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Chan AYL, Gao L, Hsieh MHC, Kjerpeseth LJ, Avelar R, Banaschewski T, Chan AHY, Coghill D, Cohen JM, Gissler M, Harrison J, Ip P, Karlstad Ø, Lau WCY, Leinonen MK, Leung WC, Liao TC, Reutfors J, Shao SC, Simonoff E, Tan KCB, Taxis K, Tomlin A, Cesta CE, Lai ECC, Zoega H, Man KKC, Wong ICK. Maternal diabetes and risk of attention-deficit/hyperactivity disorder in offspring in a multinational cohort of 3.6 million mother-child pairs. Nat Med 2024:10.1038/s41591-024-02917-8. [PMID: 38589601 DOI: 10.1038/s41591-024-02917-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024]
Abstract
Previous studies report an association between maternal diabetes mellitus (MDM) and attention-deficit/hyperactivity disorder (ADHD), often overlooking unmeasured confounders such as shared genetics and environmental factors. We therefore conducted a multinational cohort study with linked mother-child pairs data in Hong Kong, New Zealand, Taiwan, Finland, Iceland, Norway and Sweden to evaluate associations between different MDM (any MDM, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM)) and ADHD using Cox proportional hazards regression. We included over 3.6 million mother-child pairs between 2001 and 2014 with follow-up until 2020. Children who were born to mothers with any type of diabetes during pregnancy had a higher risk of ADHD than unexposed children (pooled hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.08-1.24). Higher risks of ADHD were also observed for both GDM (pooled HR = 1.10, 95% CI = 1.04-1.17) and PGDM (pooled HR = 1.39, 95% CI = 1.25-1.55). However, siblings with discordant exposure to GDM in pregnancy had similar risks of ADHD (pooled HR = 1.05, 95% CI = 0.94-1.17), suggesting potential confounding by unmeasured, shared familial factors. Our findings indicate that there is a small-to-moderate association between MDM and ADHD, whereas the association between GDM and ADHD is unlikely to be causal. This finding contrast with previous studies, which reported substantially higher risk estimates, and underscores the need to reevaluate the precise roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.
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Affiliation(s)
- Adrienne Y L Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Miyuki Hsing-Chun Hsieh
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Lars J Kjerpeseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Raquel Avelar
- Institute of Biological Psychiatry, Mental Health Centre Sct Hans, Mental Health Services, Copenhagen, Denmark
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Maarit K Leinonen
- Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Wing Cheong Leung
- Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kathryn Choon Beng Tan
- Department of Medicine, School of Clinical Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Andrew Tomlin
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Solna, Sweden.
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong.
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong.
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Pak Shek Kok, Hong Kong.
- School of Pharmacy, Medical Sciences Division, Macau University of Science and Technology, Taipa, Macau.
- Advance Data Analytics for Medical Science Limited, Hong Kong, Hong Kong.
- School of Pharmacy, Aston University, Birmingham, UK.
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Chai Y, Man KKC, Luo H, Torre CO, Wing YK, Hayes JF, Osborn DPJ, Chang WC, Lin X, Yin C, Chan EW, Lam ICH, Fortin S, Kern DM, Lee DY, Park RW, Jang JW, Li J, Seager S, Lau WCY, Wong ICK. Incidence of mental health diagnoses during the COVID-19 pandemic: a multinational network study. Epidemiol Psychiatr Sci 2024; 33:e9. [PMID: 38433286 PMCID: PMC10940053 DOI: 10.1017/s2045796024000088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/27/2023] [Accepted: 01/20/2024] [Indexed: 03/05/2024] Open
Abstract
AIMS Population-wide restrictions during the COVID-19 pandemic may create barriers to mental health diagnosis. This study aims to examine changes in the number of incident cases and the incidence rates of mental health diagnoses during the COVID-19 pandemic. METHODS By using electronic health records from France, Germany, Italy, South Korea and the UK and claims data from the US, this study conducted interrupted time-series analyses to compare the monthly incident cases and the incidence of depressive disorders, anxiety disorders, alcohol misuse or dependence, substance misuse or dependence, bipolar disorders, personality disorders and psychoses diagnoses before (January 2017 to February 2020) and after (April 2020 to the latest available date of each database [up to November 2021]) the introduction of COVID-related restrictions. RESULTS A total of 629,712,954 individuals were enrolled across nine databases. Following the introduction of restrictions, an immediate decline was observed in the number of incident cases of all mental health diagnoses in the US (rate ratios (RRs) ranged from 0.005 to 0.677) and in the incidence of all conditions in France, Germany, Italy and the US (RRs ranged from 0.002 to 0.422). In the UK, significant reductions were only observed in common mental illnesses. The number of incident cases and the incidence began to return to or exceed pre-pandemic levels in most countries from mid-2020 through 2021. CONCLUSIONS Healthcare providers should be prepared to deliver service adaptations to mitigate burdens directly or indirectly caused by delays in the diagnosis and treatment of mental health conditions.
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Affiliation(s)
- Yi Chai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
| | - Hao Luo
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
| | - Carmen Olga Torre
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Real World Data Sciences, Roche, Welwyn Garden City, UK
- School of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - David P. J. Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Xiaoyu Lin
- Real-World Solutions, IQVIA, Durham, NC, USA
| | - Can Yin
- Real-World Solutions, IQVIA, Durham, NC, USA
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, Guangdong, China
| | - Ivan C. H. Lam
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Stephen Fortin
- Observation Health Data Analytics, Janssen Research & Development, Titusville, NJ, USA
| | - David M. Kern
- Department of Epidemiology, Janssen Research & Development, Titusville, NJ, USA
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Jing Li
- Real-World Solutions, IQVIA, Durham, NC, USA
| | | | - Wallis C. Y. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Häge A, Man KKC, Inglis SK, Buitelaar J, Carucci S, Danckaerts M, Dittmann RW, Falissard B, Garas P, Hollis C, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Zuddas A, Wong ICK, Coghill D, Banaschewski T. Methylphenidate and Sleep Difficulties in Children and Adolescents With ADHD: Results From the 2-Year Naturalistic Pharmacovigilance ADDUCE Study. J Atten Disord 2024; 28:699-707. [PMID: 38389266 DOI: 10.1177/10870547241232337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Short-term RCTs have demonstrated that MPH-treatment significantly reduces ADHD-symptoms, but is also associated with adverse events, including sleep problems. However, data on long-term effects of MPH on sleep remain limited. METHODS We performed a 2-year naturalistic prospective pharmacovigilance multicentre study. Participants were recruited into three groups: ADHD patients intending to start MPH-treatment (MPH-group), those not intending to use ADHD-medication (no-MPH-group), and a non-ADHD control-group. Sleep problems were assessed with the Children's-Sleep-Habits-Questionnaire (CSHQ). RESULTS 1,410 participants were enrolled. Baseline mean CSHQ-total-sleep-scores could be considered clinically significant for the MPH-group and the no-MPH-group, but not for controls. The only group to show a significant increase in any aspect of sleep from baseline to 24-months was the control-group. Comparing the MPH- to the no-MPH-group no differences in total-sleep-score changes were found. CONCLUSION Our findings support that sleep-problems are common in ADHD, but don't suggest significant negative long-term effects of MPH on sleep.
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Affiliation(s)
| | - Kenneth K C Man
- University College London, UK
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, Hong Kong
| | | | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Sara Carucci
- University of Cagliari and "A.Cao" Paediatric Hospital, Italy
| | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital and Bethesda Children's Hospital, Budapest, Hungary
| | | | | | | | - Ian C K Wong
- The University of Hong Kong, Hong Kong
- Aston University, Birmingham, UK
| | - David Coghill
- University of Dundee, Scotland
- University of Melbourne, Australia
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Carucci S, Zuddas A, Lampis A, Man KKC, Balia C, Buitelaar J, Danckaerts M, Dittmann RW, Donno F, Falissard B, Gagliano A, Garas P, Häge A, Hollis C, Inglis SK, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Wong ICK, Banaschewski T, Coghill D. The Impact of Methylphenidate on Pubertal Maturation and Bone Age in ADHD Children and Adolescents: Results from the ADHD Drugs Use Chronic Effects (ADDUCE) Project. J Atten Disord 2024; 28:722-739. [PMID: 38366816 DOI: 10.1177/10870547241226726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The short-term safety of methylphenidate (MPH) has been widely demonstrated; however the long-term safety is less clear. The aim of this study was to investigate the safety of MPH in relation to pubertal maturation and to explore the monitoring of bone age. METHOD Participants from ADDUCE, a two-year observational longitudinal study with three parallel cohorts (MPH group, no-MPH group, and a non-ADHD control group), were compared with respect to Tanner staging. An Italian subsample of medicated-ADHD was further assessed by the monitoring of bone age. RESULTS The medicated and unmedicated ADHD groups did not differ in Tanner stages indicating no higher risk of sexual maturational delay in the MPH-treated patients. The medicated subsample monitored for bone age showed a slight acceleration of the bone maturation after 24 months, however their predicted adult height remained stable. CONCLUSION Our results do not suggest safety concerns on long-term treatment with MPH in relation to pubertal maturation and growth.
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Affiliation(s)
- Sara Carucci
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | | | | | - Kenneth K C Man
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
| | - Carla Balia
- University of Cagliari, Italy
- ASL Cagliari, Italy
| | - Jan Buitelaar
- Donders Institute for Brain, Cognition and Behavior, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | - Kerstin Konrad
- University Hospital RWTH Aachen, Germany
- RWTH Aachen and Research Centre Jülich, Germany
| | | | | | | | | | - Peter Nagy
- Bethesda Children's Hospital, Budapest, Hungary
| | | | | | - Ian C K Wong
- University College London, UK
- Hong Kong Science Park, China
- University College London Hospitals NHS Foundation Trust, UK
- The University of Hong Kong, China
- Aston University, Birmingham, UK
| | | | - David Coghill
- University of Dundee, UK
- University of Melbourne, VIC, Australia
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Ju C, Lau WCY, Chambers P, Man KKC, Forster MD, Mackenzie IS, Manisty C, Wei L. Effect of statin treatment on the risk of cancer in patients with heart failure: A target trial emulation study. Pharmacoepidemiol Drug Saf 2024; 33:e5775. [PMID: 38450806 DOI: 10.1002/pds.5775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/01/2023] [Accepted: 02/15/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE A recent observational study suggested statins could reduce cancer diagnosis in patients with heart failure (HF). The findings need to be validated using robust epidemiological methods. This study aimed to evaluate the effect of statin treatment on the risk of cancer in patients with HF. METHODS We conducted two target trial emulations using primary care data from IQVIA Medical Research Database-UK (2000 to 2019) with a clone-censor-weight design. The first emulated trial addressed the treatment initiation effect: initiating within 1 year versus not initiating a statin after the HF diagnosis. The second emulated trial addressed the cumulative exposure effect: continuing a statin for ≤3 years, 3-6 years, and >6 years after initiation. The study outcomes were any incident cancer and site-specific cancer diagnoses. Weighted pooled logistic regression models were used to estimate 10-year risk ratios (RR). 95% confidence intervals (CIs) were estimated using non-parametric bootstrapping. RESULTS The first emulated trial showed that, compared to no statin, statins did not reduce the cancer risk in patients with HF (RR, 1.05; 95% CI, 0.94-1.15). The second emulated trial showed that, compared to treatment ≤3 years, statins with longer durations did not reduce the cancer risk (3-6 years: RR, 0.94; 95% CI, 0.70-1.33. >6 years: RR, 0.97; 95% CI, 0.79-1.26). No significant risk difference was observed on any site-specific cancer diagnoses. CONCLUSIONS The results from the target trial emulations suggest that statin treatment is not associated with cancer risk in patients with HF.
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Affiliation(s)
- Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Pinkie Chambers
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Pharmacy Department, University College London Hospital NHS Trust, London, UK
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charlotte Manisty
- Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, SAR, China
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Lui DTW, Wong CKH, Man KKC. Letter to the Editor From Lui et al: "Increased Risk of Thyroid Eye Disease Following COVID-19 Vaccination". J Clin Endocrinol Metab 2024; 109:e1315. [PMID: 37847156 DOI: 10.1210/clinem/dgad614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/18/2023] [Accepted: 10/12/2023] [Indexed: 10/18/2023]
Affiliation(s)
- David Tak Wai Lui
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Carlos King Ho Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacy and Pharmacology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacy and Pharmacology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, UCL School of Pharmacy, London WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London NW1 2PB, UK
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Tsai DHT, Bell JS, Abtahi S, Baak BN, Bazelier MT, Brauer R, Chan AYL, Chan EW, Chen H, Chui CSL, Cook S, Crystal S, Gandhi P, Hartikainen S, Ho FK, Hsu ST, Ilomäki J, Kim JH, Klungel OH, Koponen M, Lau WCY, Lau KK, Lum TYS, Luo H, Man KKC, Pell JP, Setoguchi S, Shao SC, Shen CY, Shin JY, Souverein PC, Tolppanen AM, Wei L, Wong ICK, Lai ECC. Cross-Regional Data Initiative for the Assessment and Development of Treatment for Neurological and Mental Disorders. Clin Epidemiol 2023; 15:1241-1252. [PMID: 38146486 PMCID: PMC10749544 DOI: 10.2147/clep.s426485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/04/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose To describe and categorize detailed components of databases in the Neurological and Mental Health Global Epidemiology Network (NeuroGEN). Methods An online 132-item questionnaire was sent to key researchers and data custodians of NeuroGEN in North America, Europe, Asia and Oceania. From the responses, we assessed data characteristics including population coverage, data follow-up, clinical information, validity of diagnoses, medication use and data latency. We also evaluated the possibility of conversion into a common data model (CDM) to implement a federated network approach. Moreover, we used radar charts to visualize the data capacity assessments, based on different perspectives. Results The results indicated that the 15 databases covered approximately 320 million individuals, included in 7 nationwide claims databases from Australia, Finland, South Korea, Taiwan and the US, 6 population-based electronic health record databases from Hong Kong, Scotland, Taiwan, the Netherlands and the UK, and 2 biomedical databases from Taiwan and the UK. Conclusion The 15 databases showed good potential for a federated network approach using a common data model. Our study provided publicly accessible information on these databases for those seeking to employ real-world data to facilitate current assessment and future development of treatments for neurological and mental disorders.
