Association Between Exposure of Ipratropium and Salmeterol and Diagnosis of Multiple Sclerosis: A Matched Case-control Study

PURPOSE

Ipratropium and salmeterol were found to stimulate oligodendrocyte differentiation in a high-throughput drug screening assay; thus, they may play a role in the risk reduction of multiple sclerosis (MS). So far, they have not been examined in any clinical data. This study aims at investigating the association between ipratropium and salmeterol and reduced diagnosis of MS with the use of real-world clinical data.

METHODS

We conducted a 1:10 matched case-control study that compared the exposure of ipratropium and salmeterol between patients with MS and control patients over the past 2 years, using the MS Flowsheet Registry of OSF HealthCare Saint Francis Medical Center. Cases were matched to control patients, based on service year/quarter, age, sex, race, and payer type. The relationship was examined with a Poisson regression model and a generalized structural equation model.

FINDINGS

The sample in our analysis included 217 patients with MS and 2164 matched control patients. The mean (SD) age for both patients with MS and control patients was 41 (11.8) years with a range of 18 to 75 years. The MS group had consistently less prescriptions of ipratropium and salmeterol than the control group in the past 1, 2, and 3 years before the index date. Our multivariable analysis found that the control group had 3.2 more prescriptions (95% CI, 1.4-7.1; P = 0.006) of either ipratropium or salmeterol in the past 2 years than the MS group, even if controlling for other confounders. In the generalized structural equation model, we found that use of ipratropium and salmeterol was significantly associated with reduced diagnosis of MS (P = 0.036), whereas smokers and people with family history of MS were more likely to have a diagnosis of MS (P < 0.001).

IMPLICATIONS

The observed association between ipratropium and salmeterol use and reduced diagnosis of MS indicates that they might potentially serve as agents in the treatment of MS.

Evaluation of Intraoperative, Local Site Injections of Liposomal Bupivacaine as an Alternative to Standard Local Anesthetics in Patients Undergoing Total Hip Arthroplasty

Background: Achieving postsurgical pain control after total hip arthroplasty (THA) is a critical factor for successful recovery because inadequately treated pain may lead to a delay in ambulation and hospital discharge and have an adverse impact on a patient's quality of life. Objective: This study compares the effectiveness of immediate-release local anesthetics for pain control in THA vs liposomal bupivacaine (LB) related to patient outcomes and costs of care. Methods: This is a retrospective cohort study of consecutive patients undergoing THA at 3 hospitals from January 2013 to July 2016. The control group received plain bupivacaine or ropivacaine while the study group received LB. Generalized linear models were used controlling for several patient factors. Primary measures included length of stay (LOS), hospitalization costs, pain relief, opioid use, and mobility. Secondary outcomes were discharge disposition and 30-, 60-, and 90-day readmissions. Results: One hundred and ninety-six patients were identified, with 103 as controls, 70 receiving LB, and 23 excluded. The LB group showed a decrease in LOS of 0.5 days (2.5 ± 2.6 vs 3.0 ± 2.1 days, P = .010), increased mobility on the day of surgery (27.6 ± 49.3 vs 12.5 ± 48.5 feet, P = .001) and the first day after surgery (186.8 ± 133.8 vs 155.2 ± 135.6, P = .039), and decreased hospital costs ($10 670 vs $11 351, P = .022). There were no significant differences in pain scores, opioid use, adverse events, discharge disposition, or readmissions. Study limitations include retrospective analysis, unblinded participants, and generalizability of results. Conclusions: LB provides an effective alternative to standard local anesthetics in patients undergoing THA based on improvements of inpatient parameters, LOS, and cost measures.

Regional pharmacokinetics educational program

An educational program for hospital pharmacists in and near Vermont is described and its impact on departmental clinical practice evaluated. Pharmacists were instructed by practitioners from a single institution in basic pharmacokinetics, practice guidelines for aminoglycoside therapy, and use of a computer program for aminoglycoside dosage determination. Participants completed a multiple-choice precourse test, a similar postcourse test, and a third test six months after class completion. Test scores were compared with those from a control group of pharmacists. Pharmacy directors from study group hospitals completed questionnaires measuring aminoglycoside clinical services before and six months after the program. Compared with the control group, participants scored higher on the postcourse tests. Results from the questionnaire indicate that the program affected clinical practice in almost all participating pharmacy departments. A consistent pharmacokinetic strategy for reviewing aminoglycoside dosages and evaluating serum aminoglycoside concentrations is now practiced in most Vermont hospitals. An educational program originating in one hospital can expand pharmacists' knowledge and influence departmental clinical practice throughout a region.

Factors associated with creatinine clearance changes following gentamicin therapy

The relationship between creatinine clearance changes during gentamicin therapy and several patient and therapeutic variables was studied in a prospective, multicenter trial. Adult patients in three hospitals who were receiving gentamicin in doses based on lean body weight and creatinine clearance were studied. Pre- and post-therapy serum creatinine measurements were obtained for 62 patients (Group 1); only 45 of the patients had both pre- and post-therapy creatinine clearance measurements (Group 2). Other data collected for correlation with creatinine clearance changes were: body temperature, age, sex, blood pressure, albumin level, previous and concomitant therapy with nephrotoxic drugs, hematocrit, peak and trough gentamicin levels, and duration of therapy. In Group 2 patients, only peak gentamicin level, concomitant therapy, sex, and previous furosemide therapy correlated significantly (p less than or equal to 0.05) with change in creatinine clearance during gentamicin therapy. The first two variables decreased creatinine clearance, the last variable increased creatinine clearance, and women tended to have more of a decrease in clearance than did men. Sex, peak gentamicin level, prior furosemide therapy and concomitant cephalothin therapy explain about 50% of the renal function changes during gentamicin therapy, and should be considered in monitoring gentamicin therapy.