared to normothermic patients, the adjusted hazard ratio of 30-day mortality among hypothermic patients was 1.62 (95%CI 1.06-2.49) and 0.74 (95%CI 0.58-0.94) among patients with fever. CONCLUSIONS Over half of the patients admitted to an AMU with severe infection were normothermic at arrival. Hypothermia was associated with an increased risk of short-term mortality, whereas patients with fever were associated with a lower risk compared to those with normothermia.
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Affiliation(s)
- D P Henriksen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - U Havshøj
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - P B Pedersen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - C B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - H K Jensen
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - M Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
| | - A T Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense C DK-5000, Denmark
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14
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Cooksley T, Nanayakkara PWB, Nickel CH, Subbe CP, Kellett J, Kidney R, Merten H, Van Galen L, Henriksen DP, Lassen AT, Brabrand M. Readmissions of medical patients: an external validation of two existing prediction scores. QJM 2016; 109:245-8. [PMID: 26163662 DOI: 10.1093/qjmed/hcv130] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital readmissions are increasingly used as a quality indicator with a belief that they are a marker of poor care and have led to financial penalties in UK and USA. Risk scoring systems, such as LACE and HOSPITAL, have been proposed as tools for identifying patients at high risk of readmission but have not been validated in international populations. AIM To perform an external independent validation of the HOSPITAL and LACE scores. DESIGN An unplanned secondary cohort study. METHODS Patients admitted to the medical admission unit at the Hospital of South West Jutland (10/2008-2/2009; 2/2010-5/2010) and the Odense University Hospital (6/2009-8/2011) were analysed. Validation of the scores using 30 day readmissions as the endpoint was performed. RESULTS A total of 19 277 patients fulfilled the inclusion criteria. Median age was 67 (range 18-107) years and 8977 (46.6%) were female. The LACE score had a discriminatory power of 0.648 with poor calibration and the HOSPITAL score had a discriminatory power of 0.661 with poor calibration. The HOSPITAL score was significantly better than the LACE score for identifying patients at risk of 30 day readmission (P < 0.001). The discriminatory power of both scores decreased with increasing age. CONCLUSION Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health care systems may prohibit the creation of a simple prediction tool that can be used internationally.
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Affiliation(s)
- T Cooksley
- From the Department of Acute Medicine, University Hospital of South Manchester, Manchester, UK,
| | | | | | | | | | - R Kidney
- St. James' Hospital, Dublin, Ireland and
| | - H Merten
- VU University Medical Center, Amsterdam, Netherlands
| | - L Van Galen
- VU University Medical Center, Amsterdam, Netherlands
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15
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Holler JG, Henriksen DP, Mikkelsen S, Pedersen C, Lassen AT. Increasing incidence of hypotension in the emergency department; a 12 year population-based cohort study. Scand J Trauma Resusc Emerg Med 2016; 24:20. [PMID: 26936190 PMCID: PMC4776382 DOI: 10.1186/s13049-016-0209-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 02/06/2016] [Indexed: 12/03/2022] Open
Abstract
Background The epidemiology of hypotension as presenting symptom among patients in the Emergency Department (ED) is not clarified. The aim of this study was to describe the incidence, etiology, and overall mortality of hypotensive patients in the ED. Methods Population-based cohort study at an University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Patients aged ≥18 years living in the hospital catchment area with a first time presentation to the ED with hypotension (systolic blood pressure (SBP) ≤100 mm Hg) were included. Outcomes were annual incidence rates (IRs) per 100,000 person years at risk (pyar) and etiological characteristics by means of the International Classification of Diseases, Tenth Revision (ICD-10), as well as 7-day, 30-day, and 90-day all-cause mortality. Results We identified 3,268 of 438,198 (1 %) cases with a mean overall IR of 125/100,000 pyar (95 % CI: 121–130). The IR increased 28 % during the period (from 113 to 152 cases per 100,000 pyar). Patients ≥65 years had the highest IR compared to age <65 years (rate ratio for men 6.3 (95 % CI: 5.6-7.1) and for women 4.2 (95 % CI: 3.6-4.9)). The etiology was highly diversified with trauma (17 %) and cardiovascular diseases (15 %) as the most common. The overall 7-day, 30-day and 90-day mortality rates were 15 % (95 % CI: 14–16), 22 % (95 % CI: 21–24) and 28 % (95 % CI: 27–30) respectively. Conclusion During 2000–2011 the overall incidence of ED hypotension increased and remained highest among the elderly with a diversified etiology and a 90-day all-cause mortality of 28 %.
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Affiliation(s)
- Jon G Holler
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
| | - Daniel P Henriksen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
| | - Søren Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark.
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
| | - Annmarie T Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark.