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Affiliation(s)
- Daniel Hsiang-Te Tsai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Centre for Neonatal and Paediatric Infection, St George’s University of London, London, UK
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Brenda N Baak
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Marloes T Bazelier
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Adrienne Y L Chan
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, ‐Epidemiology and ‐Economics, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Esther W Chan
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Department of Pharmacy, the University of Hong Kong-Shenzhen Hospital, Shenzhen, People’s Republic of China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, People’s Republic of China
| | - Haoqian Chen
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Sharon Cook
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Stephen Crystal
- Center for Health Services Research, Rutgers University, New Brunswick, NJ, USA
| | - Poonam Gandhi
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Shao-Ti Hsu
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Terry Y S Lum
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Hao Luo
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Soko Setoguchi
- Center for Pharmacoepidemiology and Treatment Science (PETS), Institute for Health, Rutgers University, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School and Pharmacoepidemiology and Treatments Science, Institute for Health, Rutgers University, New Brunswick, NJ, USA
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Yao Shen
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Seoul, South Korea
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Special Administrative Region, People’s Republic of China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science Park, Hong Kong, Special Administrative Region, People’s Republic of China
- Aston Pharmacy School, Aston University, Birmingham, UK
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Gillespie IA, Barnes E, Wong ICK, Matthews PC, Cooke GS, Tipple C, Elston RC, Liu Y, Smith DA, Wang T, Davies J, Várnai KA, Freeman O, Man KKC, Lau WCY, Glampson B, Meng X, Morais E, Liu S, Mercuri L, Boxall N, Jenner S, Kendrick S, Dong J, Theodore D. Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies. Infect Dis Ther 2023; 12:2513-2532. [PMID: 37432642 PMCID: PMC10651815 DOI: 10.1007/s40121-023-00824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION Chronic hepatitis B virus (HBV) infection is associated with significant global morbidity and mortality. Low treatment rates are observed in patients living with HBV; the reasons for this are unclear. This study sought to describe patients' demographic, clinical and biochemical characteristics across three continents and their associated treatment need. METHODS This retrospective cross-sectional post hoc analysis of real-world data used four large electronic databases from the United States, United Kingdom and China (specifically Hong Kong and Fuzhou). Patients were identified by first evidence of chronic HBV infection in a given year (their index date) and characterized. An algorithm was designed and applied, wherein patients were categorized as treated, untreated but indicated for treatment and untreated and not indicated for treatment based on treatment status and demographic, clinical, biochemical and virological characteristics (age; evidence of fibrosis/cirrhosis; alanine aminotransferase [ALT] levels, HCV/HIV coinfection and HBV virology markers). RESULTS In total, 12,614 US patients, 503 UK patients, 34,135 patients from Hong Kong and 21,614 from Fuzhou were included. Adults (99.4%) and males (59.0%) predominated. Overall, 34.5% of patients were treated at index (range 15.9-49.6%), with nucleos(t)ide analogue monotherapy most commonly prescribed. The proportion of untreated-but-indicated patients ranged from 12.9% in Hong Kong to 18.2% in the UK; almost two-thirds of these patients (range 61.3-66.7%) had evidence of fibrosis/cirrhosis. A quarter (25.3%) of untreated-but-indicated patients were aged ≥ 65 years. CONCLUSION This large real-world dataset demonstrates that chronic hepatitis B infection remains a global health concern; despite the availability of effective suppressive therapy, a considerable proportion of predominantly adult patients apparently indicated for treatment are currently untreated, including many patients with fibrosis/cirrhosis. Causes of disparity in treatment status warrant further investigation.
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Affiliation(s)
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
- University College London, Gower St, London, WC1E 6BT, UK
| | - Graham S Cooke
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Craig Tipple
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Robert C Elston
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Yunhao Liu
- GSK, 1250 S Collegeville Rd, Collegeville, PA, 19426, USA
| | - David A Smith
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, 7 Parks Rd, Oxford, OX1 3QG, UK
| | - Kinga A Várnai
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Oliver Freeman
- Nuffield Department of Population Health, University of Oxford, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Ben Glampson
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Xing Meng
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | | | - Sen Liu
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | - Luca Mercuri
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Naomi Boxall
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Sarah Jenner
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Stuart Kendrick
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Jane Dong
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
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Gillespie IA, Barnes E, Wong ICK, Matthews PC, Cooke GS, Tipple C, Elston RC, Liu Y, Smith DA, Wang T, Davies J, Várnai KA, Freeman O, Man KKC, Lau WCY, Glampson B, Meng X, Morais E, Liu S, Mercuri L, Boxall N, Jenner S, Kendrick S, Dong J, Theodore D. Correction to: Patient Biochemistry and Treatment Need in Chronic Hepatitis B Virus Infection Across Three Continents: Retrospective Cross-Sectional Cohort Studies. Infect Dis Ther 2023; 12:2533-2534. [PMID: 37759129 PMCID: PMC10651586 DOI: 10.1007/s40121-023-00857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Affiliation(s)
| | - Eleanor Barnes
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Philippa C Matthews
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
- The Francis Crick Institute, 1 Midland Road, London, NW1 1AT, UK
- University College London, Gower St, London, WC1E 6BT, UK
| | - Graham S Cooke
- Faculty of Medicine, Department of Infectious Disease, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Craig Tipple
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Robert C Elston
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Yunhao Liu
- GSK, 1250 S Collegeville Rd, Collegeville, PA, 19426, USA
| | - David A Smith
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Old Road, Oxford, OX3 7BN, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, 7 Parks Rd, Oxford, OX1 3QG, UK
| | - Kinga A Várnai
- NIHR Health Informatics Collaborative, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Oliver Freeman
- Nuffield Department of Population Health, University of Oxford, University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - Ben Glampson
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Xing Meng
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | | | - Sen Liu
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
| | - Luca Mercuri
- NIHR Health Informatics Collaborative, Imperial College Healthcare NHS Trust, The Bays, S Wharf Rd, London, W2 1NY, UK
| | - Naomi Boxall
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Sarah Jenner
- IQVIA, The Point, 37 N Wharf Rd, London, W2 1AF, UK
| | - Stuart Kendrick
- GSK, Gunnels Wood Road, Stevenage, SG1 2NY, Hertfordshire, UK
| | - Jane Dong
- GSK Institute for Infectious Diseases and Public Health, 11F, Bldg 2, Shuangqing Plaza, No. 77, Shuangqing Road, Beijing, China
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Ge GM, Man KKC, Cheung ECL, Ip P, Leung WC, Kung AWC, Cheung CL, Wong ICK. Levothyroxine Treatment Among Pregnant Women and Risk of Seizure in Children: A Population-Based Cohort Study. Drug Saf 2023; 46:1149-1159. [PMID: 37843760 DOI: 10.1007/s40264-023-01352-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION AND OBJECTIVE The risk of seizure in offspring following prenatal exposure to levothyroxine is not well investigated. This study aimed to evaluate the association between levothyroxine treatment among pregnant women and the risk of seizure in their offspring. METHODS This population-based cohort study included all pregnant women who delivered a live birth between January 2001 to January 2018, with a follow-up to December 2020, using data from the Hong Kong Clinical Data Analysis and Reporting System. Propensity score fine-stratification weighted hazard ratios (wHR) with 95% confidence intervals (CIs) were presented to assess the association between maternal levothyroxine use during pregnancy and seizures in children. RESULTS Among 528,343 included mother-child pairs, 3044 children were prenatally exposed to levothyroxine at any time during the pregnancy period. A significantly increased risk of seizure was observed in children of the prenatally exposed group compared with the prenatally unexposed group (wHR 1.12, 95% CI 1.02-1.22). An increased risk of seizure was observed when comparing the prenatally exposed group with euthyroid mothers who had no history of thyroid-related diagnosis or prescriptions (wHR 1.12, 95% CI 1.02-1.23). However, no significant difference was observed between the prenatally exposed group and those previously exposed to levothyroxine but had stopped during pregnancy (wHR 0.97, 95% CI 0.66-1.44). No significant difference was observed in the sibling-matched analysis either (wHR 1.23, 95% CI 0.76-2.01). CONCLUSION The observed increased risk of seizure in children born from mothers exposed to levothyroxine during pregnancy might be due to residual confounding by maternal thyroid disease. The findings support the current guidelines on the safe use of levothyroxine treatment during pregnancy.
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Affiliation(s)
- Grace Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L02-57, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L02-57, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
- Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK
| | - Edmund C L Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L02-57, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Cheong Leung
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Annie W C Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L02-57, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L02-57, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong.
- Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK.
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
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Park S, Jeong HE, Bea S, Yu OHY, Cho YM, You SC, Man KKC, Shin JY. Safety of sodium-glucose co-transporter-2 inhibitors on amputation across categories of baseline cardiovascular disease and diuretics use in patients with type 2 diabetes. Diabetes Obes Metab 2023; 25:3248-3258. [PMID: 37503763 DOI: 10.1111/dom.15221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/29/2023]
Abstract
AIM To assess the risk of amputation associated with sodium-glucose co-transporter-2 inhibitors (SGLT2is) among patients with type 2 diabetes, across categories of baseline cardiovascular disease (CVD) and diuretic use (DU). MATERIALS AND METHODS We conducted an active comparator, new-user cohort study using Korea's nationwide claims data (2015-2020). The study cohort consisted of patients with type 2 diabetes who initiated SGLT2is or dipeptidyl peptidase-4 inhibitors (DPP4is). Cohort entry was defined by first prescription date. We then classified patients into four discrete subcohorts based on their baseline status of CVD and DU as (1) CVD+/DU+, (2) CVD+/DU-, (3) CVD-/DU+ and (4) CVD-/DU-. We performed 1:1 propensity score (PS) matching within each cohort and estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of amputation with SGLT2is versus DPP4is using Cox models. RESULTS We identified 219 900 PS-matched pairs of SGLT2is and DPP4is (CVD+/DU+, n = 11 719; CVD+/DU-, n = 26 092; CVD-/DU+, n = 26 894; and CVD-/DU-, n = 155 195), with well-balanced baseline covariates across all cohorts. Significantly lower risks of amputation with SGLT2is versus DPP4is were found in CVD+/DU+ (HR 0.36, 95% CI 0.14-0.90), CVD+/DU- (0.45, 0.21-0.99) and CVD-/DU- (0.48, 0.33-0.70), but not in CVD-/DU+ (0.54, 0.26-1.12). Consistent trends in estimates were found across various sensitivity analyses. CONCLUSIONS Initiating SGLT2is against DPP4is did not increase the risk of amputation across patient populations of varying vulnerability. These findings based on routine practice will reassure clinicians of the safety of SGLT2is with regard to amputation risk in selected high-risk patients with type 2 diabetes.
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Affiliation(s)
- Sohee Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Sungho Bea
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Oriana H Y Yu
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
- Division of Endocrinology and Metabolism, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Young Min Cho
- Department of Internal Medicine Seoul National University College of Medicine, Seoul, South Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Institute on Aging, Seoul National University, Seoul, South Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Wong KHTW, Lau WCY, Man KKC, Bilbow A, Ip P, Wei L. Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study. J Med Internet Res 2023; 25:e46190. [PMID: 37847536 PMCID: PMC10618879 DOI: 10.2196/46190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored. OBJECTIVE This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom. METHODS We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term "parent" or "caregiver" in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child. RESULTS Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods. CONCLUSIONS Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572.
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Affiliation(s)
- Kirstie H T W Wong
- Research Department of Practice and Policy, University College London, London, United Kingdom
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wallis C Y Lau
- Research Department of Practice and Policy, University College London, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China (Hong Kong)
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China (Hong Kong)
| | - Kenneth K C Man
- Research Department of Practice and Policy, University College London, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China (Hong Kong)
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China (Hong Kong)
| | - Andrea Bilbow
- National Attention Deficit Disorder Information and Support Services, London, United Kingdom
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Li Wei
- Research Department of Practice and Policy, University College London, London, United Kingdom
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13
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Ma TT, Wang Z, Qin X, Ju C, Lau WCY, Man KKC, Castle D, Chung Chang W, Chan AYL, Cheung ECL, Chui CSL, Wong ICK. Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008 to 2018: a sales data analysis. Sleep 2023; 46:zsad124. [PMID: 37094086 DOI: 10.1093/sleep/zsad124] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/16/2023] [Indexed: 04/26/2023] Open
Abstract
STUDY OBJECTIVES To investigate the trends in the consumption of benzodiazepines (BZDs) and Z-drugs at global, regional, and national levels from 2008 to 2018, across 67 countries and regions. METHODS This cross-sectional descriptive study investigated the consumption of BZDs and Z-drugs analyzed by global pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System database between 2008 and 2018. Consumption was measured in defined daily dose (DDD) per 1000 inhabitants per day (DDD/TID). The global, regional, and national trends were estimated using linear mixed models. Additional analyses were conducted by grouping countries by income level. The association between consumption and Gross Domestic Product (GDP) and the prevalence of different medical conditions was explored in univariable linear models. RESULTS BZD consumption decreased annually by -1.88% (95% CI: -2.27%, -1.48%), and Z-drugs increased by + 3.28% (+2.55%, +4.01%). In 2008, the top ten countries for BZD and Z-drug consumption were all European, ranging from 63.69 to 128.24 DDD/TID. Very low levels were found in Russia, Kuwait, United Arab Emirates, Saudi Arabia, French West Africa, and the Philippines, with DDD/TID < 1. The consumption in high-income countries was much higher than in middle-income countries. The results showed that increased consumption of BZDs and Z-drugs was statistically associated (p < 0.05) with higher GDP and increased prevalence of anxiety, self-harm, neurological disorders, chronic respiratory diseases, cardiovascular diseases, and cancers. CONCLUSIONS Distinct differences in consumption and trends of BZDs and Z-drugs were found across different countries and regions. Further exploration is needed to understand the association and safety of the use of BZDs and Z-drugs in patients with comorbidities.
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Affiliation(s)
- Tian-Tian Ma
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Zixuan Wang
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Xiwen Qin
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Wallis C Y Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Castle
- Department of Psychiatry, University of Toronto, Canada
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- State Key Laboratory in Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China
| | - Adrienne Y L Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Unit of Pharmacotherapy Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Edmund C L Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong, China
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
- Aston School of Pharmacy, Aston University, Birmingham, UK
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14
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Chan AYL, Yuen ASC, Tsai DHT, Lau WCY, Jani YH, Hsia Y, Osborn DPJ, Hayes JF, Besag FMC, Lai ECC, Wei L, Taxis K, Wong ICK, Man KKC. Gabapentinoid consumption in 65 countries and regions from 2008 to 2018: a longitudinal trend study. Nat Commun 2023; 14:5005. [PMID: 37591833 PMCID: PMC10435503 DOI: 10.1038/s41467-023-40637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Recent studies raised concerns about the increasing use of gabapentinoids in different countries. With their potential for misuse and addiction, understanding the global consumption of gabapentinoids will offer us a platform to examine the need for any interventional policies. This longitudinal trend study utilised pharmaceutical sales data from 65 countries and regions across the world to evaluate the global trends in gabapentinoid consumption between 2008-2018. The multinational average annual percentage change of gabapentinoid consumption was +17.20%, increased from 4.17 defined daily dose per ten thousand inhabitants per day (DDD/TID) in 2008 to 18.26 DDD/TID in 2018. High-income countries had the highest pooled gabapentinoid consumption rate (39.92 DDD/TID) in 2018, which was more than six times higher than the lower-middle income countries (6.11 DDD/TID). The study shows that despite differences in healthcare system and culture, a consistent increase in gabapentinoid consumption is observed worldwide, with high-income countries remaining the largest consumers.
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Affiliation(s)
- Adrienne Y L Chan
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, 72 9700, Groningen, The Netherlands
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
| | - Andrew S C Yuen
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Daniel H T Tsai
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, SW17 0RE, UK
- School of Pharamcy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wallis C Y Lau
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Yogini H Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Yingfen Hsia
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, SW17 0RE, UK
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
| | - David P J Osborn
- Division of Psychiatry, University College London, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London, NW1 0PE, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London, NW1 0PE, UK
| | - Frank M C Besag
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- East London Foundation NHS Trust, Bedfordshire, MK40 3JT, UK
| | - Edward C C Lai
- School of Pharamcy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, 72 9700, Groningen, The Netherlands
| | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK.
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK.
- Aston School of Pharmacy, Aston University, Birmingham, B4 7ET, UK.
| | - Kenneth K C Man
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong SAR, China.
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, WC1H 9JP, UK.
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, NW1 2PG, UK.
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Ng VWS, Gao L, Chan EW, Lee HME, Hayes JF, Osborn DPJ, Rainer TH, Man KKC, Wong ICK. Association between the pharmacological treatment of bipolar disorder and risk of traumatic injuries: a self-controlled case series study. Psychol Med 2023; 53:5185-5193. [PMID: 35866370 DOI: 10.1017/s0033291722002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Patients with bipolar disorder (BPD) are prone to engage in risk-taking behaviours and self-harm, contributing to higher risk of traumatic injuries requiring medical attention at the emergency room (ER).We hypothesize that pharmacological treatment of BPD could reduce the risk of traumatic injuries by alleviating symptoms but evidence remains unclear. This study aimed to examine the association between pharmacological treatment and the risk of ER admissions due to traumatic injuries. METHODS Individuals with BPD who received mood stabilizers and/or antipsychotics were identified using a population-based electronic healthcare records database in Hong Kong (2001-2019). A self-controlled case series design was applied to control for time-invariant confounders. RESULTS A total of 5040 out of 14 021 adults with BPD who received pharmacological treatment and had incident ER admissions due to traumatic injuries from 2001 to 2019 were included. An increased risk of traumatic injuries was found 30 days before treatment [incidence rate ratio (IRR) 4.44 (3.71-5.31), p < 0.0001]. After treatment initiation, the risk remained increased with a smaller magnitude, before returning to baseline [IRR 0.97 (0.88-1.06), p = 0.50] during maintenance treatment. The direct comparison of the risk during treatment to that before and after treatment showed a significant decrease. After treatment cessation, the risk was increased [IRR 1.34 (1.09-1.66), p = 0.006]. CONCLUSIONS This study supports the hypothesis that pharmacological treatment of BPD was associated with a lower risk of ER admissions due to traumatic injuries but an increased risk after treatment cessation. Close monitoring of symptoms relapse is recommended to clinicians and patients if treatment cessation is warranted.
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Affiliation(s)
- Vanessa W S Ng
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
| | - Ho Ming Edwin Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Joseph F Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - David P J Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London NW10PE, UK
| | - Timothy H Rainer
- Emergency Medicine Unit, The University of Hong Kong, Hong Kong, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong, China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
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16
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Wong RS, Tung KTS, Ho FKW, Man KKC. Editorial: Digital media use and mental health. Front Psychiatry 2023; 14:1253846. [PMID: 37564243 PMCID: PMC10411337 DOI: 10.3389/fpsyt.2023.1253846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/18/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Rosa S. Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Keith T. S. Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Frederick K. W. Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
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17
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Ng VWS, Leung MTY, Chan EW, Lee EHM, Hayes JF, Osborn DPJ, Wing YK, Lau WCY, Man KKC, Wong ICK. Association between the mood stabilizing treatment of bipolar disorder and risk of suicide attempts: A self-controlled case series study. Psychiatry Res 2023; 325:115236. [PMID: 37172400 DOI: 10.1016/j.psychres.2023.115236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/21/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Bipolar disorder (BPD) is associated with high rates of suicide attempts but the anti-suicidal effect of mood stabilizing agents remains unclear. This study aimed to examine the association between mood stabilizing agents (lithium, valproate, lamotrigine, carbamazepine or antipsychotics) and risk of suicide attempts in patients with BPD using self-controlled case series study design. Among 14,087 patients with BPD who received mood stabilizing agents from 2001 to 2020 in Hong Kong, 1316 patients had at least one suicide attempts during the observation period. An increased risk of suicide attempts was observed 14 days before treatment initiation compared to non-exposed period. Following treatment initiation, an increased risk with smaller magnitude was found with the use of mood stabilizing agents. A lower risk was observed with lithium and antiepileptics while the risk remained attenuated with decreasing magnitude with antipsychotics. During 30-day post-treatment period, the risk was elevated. Therefore, this study suggests that use of mood stabilizing agents is not causally associated with an increased risk of suicide attempts. Indeed, there are potential protective effects of lithium and antiepileptics against suicide attempts. Assiduous monitoring of symptoms relapse and warning signs of suicide should be part of the management plan and discussed between clinicians, caregivers and patients.
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Affiliation(s)
- Vanessa W S Ng
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China
| | - Miriam T Y Leung
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Esther W Chan
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Joseph F Hayes
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - David P J Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom; Camden and Islington NHS Foundation Trust, London NW10PE, United Kingdom
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China.
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong, China; Aston Pharmacy School, Aston University, Birmingham, United Kingdom.
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18
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Gao L, Man KKC, Tse ML, Chow ATY, Wong KHTW, Chan EW, Chui CSL, Coghill D, Hon KL, Ip P, Wong ICK. Descriptive analysis of poisoning cases involving attention deficit hyperactivity disorder medications in Hong Kong. Hong Kong Med J 2023. [PMID: 37303104 DOI: 10.12809/hkmj219624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION The number of poisoning cases involving attention deficit hyperactivity disorder (ADHD) medications has reportedly risen with their increased use. However, there is limited relevant evidence from Asia. We analysed the characteristics of poisoning events involving these medications in Hong Kong. METHODS We retrieved data regarding ADHD medication-related poisoning cases from the Hong Kong Poison Information Centre and conducted a descriptive analysis of the demographic information and poisoning information including sources of cases, exposure reason, exposure location, and outcome. The HKPIC data were linked with the Hospital Authority Clinical Data Analysis and Reporting System (CDARS) via de-identified Accident and Emergency numbers of public hospitals to investigate clinical characteristics. We also retrieved ADHD medication prescription records from the CDARS, then compared trends between poisoning cases and ADHD medication use. RESULTS We identified 72 poisoning cases involving ADHD medications between 2009 and 2019, of which approximately 70% occurred in the affected individual's residence; most were intentional poisoning events (65.3%). No statistically significant association was observed between ADHD medication prescription trends and poisoning events involving ADHD medications. Of the 66 cases (91.7%) successfully linked to CDARS, 40 (60.6%) occurred in individuals with ADHD (median age: 14 years); 26 (39.4%) occurred in individuals who lacked ADHD (median age: 33 years) but displayed higher rates of other mental disorders including depression and anxiety. CONCLUSION No significant correlation was evident between ADHD medication prescriptions and poisoning events involving ADHD medications. However, medication management and caregiver education must be emphasised to prevent potential poisoning events.