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Stage TB, Pottegård A, Henriksen DP, Christensen MMH, Højlund K, Brøsen K, Damkier P. Initiation of glucose-lowering treatment decreases international normalized ratio levels among users of vitamin K antagonists: a self-controlled register study. J Thromb Haemost 2016; 14:129-33. [PMID: 26559049 DOI: 10.1111/jth.13187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 07/29/2015] [Accepted: 11/01/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED ESSENTIALS: It is not known if initiation of glucose-lowering drugs alters the efficacy of vitamin K antagonists (VKA). We examined if glucose-lowering drugs affected international normalized ratio (INR) in VKA-treated patients. Upon initiating glucose-lowering drugs, 51% of patients had INR values below the therapeutic window. Monitoring of INR levels should be intensified upon initiation of glucose-lowering drugs. BACKGROUND It is not known whether initiation of antidiabetic treatment affects the effect of vitamin K antagonists (VKAs). It was previously shown that metformin affects the effect of one VKA, phenprocoumon. OBJECTIVES The aim of this study was to determine if initiation of glucose-lowering treatment affects the international normalized ratio (INR) and dose requirements of the anticoagulant VKAs warfarin and phenprocoumon. PATIENTS/METHODS We performed a self-controlled retrospective register-based study. A total of 118 patients commencing glucose-lowering treatment while being treated with warfarin or phenprocoumon were included in the study. We compared INR, dose/INR and proportion of patients with at least one sub-therapeutic INR measurement before and after initiation of glucose-lowering treatment. RESULTS Initiation of glucose-lowering treatment caused mean INR to decrease from 2.5 to 2.2 (decrease of -0.3 [95% CI: -0.1; -0.5]) and led to more than half of the patients having at least one sub-therapeutic INR measurement. Six to 12 weeks later, the VKA dose/INR was increased by 11%, indicating a weakened effect of the VKA. CONCLUSION Initiation of glucose-lowering treatment reduces the anticoagulant effect of VKAs to an extent that is likely to be clinically relevant. This finding needs confirmation and mechanistic explanation.
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Affiliation(s)
- T B Stage
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Pharmacometrics Group, Department of Biosciences, Uppsala University, Uppsala, Sweden
| | - A Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - D P Henriksen
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - M M H Christensen
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - K Højlund
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - K Brøsen
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - P Damkier
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Henriksen DP, Jensen HCK, Laursen CB, Lassen AT. Increased short-term mortality among normothermic patients presenting to a medical emergency department with infection - a cohort study. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511171 DOI: 10.1186/1757-7241-23-s1-a26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Brabrand M, Henriksen DP. Lack of diuresis four hours prior to admission is associated with increased mortality in acutely admitted medical patients. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511505 DOI: 10.1186/1757-7241-23-s1-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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19
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Henriksen DP, Laursen CB, Lassen AT. Patients hospitalized with severe infections and hypothermia, a cohort study of mortality and prognostic factors. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511395 DOI: 10.1186/1757-7241-23-s1-a27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Brabrand M, Henriksen DP. Acutely admitted medical patients have increasing one-year mortality with increasing age. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511175 DOI: 10.1186/1757-7241-23-s1-a36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Laursen CB, Sloth E, Lassen AT, Lambrechtsen J, Henriksen DP, Rasmussen F. Patient-rated level of discomfort during assessment with point-of-care ultrasonography. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511611 DOI: 10.1186/1757-7241-23-s1-a17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Henriksen DP, Laursen CB, Lassen AT. Risk of readmission following admission with community-acquired sepsis to a medical emergency department - a follow up study. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511577 DOI: 10.1186/1757-7241-23-s1-a28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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23
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Holler JG, Henriksen DP, Mikkelsen S, Pedersen C, Lassen A. Incidence and mortality of hypotension in the emergency department; an 12-year population based study. Scand J Trauma Resusc Emerg Med 2015. [PMCID: PMC4511614 DOI: 10.1186/1757-7241-23-s1-a22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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24
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Pottegård A, Henriksen DP, Madsen KG, Hellfritzsch M, Damkier P, Stage TB. Change in International Normalized Ratio Among Patients Treated With Dicloxacillin and Vitamin K Antagonists. JAMA 2015. [PMID: 26197191 DOI: 10.1001/jama.2015.6669] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology, University of Southern Denmark, Odense
| | - Daniel P Henriksen
- Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | | | | | - Per Damkier
- Clinical Pharmacology, University of Southern Denmark, Odense
| | - Tore B Stage
- Clinical Pharmacology, University of Southern Denmark, Odense
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25
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Nielsen AL, Henriksen DP, Marinakis C, Hellebek A, Birn H, Nybo M, Søndergaard J, Nymark A, Pedersen C. Drug dosing in patients with renal insufficiency in a hospital setting using electronic prescribing and automated reporting of estimated glomerular filtration rate. Basic Clin Pharmacol Toxicol 2014; 114:407-13. [PMID: 24373255 DOI: 10.1111/bcpt.12185] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/16/2013] [Indexed: 11/28/2022]
Abstract
In patients with impaired renal function, drug dose adjustment is often required. Non-adherence to clinical prescribing recommendations may result in severe adverse events. In previous studies, the prevalence rate of non-adherence to recommended dosing has been reported to be 19-67%. Using the clinical support system Renbase(®) as reference, we investigated the use and dosing of drugs in patients with impaired renal function in a university hospital setting using electronic prescription and automatic reporting of estimated glomerular filtration rate (eGFR). In all, 232 patients with an eGFR in the range of 10-49 ml/min./1.73 m(2) were included. We identified 436 episodes with administration of renal risk drugs (prescribed to 183 patients): 410 drugs required dose adjustment according to the eGFR and 26 should be avoided. In total, the use or dosing of 66 (15%) of the 436 renal risk drugs was not in agreement with recommendations in Renbase(®) . This reflects less disagreement with expert guidelines than reported previously, indicating a possible beneficial effect of electronic prescribing and reporting of eGFR. However, we also found that disagreement to some extent reflected inappropriate drug use. We conclude that despite implementation of electronic prescribing and automated reporting of eGFR, patients with renal insufficiency may still be exposed to inappropriate drug use, with potential increased risk of adverse effects. Initiatives to reduce medication errors such as the use of electronic decision support systems should be explored.
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Affiliation(s)
- Anita L Nielsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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