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Affiliation(s)
- L Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Medicines Optimisation Research and Education, Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom
| | - M L Tse
- Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong SAR, China
| | - A T Y Chow
- Hong Kong Poison Information Centre, United Christian Hospital, Hong Kong SAR, China
| | - K H T W Wong
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - E W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - C S L Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - D Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - K L Hon
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - P Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - I C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- Centre for Medicines Optimisation Research and Education, Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom
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Luo H, Man KKC, Wong ICK. Considerations Regarding Antipsychotic Drug Prescriptions Among People With Dementia During the COVID-19 Pandemic-Reply. JAMA Psychiatry 2023:2804649. [PMID: 37195707 DOI: 10.1001/jamapsychiatry.2023.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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Affiliation(s)
| | - Kenneth K C Man
- UCL School of Pharmacy, London, United Kingdom
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Ian C K Wong
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Jacob George
- Ninewells Hospital, University of Dundee Medical School, Dundee, United Kingdom
| | - Peter Wilson
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Li Wei
- UCL School of Pharmacy, London, United Kingdom
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
- Centre for Medicines Optimisation Research and Education, University College London Hospitals National Health Service (NHS) Foundation Trust, London, United Kingdom
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Calvert C, Brockway MM, Zoega H, Miller JE, Been JV, Amegah AK, Racine-Poon A, Oskoui SE, Abok II, Aghaeepour N, Akwaowo CD, Alshaikh BN, Ayede AI, Bacchini F, Barekatain B, Barnes R, Bebak K, Berard A, Bhutta ZA, Brook JR, Bryan LR, Cajachagua-Torres KN, Campbell-Yeo M, Chu DT, Connor KL, Cornette L, Cortés S, Daly M, Debauche C, Dedeke IOF, Einarsdóttir K, Engjom H, Estrada-Gutierrez G, Fantasia I, Fiorentino NM, Franklin M, Fraser A, Gachuno OW, Gallo LA, Gissler M, Håberg SE, Habibelahi A, Häggström J, Hookham L, Hui L, Huicho L, Hunter KJ, Huq S, Kc A, Kadambari S, Kelishadi R, Khalili N, Kippen J, Le Doare K, Llorca J, Magee LA, Magnus MC, Man KKC, Mburugu PM, Mediratta RP, Morris AD, Muhajarine N, Mulholland RH, Bonnard LN, Nakibuuka V, Nassar N, Nyadanu SD, Oakley L, Oladokun A, Olayemi OO, Olutekunbi OA, Oluwafemi RO, Ogunkunle TO, Orton C, Örtqvist AK, Ouma J, Oyapero O, Palmer KR, Pedersen LH, Pereira G, Pereyra I, Philip RK, Pruski D, Przybylski M, Quezada-Pinedo HG, Regan AK, Rhoda NR, Rihs TA, Riley T, Rocha TAH, Rolnik DL, Saner C, Schneuer FJ, Souter VL, Stephansson O, Sun S, Swift EM, Szabó M, Temmerman M, Tooke L, Urquia ML, von Dadelszen P, Wellenius GA, Whitehead C, Wong ICK, Wood R, Wróblewska-Seniuk K, Yeboah-Antwi K, Yilgwan CS, Zawiejska A, Sheikh A, Rodriguez N, Burgner D, Stock SJ, Azad MB. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries. Nat Hum Behav 2023; 7:529-544. [PMID: 36849590 PMCID: PMC10129868 DOI: 10.1038/s41562-023-01522-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/06/2023] [Indexed: 03/01/2023]
Abstract
Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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Affiliation(s)
- Clara Calvert
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Meredith Merilee Brockway
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helga Zoega
- School of Population Health, Faculty of Medicine & Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jessica E Miller
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics; Department of Obstetrics and Gynaecology; Department of Public Health; Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Adeladza Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Ishaya I Abok
- Department of Pediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Nima Aghaeepour
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Christie D Akwaowo
- Institute of Health Research and Development, University of Uyo Teaching Hospital, Uyo, Nigeria
- College of Health Sciences, University of Uyo, Uyo, Nigeria
| | - Belal N Alshaikh
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Adejumoke I Ayede
- Department of Pediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Behzad Barekatain
- Department of Pediatrics, Division of Neonatology, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Karolina Bebak
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Anick Berard
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- CHU Ste-Justine, Montreal, Quebec, Canada
- Faculty of Medicine, Université Claude Bernard Lyon 1, Lyon, France
| | - Zulfiqar A Bhutta
- Center of Excellence in Women Child Health, The Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lenroy R Bryan
- Department of Obstetrics & Gynaecology and Child Health, University of The West MonaIndies, Mona, Jamaica
| | - Kim N Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University and IWK Health, Halifax, Nova Scotia, Canada
| | - Dinh-Toi Chu
- Center for Biomedicine and Community Health, International School, Vietnam National University, Hanoi, Vietnam
| | - Kristin L Connor
- Department of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Luc Cornette
- AZ St-Jan Bruges-Ostend AV Hospital, Bruges, Belgium
| | - Sandra Cortés
- Department of Public Health, School of Medicine, Advanced Center for Chronic Diseases Diagonal (ACCDIS), Santiago, Chile
| | - Mandy Daly
- Irish Neonatal Health Alliance, Wicklow, Ireland
| | - Christian Debauche
- Department of Neonatology, Cliniques Universitaires Saint-Luc, IREC, UCLouvain, Brussels, Belgium
- CEpiP (Centre d'Epidémiologie Périnatale), Brussels, Belgium
| | | | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Hilde Engjom
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ilaria Fantasia
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo Children's Hospital, Trieste, Italy
| | - Nicole M Fiorentino
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meredith Franklin
- Department of Statistical Sciences and School of the Environment, University of Toronto, Toronto, Ontario, Canada
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Onesmus W Gachuno
- Obstetrics and Gynecology, Medicine, University of Nairobi, Nairobi, Kenya
| | - Linda A Gallo
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Abbas Habibelahi
- Neonatology, Neonatal Health Office, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Lauren Hookham
- St. George's University, Makerere University - Johns Hopkins University Research Collaboration, London, UK
| | - Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil, Centro de Investigación para el Desarrollo Integral y Sostenible and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Sayeeda Huq
- Nutrition and Clinical Services Division, ICDDR,B (International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Seilesh Kadambari
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Roya Kelishadi
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narjes Khalili
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Joanna Kippen
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Kirsty Le Doare
- International Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, UK
- Medical Research Council/Uganda Virus Research Institute and London School of Medical Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Javier Llorca
- Universidad de Cantabria, Santander, Spain
- CIBERESP (Consortium for Biomedical Research in Epidemiology & Public Health, en Epidemiología y Salud Pública), Madrid, Spain
| | - Laura A Magee
- Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kenneth K C Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong
| | - Patrick M Mburugu
- Department of Child Health and Paediatrics, School of Medicine, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Rishi P Mediratta
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Nazeem Muhajarine
- Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Livia Nagy Bonnard
- Melletted a helyem Egyesület, Right(s) Beside You Association, Budapest, Hungary
| | - Victoria Nakibuuka
- Department of Paediatrics, St. Francis Nsambya Hospital, Kampala, Uganda
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sylvester D Nyadanu
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Education, Culture, and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
| | - Laura Oakley
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Adesina Oladokun
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | | | - Rosena O Oluwafemi
- Department of Paediatrics and Child Health, Mother and Child Hospital, Akure, Nigeria
| | - Taofik O Ogunkunle
- Department of Paediatrics, Dalhatu Araf Specialist Hospital, Lafia, Nigeria
| | | | - Anne K Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
| | - Joseph Ouma
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Oyejoke Oyapero
- Paediatrics Department, Ikorodu General Hospital, Ikorodu, Nigeria
| | - Kirsten R Palmer
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Lars H Pedersen
- Department of Obstetrics and Gynecology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Gavin Pereira
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Curtin School of Population Health and enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Isabel Pereyra
- School of Nutrition, Catholic University del Maule, Region del Maule, Chile
| | - Roy K Philip
- Division of Neonatology, Department of Paediatrics, University Maternity Hospital Limerick and University of Limerick School of Medicine, Limerick, Ireland
| | - Dominik Pruski
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Marcin Przybylski
- Obstetrics and Gynaecology Ward, District Public Hospital in Poznań, Poznań, Poland
| | - Hugo G Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- The Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Annette K Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Natasha R Rhoda
- Paediatric Department, School of Adolescent and Child Health, University of Cape Town, Cape Town, South Africa
- Mowbray Maternity Hospital, Western Cape Department of Health, Cape Town, South Africa
| | - Tonia A Rihs
- Federal Statistical Office (FSO), Neuchâtel, Switzerland
| | - Taylor Riley
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Thiago Augusto Hernandes Rocha
- Evidence and Intelligence for Action in Health Department, Pan-American Health Organization - World Health Organization, Washington, DC, USA
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Christoph Saner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
- Division of Pediatric Endocrinology, Diabetology and Metabolism, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Francisco J Schneuer
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Shengzhi Sun
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Emma M Swift
- Faculty of Nursing, Department of Midwifery, University of Iceland, Reykjavík, Iceland
| | - Miklós Szabó
- Division of Neonatology, 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Lloyd Tooke
- Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter von Dadelszen
- Institute of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Gregory A Wellenius
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Clare Whitehead
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Ian C K Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong
| | - Rachael Wood
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Edinburgh, UK
| | | | - Kojo Yeboah-Antwi
- Public Health Unit, Father Thomas Alan Rooney Memorial Hospital, Asankrangwa, Western Region, Ghana
| | | | - Agnieszka Zawiejska
- Department of Medical Simulation, Chair of Medical Education, Poznań University of Medical Sciences, Poznań, Poland
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Natalie Rodriguez
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Burgner
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
| | - Sarah J Stock
- Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Meghan B Azad
- Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
- Departments of Pediatrics and Child Health, Community Health Sciences, and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada, Winnipeg, Manitoba, Canada.
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22
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Man KKC, Häge A, Banaschewski T, Inglis SK, Buitelaar J, Carucci S, Danckaerts M, Dittmann RW, Falissard B, Garas P, Hollis C, Konrad K, Kovshoff H, Liddle E, McCarthy S, Neubert A, Nagy P, Rosenthal E, Sonuga-Barke EJS, Zuddas A, Wong ICK, Coghill D. Long-term safety of methylphenidate in children and adolescents with ADHD: 2-year outcomes of the Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects (ADDUCE) study. Lancet Psychiatry 2023; 10:323-333. [PMID: 36958362 DOI: 10.1016/s2215-0366(23)00042-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Methylphenidate is the most frequently prescribed medication for the treatment of ADHD in children and adolescents in many countries. Although many randomised controlled trials support short-term efficacy, tolerability, and safety, data on long-term safety and tolerability are scarce. The aim of this study was to investigate the safety of methylphenidate over a 2-year period in relation to growth and development, psychiatric health, neurological health, and cardiovascular function in children and adolescents. METHODS We conducted a naturalistic, longitudinal, controlled study as part of the ADDUCE research programme in 27 European child and adolescent mental health centres in the UK, Germany, Switzerland, Italy, and Hungary. Participants aged 6-17 years were recruited into three cohorts: medication-naive ADHD patients who intended to start methylphenidate treatment (methylphenidate group), medication-naive ADHD patients who did not intend to start any ADHD medication (no-methylphenidate group), and a control group without ADHD. Children with ADHD diagnosed by a qualified clinician according to the DSM-IV criteria and, in the control group, children who scored less than 1·5 on average on the Swanson, Nolan, and Pelham IV rating scale for ADHD items, and whose hyperactivity score on the parent-rated Strengths and Difficulties Questionnaire was within the normal range (<6) were eligible for inclusion. Participants were excluded if they had previously taken any ADHD medications but remained eligible if they had previously taken or were currently taking other psychotropic drugs. The primary outcome was height velocity (height velocity SD score; estimated from at least two consecutive height measurements, and normalised with reference to the mean and SD of a population of the same age and sex). FINDINGS Between Feb 01, 2012, and Jan 31, 2016, 1410 participants were enrolled (756 in methylphenidate group, 391 in no-methylphenidate group, and 263 in control group). 1070 (76·3%) participants were male, 332 (23·7%) were female, and for eight gender was unknown. The average age for the cohort was 9·28 years (SD 2·78; IQR 7-11). 1312 (93·0%) of 1410 participants were White. The methylphenidate and no-methylphenidate groups differed in ADHD symptom severity and other characteristics. After controlling for the effects of these variables using propensity scores, there was little evidence of an effect on growth (24 months height velocity SD score difference -0·07 (95% CI -0·18 to 0·04; p=0·20) or increased risk of psychiatric or neurological adverse events in the methylphenidate group compared with the no-methylphenidate group. Pulse rate and systolic and diastolic blood pressure were higher in the methylphenidate group compared with the no-methylphenidate group after 24 months of treatment. No serious adverse events were reported during the study. INTERPRETATION Our results suggest that long-term treatment with methylphenidate for 2 years is safe. There was no evidence to support the hypothesis that methylphenidate treatment leads to reductions in growth. Methylphenidate-related pulse and blood pressure changes, although relatively small, require regular monitoring. FUNDING EU Seventh Framework Programme.
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Affiliation(s)
- Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China
| | - Alexander Häge
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Sarah K Inglis
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Jan Buitelaar
- Radboudumc, Donders Institute for Brain, Cognition and Behavior, Department of Cognitive Neuroscience, Nijmegen, Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Netherlands
| | - Sara Carucci
- Division of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy; Child and Adolescent Neuropsychiatry Unit, A Cao Paediatric Hospital, Cagliari, Italy
| | - Marina Danckaerts
- Department of Neurosciences, Developmental Psychiatry, KU Leuven, Leuven, Belgium; Department of Child and Adolescent Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Ralf W Dittmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Bruno Falissard
- Centre de Recherche en Epidemiologie et Santé des Populations, CESP, INSERM U1018, Université Paris-Saclay, Paris, France
| | - Peter Garas
- Mental Health Sciences, Schools of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Chris Hollis
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK; NIHR MindTech MedTech Co-operative, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Mental Health, and Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital RWTH Aachen, Aachen, Germany; JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen and Research Centre Jülich, Jülich, Germany
| | - Hanna Kovshoff
- School of Psychology, University of Southampton, Southampton, UK
| | - Elizabeth Liddle
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, University of Nottingham, Nottingham, UK
| | | | - Antje Neubert
- Department of Paediatrics and Adolescents Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Peter Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary
| | | | - Edmund J S Sonuga-Barke
- School of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari and A Cao Paediatric Hospital, G Brotzu Hospital Trust, Cagliari, Italy
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Faculty of Medicine, University of Dundee, Dundee, UK.
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23
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Gao L, Man KKC, Fan M, Ge GMQ, Lau WCY, Cheung CL, Coghill D, Ip P, Wong KHTW, Wong ICK. Treatment with methylphenidate and the risk of fractures among children and young people: a systematic review and self-controlled case series study. Br J Clin Pharmacol 2023. [PMID: 36918367 DOI: 10.1111/bcp.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Animal studies suggest that methylphenidate treatment for around 3 months may lead to less mineralized and weaker appendicular bones. A systematic review was conducted to summarize the evidence from observational studies, and a self-controlled case series study was used to compare the risk before and after treatment initiation. METHODS Literature search was conducted using PubMed, Embase, and the Cochrane Library to identify observational studies on methylphenidate and fractures. We also conducted a self-controlled case series study with individuals aged from 5-24 years who received methylphenidate treatment and experienced fractures from 2001-2020 in Hong Kong. Incidence rate ratios and 95% confidence intervals were calculated by comparing the incidence rate in the methylphenidate-exposed period compared to non-exposed period. RESULTS Six cohort studies and two case-control studies were included. For all-cause fractures, studies found a 39-74% lower risk in treated-ADHD group compared with untreated-ADHD, but no difference between stimulants and non-stimulants. Differences between sexes and treatment duration were also found - significant results were shown in males and those with longer treatment duration. Among 43,841 individuals with ADHD medication before year 2020, 2,203 were included in the self-controlled case series analysis. The risks of fractures were lower by 32-41% in the different treatment periods when compared with 6-month before treatment initiation. CONCLUSION In conclusion, methylphenidate treatment may lower the risk of all-cause fractures from both study designs, however, further evidence is needed about the treatment duration and sex effect. Conclusions on stress fractures are not yet established and further research is required.
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Affiliation(s)
- Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.,Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science and Technology Parks, Hong Kong, Special Administrative Region, China
| | - Min Fan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Grace M Q Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Wallis C Y Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.,Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science and Technology Parks, Hong Kong, Special Administrative Region, China
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - David Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Kirstie H T W Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.,Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.,Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science and Technology Parks, Hong Kong, Special Administrative Region, China.,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK
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Chan AYL, Gao L, Howard LM, Simonoff E, Coghill D, Ip P, Lau WCY, Taxis K, Wong ICK, Man KKC. Maternal Benzodiazepines and Z-Drugs Use during Pregnancy and Adverse Birth and Neurodevelopmental Outcomes in Offspring: A Population-Based Cohort Study. Psychother Psychosom 2023:1-11. [PMID: 36907183 DOI: 10.1159/000529141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION The use of benzodiazepines and/or z-drugs in women of childbearing age has increased. OBJECTIVE The aim of the study was to evaluate whether gestational benzodiazepine and/or z-drug exposure is associated with adverse birth and neurodevelopmental outcomes. METHODS A population-based cohort including mother-child pairs from 2001 to 2018 in Hong Kong was analysed to compare gestationally exposed and nonexposed children on the risk of preterm birth, small for gestational age, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) through logistic/Cox proportional hazards regression with a 95% confidence interval (CI). Sibling-matched analyses and negative control analyses were applied. RESULTS When comparing gestationally exposed with gestationally nonexposed children, the weighted odds ratio (wOR) was 1.10 (95% CI = 0.97-1.25) for preterm birth and 1.03 (95% CI = 0.76-1.39) for small for gestational age, while the weighted hazard ratio (wHR) was 1.40 (95% CI = 1.13-1.73) for ASD and 1.15 (95% CI = 0.94-1.40) for ADHD. Sibling-matched analyses showed no association between gestationally exposed children and their gestationally nonexposed siblings for all outcomes (preterm birth: wOR = 0.84, 95% CI = 0.66-1.06; small for gestational age: wOR = 1.02, 95% CI = 0.50-2.09; ASD: wHR = 1.10, 95% CI = 0.70-1.72; ADHD: wHR = 1.04, 95% CI = 0.57-1.90). Similarly, no significant differences were observed when comparing children whose mothers took benzodiazepines and/or z-drugs during pregnancy to children whose mothers took benzodiazepines and/or z-drugs before but not during pregnancy for all outcomes. CONCLUSIONS The findings do not support a causal relationship between gestational benzodiazepines and/or z-drugs exposure and preterm birth, small for gestational age, ASD, or ADHD. Clinicians and pregnant women should carefully balance the known risks of benzodiazepines and/or z-drugs use against those of untreated anxiety and sleep problems.
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Affiliation(s)
- Adrienne Y L Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong, China.,Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dave Coghill
- Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong, China
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Katja Taxis
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.,Aston Pharmacy School, Aston University, Birmingham, UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
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25
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Noh Y, Jeong HE, Choi A, Choi EY, Pasternak B, Nordeng H, Bliddal M, Man KKC, Wong ICK, Yon DK, Shin JY. Prenatal and Infant Exposure to Acid-Suppressive Medications and Risk of Allergic Diseases in Children. JAMA Pediatr 2023; 177:267-277. [PMID: 36622684 PMCID: PMC9857801 DOI: 10.1001/jamapediatrics.2022.5193] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/15/2022] [Indexed: 01/10/2023]
Abstract
Importance Existing observational data have indicated positive associations of acid-suppressive medication (ASM) use in prenatal and early life with allergic diseases in children; however, no study to date has accounted for confounding by indication or within-familial factors. Objective To evaluate the association of prenatal or infant exposure to ASMs with risk of allergic diseases in children. Design, Setting, and Participants This nationwide, cohort study included data from South Korea's National Health Insurance Service mother-child-linked database from January 1, 2007, to December 31, 2020. Participants included mother-child pairs of neonates born from April 1, 2008, to December 31, 2019. Exposures Prenatal and infant exposure to ASMs (histamine 2 receptor antagonists [H2RAs] and proton pump inhibitors [PPIs]). Main Outcomes and Measures Composite and individual outcomes of allergic diseases (asthma, allergic rhinitis, atopic dermatitis, and food allergy) in children (followed up to 13 years of age) were assessed. The ASM-exposed individuals were compared with unexposed individuals in propensity score (PS)-matched and sibling-matched analyses to control for various potential confounders and within-familial factors. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazards regression models. Results The study included 4 149 257 mother-child pairs. Prenatal exposure analyses included 808 067 PS-matched pairs (763 755 received H2RAs, 36 529 received PPIs) among women with a mean (SD) age of 31.8 (4.2) years. The PS-matched HR was 1.01 (95% CI, 1.01-1.02) for allergic diseases overall (asthma: HR, 1.02 [95% CI, 1.01-1.03]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.02]; atopic dermatitis: HR, 1.02 [95% CI, 1.01-1.02]; food allergy: HR, 1.03 [95% CI, 0.98-1.07]); in sibling-matched analyses, the HRs were similar to those of PS-matched analyses but were not significant (allergic diseases: HR, 1.01; 95% CI, 0.997-1.01). Infant exposure analyses included 84 263 PS-matched pairs (74 188 received H2RAs, 7496 received PPIs). The PS-matched HR was 1.06 (95% CI, 1.05-1.07) for allergic diseases overall (asthma: HR, 1.16 [95% CI, 1.14-1.18]; allergic rhinitis: HR, 1.02 [95% CI, 1.01-1.03]; atopic dermatitis: HR, 1.05 [95% CI, 1.02-1.08]; food allergy: HR, 1.28 [95% CI, 1.10-1.49]); asthma risk (HR, 1.13; 95% CI, 1.09-1.17) remained significantly higher among children exposed to ASMs during infancy in sibling-matched analyses. The findings were similar for H2RAs and PPIs analyzed separately and were robust across all sensitivity analyses. Conclusions and Relevance The findings of this cohort study suggest that there is no association between prenatal exposure to ASMs and allergic diseases in offspring. However, infant exposure to ASMs was associated with a higher risk of developing asthma, although the magnitude was more modest than previously reported. Clinicians should carefully weigh the benefits of prescribing ASMs to children, accompanied by subsequent close monitoring for any clinically relevant safety signals.
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Affiliation(s)
- Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Ahhyung Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Eun-Young Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Research Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Mette Bliddal
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, England
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
| | - Ian C. K. Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, England
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
- Aston Pharmacy School, Aston University, Birmingham, England
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, South Korea
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Luo H, Lau WCY, Chai Y, Torre CO, Howard R, Liu KY, Lin X, Yin C, Fortin S, Kern DM, Lee DY, Park RW, Jang JW, Chui CSL, Li J, Reich C, Man KKC, Wong ICK. Rates of Antipsychotic Drug Prescribing Among People Living With Dementia During the COVID-19 Pandemic. JAMA Psychiatry 2023; 80:211-219. [PMID: 36696128 PMCID: PMC9878427 DOI: 10.1001/jamapsychiatry.2022.4448] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Importance Concerns have been raised that the use of antipsychotic medication for people living with dementia might have increased during the COVID-19 pandemic. Objective To examine multinational trends in antipsychotic drug prescribing for people living with dementia before and during the COVID-19 pandemic. Design, Setting, and Participants This multinational network cohort study used electronic health records and claims data from 8 databases in 6 countries (France, Germany, Italy, South Korea, the UK, and the US) for individuals aged 65 years or older between January 1, 2016, and November 30, 2021. Two databases each were included for South Korea and the US. Exposures The introduction of population-wide COVID-19 restrictions from April 2020 to the latest available date of each database. Main Outcomes and Measures The main outcomes were yearly and monthly incidence of dementia diagnosis and prevalence of people living with dementia who were prescribed antipsychotic drugs in each database. Interrupted time series analyses were used to quantify changes in prescribing rates before and after the introduction of population-wide COVID-19 restrictions. Results A total of 857 238 people with dementia aged 65 years or older (58.0% female) were identified in 2016. Reductions in the incidence of dementia were observed in 7 databases in the early phase of the pandemic (April, May, and June 2020), with the most pronounced reduction observed in 1 of the 2 US databases (rate ratio [RR], 0.30; 95% CI, 0.27-0.32); reductions were also observed in the total number of people with dementia prescribed antipsychotic drugs in France, Italy, South Korea, the UK, and the US. Rates of antipsychotic drug prescribing for people with dementia increased in 6 databases representing all countries. Compared with the corresponding month in 2019, the most pronounced increase in 2020 was observed in May in South Korea (Kangwon National University database) (RR, 2.11; 95% CI, 1.47-3.02) and June in the UK (RR, 1.96; 95% CI, 1.24-3.09). The rates of antipsychotic drug prescribing in these 6 databases remained high in 2021. Interrupted time series analyses revealed immediate increases in the prescribing rate in Italy (RR, 1.31; 95% CI, 1.08-1.58) and in the US Medicare database (RR, 1.43; 95% CI, 1.20-1.71) after the introduction of COVID-19 restrictions. Conclusions and Relevance This cohort study found converging evidence that the rate of antipsychotic drug prescribing to people with dementia increased in the initial months of the COVID-19 pandemic in the 6 countries studied and did not decrease to prepandemic levels after the acute phase of the pandemic had ended. These findings suggest that the pandemic disrupted the care of people living with dementia and that the development of intervention strategies is needed to ensure the quality of care.
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Affiliation(s)
- Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
- The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong
| | - Wallis C. Y. Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
| | - Yi Chai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Carmen Olga Torre
- Real World Data Enabling Platform, Roche, Welwyn Garden City, England
- School of Science and Engineering, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Robert Howard
- Division of Psychiatry, Faculty of Brain Science, University College London, London, England
| | - Kathy Y. Liu
- Division of Psychiatry, Faculty of Brain Science, University College London, London, England
| | - Xiaoyu Lin
- Real-World Solutions, IQVIA, Durham, North Carolina
| | - Can Yin
- Real-World Solutions, IQVIA, Durham, North Carolina
| | | | - David M. Kern
- Janssen Research & Development, LLC, Horsham, Pennsylvania
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Jing Li
- Real-World Solutions, IQVIA, Durham, North Carolina
| | | | - Kenneth K. C. Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong
| | - Ian C. K. Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine and Musketeers Foundation Institute of Data Science, The University of Hong Kong, Hong Kong
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Lee H, Baek YH, Kim JH, Liao TC, Lau WCY, Man KKC, Qin X, Wood S, Ilomäki J, Bell JS, Lai ECC, Leung MTY, Chan AYL, Chui CSL, Wong ICK, Shin JY. Trends of polypharmacy among older people in Asia, Australia and the United Kingdom: a multinational population-based study. Age Ageing 2023; 52:7049629. [PMID: 36821644 DOI: 10.1093/ageing/afad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Polypharmacy among older people represents a global challenge due to its association with adverse drug events. The reported prevalence of polypharmacy varies widely across countries, and is particularly high in Asian countries. However, there is no multinational study using standardised measurements exploring variations in prescribing trends. OBJECTIVE To compare polypharmacy trends in older people in Asia, Australia and the United Kingdom. DESIGN Multinational, retrospective, time-trend, observational study using a common study protocol. SETTING Outpatient and community settings. SUBJECTS All individuals aged ≥ 65 years between 2013 and 2016. METHODS We defined polypharmacy as the concomitant use of ≥5 medications for ≥45 days per year. We estimated the annual prevalence of polypharmacy and calculated average annual percentage change (AAPC) to assess the time trends. RESULTS A total of 1.62 million individuals were included in this study. The highest prevalence of polypharmacy was observed in Hong Kong (46.4%), followed by Taiwan (38.8%), South Korea (32.0%), the United Kingdom (23.5%) and Australia (20.1%) in 2016. For the time trend, the Asian region showed a steady increase, particularly in Hong Kong and South Korea (AAPC: Hong Kong, 2.7%; South Korea, 1.8%; Taiwan, 1.0%). However, Australia and the United Kingdom showed a decreasing trend (Australia, -4.9%; the United Kingdom, -1.1%). CONCLUSIONS Polypharmacy prevalence in older people was higher in Hong Kong, Taiwan and South Korea, with an increasing trend over time, compared with Australia and the United Kingdom. Our findings underline the necessity to monitor polypharmacy among older people in Asia by conducting government-level interventions and introducing medicine-optimisation strategies.
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Affiliation(s)
- Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, SouthKorea.,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, SouthKorea
| | - Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, SouthKorea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, SouthKorea.,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, SouthKorea
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wallis C Y Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.,Centre for Medicines Optimisation Research and Education (CMORE), University College London Hospitals NHS Foundation Trust, London, UK
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.,Centre for Medicines Optimisation Research and Education (CMORE), University College London Hospitals NHS Foundation Trust, London, UK
| | - Xiwen Qin
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Stephen Wood
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Adrienne Y L Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.,Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and -Economics, University of Groningen, Groningen, The Netherlands
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.,School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.,Research Department of Practice and Policy, University College London School of Pharmacy, London, UK.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong SAR, China.,Centre for Medicines Optimisation Research and Education (CMORE), University College London Hospitals NHS Foundation Trust, London, UK.,Aston Pharmacy School, Aston University, Birmingham B4 7ET, UK
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, SouthKorea.,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, SouthKorea.,Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, SouthKorea
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28
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Choi A, Noh Y, Jeong HE, Choi EY, Man KKC, Han JY, Kim HS, Yon DK, Shin JY. Association Between Proton Pump Inhibitor Use During Early Pregnancy and Risk of Congenital Malformations. JAMA Netw Open 2023; 6:e2250366. [PMID: 36626173 PMCID: PMC9856708 DOI: 10.1001/jamanetworkopen.2022.50366] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Proton pump inhibitors (PPIs) are increasingly used during pregnancy; however, several observational studies have raised concerns about an increased risk of specific types of congenital malformations. OBJECTIVE To examine the association between PPI exposure during early pregnancy and the risk of congenital malformations. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the National Health Insurance Service-National Health Information Database of South Korea (2010-2020); sibling-controlled analyses were conducted to account for familial factors. A total of 2 696 216 pregnancies in women aged 19 to 44 years between June 1, 2011, and December 31, 2019, and their live-born infants were identified. Pregnant women who were exposed to known teratogens or who delivered infants with chromosomal abnormalities or genetic syndromes were excluded. Data on participant race and ethnicity were not collected because the National Health Information Database does not report this information. EXPOSURES Proton pump inhibitor use during the first trimester. MAIN OUTCOMES AND MEASURES Primary outcomes were major congenital malformations, congenital heart defects, cleft palate, hydrocephalus, and hypospadias. The subtypes of major congenital malformations and congenital heart defects were evaluated as exploratory outcomes. Propensity score fine stratification was used to control for potential confounders, and a weighted generalized linear model was used to estimate relative risks with 95% CIs. RESULTS Of 2 696 216 pregnancies (mean [SD] maternal age, 32.1 [4.2] years), 40 540 (1.5%; mean [SD] age, 32.4 [4.6] years) were exposed to PPIs during the first trimester. The absolute risk of major congenital malformations was 396.7 per 10 000 infants in PPI-exposed pregnancies and 323.4 per 10 000 infants in unexposed pregnancies. The propensity score-adjusted relative risks were 1.07 (95% CI, 1.02-1.13) for major congenital malformations, 1.09 (95% CI, 1.01-1.17) for congenital heart defects, 1.02 (95% CI, 0.72-1.43) for cleft palate, 0.94 (95% CI, 0.54-1.63) for hydrocephalus, and 0.77 (95% CI, 0.51-1.17) for hypospadias. In the sibling-controlled analyses, no associations were observed between PPI use and primary outcomes, including major congenital malformations (odds ratio, 1.05; 95% CI, 0.91-1.22) and congenital heart defects (odds ratio, 1.07; 95% CI, 0.88-1.30). A range of sensitivity analyses revealed results that were similar to the main findings. CONCLUSIONS AND RELEVANCE In this cohort study, the use of PPIs during early pregnancy was not associated with a substantial increase in the risk of congenital malformations, although small increased risks were observed for major congenital malformations and congenital heart defects; findings from sibling-controlled analyses revealed that PPIs were unlikely to be major teratogens. These findings may help guide clinicians and patients in decision-making about PPI use in the first trimester.
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Affiliation(s)
- Ahhyung Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Yunha Noh
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Eun-Young Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
- Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Jung Yeol Han
- Korean Mothersafe Counselling Center, Department of Obstetrics and Gynecology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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Bryant OK, Man KKC, Jani YH, Wong ICK, Lau WCY. Antibiotic prescribing in general practice during COVID-19 and beyond. Lancet Infect Dis 2023; 23:32-33. [PMID: 36495916 PMCID: PMC9762744 DOI: 10.1016/s1473-3099(22)00814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Olivia K Bryant
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London WC1H 9JP, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London WC1H 9JP, UK,Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yogini H Jani
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London WC1H 9JP, UK,Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London WC1H 9JP, UK,Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London WC1H 9JP, UK,Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Ge GM, Cheung ECL, Man KKC, Ip P, Leung WC, Li GHY, Kung AWC, Cheung CL, Wong ICK. Association of maternal levothyroxine use during pregnancy with offspring birth and neurodevelopmental outcomes: a population-based cohort study. BMC Med 2022; 20:390. [PMID: 36344981 PMCID: PMC9641874 DOI: 10.1186/s12916-022-02586-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/27/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring. METHODS This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model. RESULTS Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD. CONCLUSIONS There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy.
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Affiliation(s)
- Grace Mengqin Ge
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Edmund C L Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.,Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wing Cheong Leung
- Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong Special Administrative Region, China
| | - Gloria H Y Li
- Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Annie W C Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ching-Lung Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. .,Research Department of Practice and Policy, UCL, School of Pharmacy, London, UK. .,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.
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Insani WN, Whittlesea C, Ju C, Man KKC, Alwafi H, Alsharif A, Chapman S, Wei L. Statin-related adverse drug reactions in UK primary care consultations: A retrospective cohort study to evaluate the risk of cardiovascular events and all-cause mortality. Br J Clin Pharmacol 2022; 88:4902-4914. [PMID: 35695656 PMCID: PMC9796911 DOI: 10.1111/bcp.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/28/2022] [Accepted: 06/05/2022] [Indexed: 01/07/2023] Open
Abstract
AIMS To investigate the risk of cardiovascular disease (CVD) events and all-cause mortality in patients with statin-related adverse drug reaction (ADR) consultation in primary care and examine whether different treatments following the ADR affect subsequent outcomes. METHODS This was a retrospective cohort study of statin users between 2004 and 2019 using IQVIA Medical Research Data (formally known as the THIN database). Patients with statin-related ADR consultation were matched by propensity score (1:1) to statin users without ADR consultation based on demographics, comorbidities and concomitant medication. Cox proportional hazard regression was used to compare the risk of subsequent CVD event and all-cause mortality, stratified by history of CVD. In the secondary analysis among patients with statin-related ADR, treatment changes within a 1-year period following the ADR were examined and the outcomes were compared between different treatment groups. RESULTS Among 1 564 687 statin users, 19 035 (1.22%) had a statin-related ADR consultation in primary care. The mean (standard deviation) follow-up time was 6.32 (3.74) years and 5.31 (3.83) years for CVD primary and secondary prevention cohorts, respectively. Statin-related ADR consultation was associated with subsequent CVD events in both cohorts (adjusted hazard ratio [HR] of 1.39 [95% CI 1.23, 1.57] and 1.34 [95% CI 1.25,1.42], respectively). In the secondary analysis among patients with statin-related ADR consultation, we found that (i) continued statin prescription or combination of any statin with additional lipid-lowering treatment (LLT) and (ii) other LLT only were associated with lower risks of CVD event (adjusted HR 0.71 [95% CI 0.64, 0.78] and 0.75 [95% CI 0.62, 0.92], respectively) and all-cause mortality (adjusted HR 0.46 [95% CI 0.42, 0.50] and 0.52 [95% CI, 0.43, 0.64], respectively), compared to discontinuation of all LLT. CONCLUSION Statin-related ADR was associated with an increased risk of subsequent CVD event, indicating that these patients should be monitored more closely. Continued lipid-lowering medication is of importance to protect against CVD events and mortality.
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Affiliation(s)
- Widya N. Insani
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Clinical Pharmacy, Centre of Excellence for Pharmaceutical Care InnovationPadjadjaran UniversityBandungIndonesia
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK
| | - Kenneth K. C. Man
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and ResearchUniversity of Hong KongHong Kong Special Administrative RegionChina,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
| | - Hassan Alwafi
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Faculty of MedicineUmm Al Qura UniversityMeccaSaudi Arabia
| | - Alaa Alsharif
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Department of Pharmacy Practice, Faculty of PharmacyPrincess Nourah bint Abdulrahman UniversityRiyadhSaudi Arabia
| | - Sarah Chapman
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Li Wei
- Research Department of Practice and Policy, School of PharmacyUniversity College LondonLondonUK,Laboratory of Data Discovery for HealthHong Kong Science ParkHong Kong Special Administrative RegionChina
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Buitelaar JK, van de Loo-Neus GHH, Hennissen L, Greven CU, Hoekstra PJ, Nagy P, Ramos-Quiroga A, Rosenthal E, Kabir S, Man KKC, Ic W, Coghill D. Long-term methylphenidate exposure and 24-hours blood pressure and left ventricular mass in adolescents and young adults with attention deficit hyperactivity disorder. Eur Neuropsychopharmacol 2022; 64:63-71. [PMID: 36209558 DOI: 10.1016/j.euroneuro.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2022]
Abstract
Young people with attention deficit hyperactivity disorder (ADHD) are now being treated with psychostimulant medication for longer than was previously the case and are increasingly likely to remain on methylphenidate into adolescence and adulthood. This study was designed to determine whether the long-term use of methylphenidate (MPH, immediate release or extended release) increases blood pressure and left ventricular mass (LVM) identified by echocardiography in adolescents and young adults with ADHD aged 12-25 years. In a five-site cross-sectional design two groups were compared for 24- hour blood pressure and heart rate (HR) registrations and LVM: 1) adolescents and young adults with ADHD who had been treated with MPH for > 2 years (N=162, age mean (SD) 15.6 (3.0)), and 2) adolescents and young adults with ADHD who had never been treated with methylphenidate (N=71, age mean 17.4 (4.2)). The analyses were controlled for propensity scores derived from age, sex, height, weight, and 19 relevant background variables. A blood pressure indicative of hypertension (>95th percentile) was observed in 12.2% (95% confidence interval 7.3 - 18.9%) of the participants in the MPH treated group and in 9.6% (95%CI 3.2 - 21.0%) of the MPH naïve group, with overlapping intervals. The 24-hour recorded systolic blood pressure (SBP) and HR were significantly higher during daytime in medicated individuals with ADHD than in those with unmedicated ADHD, but were similar in both groups during the night. 24-hour diastolic blood pressure (DBP) did not differ between both groups during either daytime or at night. LVM, corrected for body-surface area (LVMBSA), also did not differ between the two groups (p=0.20, controlling for confounders). Further, MPH daily dose and duration of treatment were unrelated to LVMBSA, SBP, and DBP. Long-term MPH use in adolescents and young adults with ADHD is associated with small but significant increases of SBP and HR during daytime. Given the current sample size, the proportions of hypertension do not differ significantly between MPH treated and MPH-naïve individuals with ADHD. Future studies with larger samples, longer treatment duration, and/or with within-subject designs are necessary. The results do, however, further support recommendations that highlight the importance of monitoring blood pressure and HR during MPH treatment.
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Affiliation(s)
- J K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
| | - G H H van de Loo-Neus
- Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - L Hennissen
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands
| | - C U Greven
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboudumc, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - P J Hoekstra
- University of Groningen, University Medical Center Groningen, Department of Child and Adolescent Psychiatry & Accare Child Study Center, Groningen, Netherlands
| | - P Nagy
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Bethesda Children's Hospital, Budapest, Hungary
| | - A Ramos-Quiroga
- Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Rosenthal
- Evelina London Children's Hospital, London, UK
| | - S Kabir
- Evelina London Children's Hospital, London, UK
| | - K K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Wong Ic
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - D Coghill
- Departments of Paediatrics and Psychiatry, University of Melbourne, Australia
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Lau WCY, Torre CO, Man KKC, Stewart HM, Seager S, Van Zandt M, Reich C, Li J, Brewster J, Lip GYH, Hingorani AD, Wei L, Wong ICK. Comparative Effectiveness and Safety Between Apixaban, Dabigatran, Edoxaban, and Rivaroxaban Among Patients With Atrial Fibrillation : A Multinational Population-Based Cohort Study. Ann Intern Med 2022; 175:1515-1524. [PMID: 36315950 DOI: 10.7326/m22-0511] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/22/2022] Open
Abstract
BACKGROUND Current guidelines recommend using direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), but head-to-head trial data do not exist to guide the choice of DOAC. OBJECTIVE To do a large-scale comparison between all DOACs (apixaban, dabigatran, edoxaban, and rivaroxaban) in routine clinical practice. DESIGN Multinational population-based cohort study. SETTING Five standardized electronic health care databases, which covered 221 million people in France, Germany, the United Kingdom, and the United States. PARTICIPANTS Patients who were newly diagnosed with AF from 2010 through 2019 and received a new DOAC prescription. MEASUREMENTS Database-specific hazard ratios (HRs) of ischemic stroke or systemic embolism, intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality between DOACs were estimated using a Cox regression model stratified by propensity score and pooled using a random-effects model. RESULTS A total of 527 226 new DOAC users met the inclusion criteria (apixaban, n = 281 320; dabigatran, n = 61 008; edoxaban, n = 12 722; and rivaroxaban, n = 172 176). Apixaban use was associated with lower risk for GIB than use of dabigatran (HR, 0.81 [95% CI, 0.70 to 0.94]), edoxaban (HR, 0.77 [CI, 0.66 to 0.91]), or rivaroxaban (HR, 0.72 [CI, 0.66 to 0.79]). No substantial differences were observed for other outcomes or DOAC-DOAC comparisons. The results were consistent for patients aged 80 years or older. Consistent associations between lower GIB risk and apixaban versus rivaroxaban were observed among patients receiving the standard dose (HR, 0.72 [CI, 0.64 to 0.82]), those receiving a reduced dose (HR, 0.68 [CI, 0.61 to 0.77]), and those with chronic kidney disease (HR, 0.68 [CI, 0.59 to 0.77]). LIMITATION Residual confounding is possible. CONCLUSION Among patients with AF, apixaban use was associated with lower risk for GIB and similar rates of ischemic stroke or systemic embolism, ICH, and all-cause mortality compared with dabigatran, edoxaban, and rivaroxaban. This finding was consistent for patients aged 80 years or older and those with chronic kidney disease, who are often underrepresented in clinical trials. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Wallis C Y Lau
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (W.C.Y.L., K.K.C.M.)
| | - Carmen Olga Torre
- IQVIA, Real-World Solutions, Brighton, United Kingdom (C.O.T., H.M.S., S.S.)
| | - Kenneth K C Man
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (W.C.Y.L., K.K.C.M.)
| | | | - Sarah Seager
- IQVIA, Real-World Solutions, Brighton, United Kingdom (C.O.T., H.M.S., S.S.)
| | - Mui Van Zandt
- IQVIA, Real-World Solutions, Plymouth Meeting, Pennsylvania (M.V., C.R.)
| | - Christian Reich
- IQVIA, Real-World Solutions, Plymouth Meeting, Pennsylvania (M.V., C.R.)
| | - Jing Li
- IQVIA, Real-World Solutions, Durham, North Carolina (J.L., J.B.)
| | - Jack Brewster
- IQVIA, Real-World Solutions, Durham, North Carolina (J.L., J.B.)
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, and Department of Clinical Medicine, Aalborg University, Aalborg, Denmark (G.Y.H.L.)
| | - Aroon D Hingorani
- Institute of Cardiovascular Sciences, University College London, and University College London British Heart Foundation Research Accelerator, London, United Kingdom (A.D.H.)
| | - Li Wei
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (L.W.)
| | - Ian C K Wong
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom, Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom, Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, and Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong (I.C.K.W.)
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Wong CKH, Au ICH, Cheng WY, Man KKC, Lau KTK, Mak LY, Lui SL, Chung MSH, Xiong X, Lau EHY, Cowling BJ. Remdesivir use and risks of acute kidney injury and acute liver injury among patients hospitalised with COVID-19: a self-controlled case series study. Aliment Pharmacol Ther 2022; 56:121-130. [PMID: 35318694 PMCID: PMC9111503 DOI: 10.1111/apt.16894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/04/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM To investigate and quantify the risks of AKI and ALI associated with remdesivir use, given the underlying diseases of SARS-CoV-2 infection. METHODS This self-controlled case series (SCCS) study was conducted using electronic hospital records between 23 January 2020 and 31 January 2021 as retrieved from the Hong Kong Hospital Authority which manages all laboratory-confirmed COVID-19 cases in Hong Kong. Outcomes of AKI and ALI were defined using the KDIGO Guideline and Asia Pacific Association of Study of Liver consensus guidelines. Incidence rate ratios (IRR) for AKI and ALI following the administration of remdesivir (exposure) in comparison to a non-exposure period were estimated using the conditional Poisson regression models. RESULTS Of 860 COVID-19 patients administered remdesivir during hospitalisation, 334 (38.8%) and 137 (15.9%) had incident ALI and AKI, respectively. Compared with the baseline period, both ALI and AKI risks were increased significantly during the pre-exposure period (ALI: IRR = 6.169, 95% CI = 4.549-8.365; AKI: IRR = 7.074, 95% CI = 3.763-13.298) and remained elevated during remdesivir treatment. Compared to the pre-exposure period, risks of ALI and AKI were not significantly higher in the first 2 days of remdesivir initiation (ALI: IRR = 1.261, 95% CI = 0.915-1.737; AKI: IRR = 1.261, 95% CI = 0.889-1.789) and between days 2 and 5 of remdesivir treatment (ALI: IRR = 1.087, 95% CI = 0.793-1.489; AKI: IRR = 1.152, 95% CI = 0.821-1.616). CONCLUSION The increased risks of AKI and ALI associated with intravenous remdesivir treatment for COVID-19 may be due to the underlying SARS-CoV-2 infection. The risks of AKI and ALI were elevated in the pre-exposure period, yet no such increased risks were observed following remdesivir initiation when compared to the pre-exposure period.
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Affiliation(s)
- Carlos K. H. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina
| | - Ivan C. H. Au
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Wing Yiu Cheng
- School of Biomedical Sciences, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,Research Department of Practice and PolicyUCL School of PharmacyLondonUK
| | - Kristy T. K. Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Lung Yi Mak
- Department of Medicine, School of Clinical Medicine, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina,State Key Laboratory of Liver ResearchThe University of Hong KongHong Kong SARChina
| | - Sing Leung Lui
- Department of Medicine, Tung Wah HospitalHong Kong SARChina
| | - Matthew S. H. Chung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Eric H. Y. Lau
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of MedicineThe University of Hong KongHong KongSARChina
| | - Benjamin J. Cowling
- Laboratory of Data Discovery for Health Limited (D4H), Hong Kong Science ParkHong Kong SARChina,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of MedicineThe University of Hong KongHong KongSARChina
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Chai Y, Luo H, Wei Y, Chan SKW, Man KKC, Yip PSF, Wong ICK, Chan EW. Risk of self-harm or suicide associated with specific drug use disorders, 2004-2016: a population-based cohort study. Addiction 2022; 117:1940-1949. [PMID: 35112757 DOI: 10.1111/add.15820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Drug use disorders are associated with increased risk of self-harm. Risk differences associated with specific types of drug use disorders are yet to be comprehensively reported. This study aimed to examine the risk of self-harm or suicide associated with different drug use disorders in Hong Kong. DESIGN Population-based cohort study. SETTING The Clinical Data Analysis and Reporting System (CDARS) managed by the Hong Kong Hospital Authority. PARTICIPANTS Cases were people ages 10 years or older who visited a hospital Accident and Emergency department between 1 January, 2004 and 31 December, 2016 with any of 10 specific drug use disorders (comprising opioid; ketamine; methamphetamine; sedative, hypnotic, or anxiolytic; amphetamine or related stimulant; cocaine; cannabis; hallucinogen; unspecified or other drug; and polydrug). Each case was matched with two controls, selected from a subset of people in CDARS sharing the same gender, age and psychiatric profile. A total of 8270 cases and 16 540 matched controls were included. MEASUREMENTS Incidence and adjusted hazard ratio (aHR) of subsequent self-harm or suicide for each specific drug use disorder were estimated. FINDINGS The most prevalent drug use disorder was opioid use disorder (2523; 30.51%) and the least prevalent was hallucinogen use disorder (77; 0.93%). The crude incidence of self-harm or suicide ranged from 26.57 (95% CI, 14.23-44.55) per 1000 person-years for cannabis use disorder to 91.97 (77.32-108.37) for polydrug use disorder. The highest risk of self-harm or suicide was observed in ketamine (aHR, 16.36; 95% CI, 11.03-24.29) and opioid (15.97; 10.73-23.23) use disorders. CONCLUSIONS In Hong Kong, all types of drug use disorders appear to be significantly associated with increased risk of self-harm or suicide, but risk levels vary by type of drug use disorder.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China.,Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sherry K W Chan
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.,Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong SAR, China
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China.,The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong SAR, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
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Wei Y, Yan VKC, Kang W, Wong ICK, Castle DJ, Gao L, Chui CSL, Man KKC, Hayes JF, Chang WC, Chan EW. Association of Long-Acting Injectable Antipsychotics and Oral Antipsychotics With Disease Relapse, Health Care Use, and Adverse Events Among People With Schizophrenia. JAMA Netw Open 2022; 5:e2224163. [PMID: 35900760 PMCID: PMC9335136 DOI: 10.1001/jamanetworkopen.2022.24163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence for improved clinical outcomes with long-acting injectable antipsychotics (LAIAs) vs oral antipsychotics (OAs) is limited in Asian populations and special patient groups, including older people (>65 years), people with substance use, and early initiators of LAIAs. OBJECTIVE To compare the risk of disease relapse, health care use, and adverse events associated with the use of LAIAs vs OAs among people in Hong Kong with schizophrenia. DESIGN, SETTING, AND PARTICIPANTS In this self-controlled case series study, individuals with a diagnosis of schizophrenia who were prescribed LAIAs and OAs between January 1, 2004, and December 31, 2019, were identified from the Clinical Database Analysis and Reporting System of the Hong Kong Hospital Authority. Data analysis was conducted from May to August in 2021. EXPOSURES Use of LAIAs vs OAs. MAIN OUTCOMES AND MEASURES Risk of disease relapse (hospitalizations for psychiatric disorders, hospitalizations for schizophrenia, and suicide attempts), health care use (all-cause emergency department visits and hospitalizations), and adverse events (hospitalizations for somatic disorders, hospitalizations for cardiovascular diseases, and extrapyramidal symptoms) between the period in which patients were treated with LAIAs and the period in which patients were treated with OAs were compared using Poisson regression. RESULTS Of the 70 396 individuals with schizophrenia (37 200 women [52.8%]; mean [SD] age, 44.2 [15.8] years), 23 719 (33.7%) were prescribed both LAIAs and OAs. Compared with OAs, LAIAs were associated with a lower risk of hospitalizations for any cause (n = 20 973; incidence rate ratio [IRR], 0.63 [95% CI, 0.61-0.65]), hospitalizations for psychiatric disorders (n = 19 283; IRR, 0.52 [95% CI, 0.50-0.53]), hospitalizations for schizophrenia (n = 18 385; IRR, 0.53 [95% CI, 0.51-0.55]), and incident suicide attempts (n = 1453; IRR, 0.56 [95% CI, 0.44-0.71]). During full treatment with LAIAs, there was a reduction in hospitalizations for somatic disorders (n = 15 396; IRR, 0.88 [95% CI, 0.85-0.91]), hospitalizations for cardiovascular diseases (n = 3710; IRR, 0.88 [95% CI, 0.81-0.96]), and extrapyramidal symptoms (n = 22 182; IRR, 0.86 [95% CI, 0.82-0.91]) compared with full treatment with OAs. No significant difference was found for emergency department visits. Similar associations were observed during the subsequent treatment periods (beyond 90 days) and among older people and those with substance use, except for an increased risk of extrapyramidal symptoms among older people when initiating LAIAs (first 90 days). Compared with late initiators, early LAIA initiators had a greater reduction in these outcome events. CONCLUSIONS AND RELEVANCE This self-controlled case series study of people in Hong Kong with schizophrenia suggests that LAIAs were associated with a lower risk of disease relapse and hospitalization than OAs, without an increased risk of adverse events. Clinicians should more broadly consider the long-term use of LAIAs for Chinese people with schizophrenia, especially early in the course of illness.
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Affiliation(s)
- Yue Wei
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Vincent K. C. Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Wei Kang
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Ian C. K. Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - David J. Castle
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
| | - Celine S. L. Chui
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth K. C. Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, University College London School of Pharmacy, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, University College London, London, United Kingdom
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Esther W. Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong Special Administration Region (SAR), China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong SAR, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, Guangdong, China
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Wong RS, Tung KTS, Ho FKW, Lee TMC, Chan KL, Bacon-Shone J, Coghill D, Man KKC, Sham PC, Wong WHS, Tso WWY, Chua GT, Wong ICK, Ip P. Associations between childhood maltreatment and psychiatric disorders: analysis from electronic health records in Hong Kong. Transl Psychiatry 2022; 12:231. [PMID: 35668084 PMCID: PMC9170694 DOI: 10.1038/s41398-022-01986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
There has been a lack of high-quality evidence concerning the association between childhood maltreatment and psychiatric diagnoses particularly for Axis II disorders. This study aimed to examine the association between childhood maltreatment exposure and Axis I and Axis II psychiatry disorders using electronic health records. In this study, the exposed group (n = 7473) comprised patients aged 0 to 19 years with a first-time record of maltreatment episode between January 1, 2001 and December 31, 2010, whereas the unexposed group (n = 26,834) comprised individuals of the same gender and age who were admitted into the same hospital in the same calendar year and month but had no records of maltreatment in the Hong Kong Clinical Data Analysis and Reporting System (CDARS). Data on their psychiatric diagnoses recorded from the date of admission to January 31, 2019 were extracted. A Cox proportional hazard regression model was fitted to estimate the hazard ratio (HR, plus 95% CIs) between childhood maltreatment exposure and psychiatric diagnoses, adjusting for age at index visit, sex, and government welfare recipient status. Results showed that childhood maltreatment exposure was significantly associated with subsequent diagnosis of conduct disorder/ oppositional defiant disorder (adjusted HR, 10.99 [95% CI 6.36, 19.01]), attention deficit hyperactivity disorder (ADHD) (7.28 [5.49, 9.65]), and personality disorders (5.36 [3.78, 7.59]). The risk of psychiatric disorders following childhood maltreatment did not vary by history of childhood sexual abuse, age at maltreatment exposure, and gender. Individuals with a history of childhood maltreatment are vulnerable to psychiatric disorders. Findings support the provision of integrated care within the primary health care setting to address the long-term medical and psychosocial needs of individuals with a history of childhood maltreatment.
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Affiliation(s)
- Rosa S. Wong
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Keith T. S. Tung
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Frederick K. W. Ho
- grid.8756.c0000 0001 2193 314XInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tatia M. C. Lee
- grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, China
| | - Ko Ling Chan
- grid.16890.360000 0004 1764 6123Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - John Bacon-Shone
- grid.194645.b0000000121742757Social Sciences Research Centre, The University of Hong Kong, Hong Kong, China
| | - David Coghill
- grid.1008.90000 0001 2179 088XDepartment of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, VIC Australia
| | - Kenneth K. C. Man
- grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.83440.3b0000000121901201Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Pak C. Sham
- grid.194645.b0000000121742757Department of Psychiatry, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757Centre for PanorOmic Sciences, The University of Hong Kong, Hong Kong, China
| | - Wilfred H. S. Wong
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Winnie W. Y. Tso
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China ,grid.194645.b0000000121742757State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Gilbert T. Chua
- grid.194645.b0000000121742757Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Ian C. K. Wong
- grid.194645.b0000000121742757Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China ,grid.83440.3b0000000121901201Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China.
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Wang Z, Chan AYL, Ho PWH, Wong KHTW, Brauer R, Besag FMC, Ip P, Howard LM, Lau WCY, Taxis K, Wei L, Wong ICK, Man KKC. Prenatal exposure to antidepressants or antipsychotics and the risk of seizure in children. World Psychiatry 2022; 21:322-323. [PMID: 35524597 PMCID: PMC9077607 DOI: 10.1002/wps.20948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Adrienne Y L Chan
- University of Hong Kong, Hong Kong, China
- University of Groningen, Groningen, The Netherlands
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
| | | | - Kirstie H T W Wong
- UCL School of Pharmacy, London, UK
- University of Hong Kong, Hong Kong, China
| | | | - Frank M C Besag
- UCL School of Pharmacy, London, UK
- East London Foundation NHS Trust, Bedfordshire, UK
| | - Patrick Ip
- University of Hong Kong, Hong Kong, China
| | | | - Wallis C Y Lau
- UCL School of Pharmacy, London, UK
- University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
| | - Katja Taxis
- University of Groningen, Groningen, The Netherlands
| | - Li Wei
- UCL School of Pharmacy, London, UK
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
| | - Ian C K Wong
- UCL School of Pharmacy, London, UK
- University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
| | - Kenneth K C Man
- UCL School of Pharmacy, London, UK
- University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
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Wong CKH, Au ICH, Cheng WY, Man KKC, Lau KTK, Mak LY, Lui SL, Chung MSH, Xiong X, Lau EHY, Cowling BJ. Editorial: liver and kidney injury from remdesivir-an issue not as much as its purpose. Authors' reply. Aliment Pharmacol Ther 2022; 55:1457-1458. [PMID: 35538354 DOI: 10.1111/apt.16932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Carlos K H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
| | - Ivan C H Au
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wing Yiu Cheng
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Kristy T K Lau
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lung Yi Mak
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong SAR, China
| | - Sing Leung Lui
- Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China
| | - Matthew S H Chung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xi Xiong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Eric H Y Lau
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China.,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, Hong Kong SAR, China
| | - Benjamin J Cowling
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China.,WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, Hong Kong SAR, China
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40
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Ju C, Wei L, Man KKC, Wang Z, Ma TT, Chan AYL, Brauer R, Chui CSL, Chan EW, Jani YH, Hsia Y, Wong ICK, Lau WCY. Global, regional, and national trends in opioid analgesic consumption from 2015 to 2019: a longitudinal study. Lancet Public Health 2022; 7:e335-e346. [PMID: 35366408 DOI: 10.1016/s2468-2667(22)00013-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have reported an extremely unbalanced global access to opioid analgesics. We aimed to determine contemporary trends and patterns of opioid analgesic consumption at the global, regional, and national levels. METHODS We analysed the global pharmaceutical sales data of 66 countries or regions from the IQVIA-Multinational Integrated Data Analysis System database on opioid analgesics between 2015 and 2019. Opioid analgesic consumption was measured in milligram morphine equivalent per 1000 inhabitants per day (MME per 1000/day). The global, regional, and national trend changes were estimated using linear regressions. Factors associated with consumption patterns and trend changes were explored in multivariable linear regression analyses. FINDINGS Overall opioid analgesic sales in the 66 countries or regions increased from 27·52 MME per 1000/day (16·63-45·54) in 2015 to 29·51 MME per 1000/day (17·85-48·79) in 2019 (difference per year 3·96%, 95% CI 0·26 to 7·80). Sales reduced yearly in North America (-12·84%; 95% CI -15·34 to -10·27) and Oceania (-2·96%; -4·20 to -1·70); increased in South America (28·69%; 7·18 to 54·53), eastern Europe (7·68%; 3·99 to 11·49), Asia (5·74%; 0·61 to 11·14), and western and central Europe (1·64%; 0·52 to 2·78); and did not differ in Africa or central America and the Caribbean. The global opioid consumption patterns were associated with country-level Human Development Index (p=0·040), cancer death rate excluding leukaemia (p=0·0072), and geographical location (p<0·0001). In 2019, opioid analgesic consumption ranged from 0·01 MME per 1000/day to 5·40 MME per 1000/day in the 17 countries and regions in the lowest consumption quartile, despite high income levels and cancer death rates in some of them. INTERPRETATION Global opioid analgesic consumption increased from 2015 to 2019. The trend changes were distinctive across regions, which could reflect the different actions in response to known issues of opioid use and misuse. Disparities in opioid analgesic consumption remained, indicating potential inadequate access to essential pain relief in countries with low consumption. FUNDING None.
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Affiliation(s)
- Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zixuan Wang
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Tian-Tian Ma
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Adrienne Y L Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther W Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - Yogini H Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Yingfen Hsia
- School of Pharmacy, Queen's University, Belfast, UK; St George's University of London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Lau KTK, Wong CKH, Au ICH, Lau WCY, Man KKC, Chui CSL, Wong ICK. Switching to Versus Addition of Incretin-Based Drugs Among Patients With Type 2 Diabetes Taking Sodium-Glucose Cotransporter-2 Inhibitors. J Am Heart Assoc 2022; 11:e023489. [PMID: 35322676 PMCID: PMC9075422 DOI: 10.1161/jaha.121.023489] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Evidence is limited in comparing treatment modification by substitution or add‐on of glucose‐lowering medications in patients with type 2 diabetes. This observational study aims to compare switching versus add‐on of incretin‐based drugs among patients with type 2 diabetes on background sodium‐glucose cotransporter‐2 inhibitors (SGLT2i). Methods and Results This population‐based, retrospective cohort study was conducted using the IQVIA Medical Research Data, including adults with type 2 diabetes on background SGLT2i from 2005 to 2020. New users of incretin‐based drugs were allocated into the “Switch” group if they had discontinued SGLT2i treatment, or the “Add‐on” group if their background SGLT2i was continued. Baseline characteristics of patients were balanced between groups. Study outcomes were all‐cause mortality, cardiovascular diseases, kidney diseases, hypoglycemia, and ketoacidosis. Patients were observed from the index date of initiating incretin‐based drugs until the earliest of an outcome event, death, or data cut‐off date. Changes in anthropometric and metabolic parameters were also compared between groups from baseline to 12‐month follow‐up. A total of 2888 patients were included, classified into “Switch” (n=1461) or “Add‐on” group (n=1427). Median follow‐up was 18 months with 5183 person‐years. Overall, no significant differences in the risks of study outcomes were observed between groups; however, patients in the “Add‐on” group achieved significantly greater reductions in glycated hemoglobin, weight, percentage weight loss, and systolic blood pressure than their “Switch” counterparts. Conclusions Initiating incretin‐based drugs as add‐on among patients with type 2 diabetes on background SGLT2i was associated with risks of clinical end points comparable to switching treatments, in addition to better glycemic and weight control observed with the combination approach.
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Affiliation(s)
- Kristy T K Lau
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Carlos K H Wong
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Department of Family Medicine and Primary Care School of Clinical Medicine Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China
| | - Ivan C H Au
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Wallis C Y Lau
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
| | - Kenneth K C Man
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China.,School of Nursing Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,School of Public Health Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Laboratory of Data Discovery for Health (D24H) Hong Kong Science Park, New Territories Hong Kong SAR China.,Research Department of Policy and Practice University College London School of Pharmacy London UK
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Wang Z, Wong ICK, Man KKC. Prenatal Exposure to Antipsychotics-Handle With Caution-Reply. JAMA Intern Med 2022; 182:355-356. [PMID: 35006240 DOI: 10.1001/jamainternmed.2021.7573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
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Man KKC, Shao SC, Chaiyakunapruk N, Dilokthornsakul P, Kubota K, Li J, Ooba N, Pratt N, Pottegård A, Rasmussen L, Roughead EE, Shin JY, Su CC, Wong ICK, Kao Yang YH, Lai ECC. Metabolic events associated with the use of antipsychotics in children, adolescents and young adults: a multinational sequence symmetry study. Eur Child Adolesc Psychiatry 2022; 31:99-120. [PMID: 33185773 DOI: 10.1007/s00787-020-01674-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022]
Abstract
It is known that younger patients treated with antipsychotics are at increased risk of metabolic events; however, it is unknown how this risk varies according to ethnicity, the class of antipsychotic and the specific product used, and by age group. We conducted a multinational sequence symmetry study in Asian populations (Hong Kong, Japan, Korea, Taiwan and Thailand) and non-Asian populations (Australia and Denmark) to evaluate the metabolic events associated with antipsychotics in both Asian and non-Asian populations, for typical and atypical antipsychotics, and by the subgroups of children and adolescents, and young adults. Patients aged 6-30 years newly initiating oral antipsychotic drugs were included. We defined a composite outcome for metabolic events which included dyslipidemia, hypertension and hyperglycemia. We calculated the sequence ratio (SR) by dividing the number of people for whom a medicine for one of the outcome events was initiated within a 12-month period after antipsychotic initiation by the number before antipsychotic initiation. This study included 346,904 antipsychotic initiators across seven countries. Antipsychotic use was associated with an increased risk of composite metabolic events with a pooled adjusted SR (ASR) of 1.22 (95% CI 1.00-1.50). Pooled ASRs were similar between Asian (ASR, 1.22; 95% CI 0.88-1.70) and non-Asian populations (ASR, 1.22; 95% CI 1.04-1.43). The pooled ASR for typical and atypical antipsychotics was 0.98 (95% CI 0.85-1.12) and 1.24 (95% CI 0.97-1.59), respectively. No difference was observed in the relative effect in children and adolescents compared to young adults. The risk of metabolic events associated with antipsychotics use was similar in magnitude in Asian and non-Asian populations despite the marked difference in drug utilization patterns.
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Affiliation(s)
- Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | | | - Junqing Li
- School of Pharmacy, Sungkyunkwan University, Seoul, South Korea
| | - Nobuhiro Ooba
- Department of Clinical Pharmacy, Nihon University School of Pharmacy, Chiba, Japan
| | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lotte Rasmussen
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Seoul, South Korea
| | - Chien-Chou Su
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
| | - Yea-Huei Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan.
- Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan.
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Isa N, Mudhafar D, Ju C, Man KKC, Lau WCY, Cheng LY, Wei L. Effects of Phosphodiesterase-5 Inhibitors in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. COPD 2022; 19:300-308. [PMID: 35723554 DOI: 10.1080/15412555.2022.2067525] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major burden of healthcare worldwide. We aimed to determine the effects of PDE-5 inhibitors on clinical outcomes and haemodynamic parameters in patients with COPD. A PROSPERO-registered systematic review and meta-analysis (identification number CRD42021227578) were performed to analyse the effects of PDE-5 inhibitors in patients with COPD. Data were sourced from MEDLINE, EMBASE, Cochrane Register of Controlled Trials and "ClinicalTrials.gov." Randomised controlled trials (RCTs) comparing PDE-5 inhibitors with control in patients with COPD were included. Quality assessment was carried out using the Cochrane Collaboration's tool for assessing the risk of bias in randomised trials. The pooled mean difference of 6-minute walk distance (6MWD) and mean pulmonary arterial pressure based on inverse variance estimation were analysed with a fixed-effect model or random-effects model meta-analysis. Nine RCTs involving 414 patients were included in the review. There was no significant difference in 6MWD (mean difference = 22.06 metres, 95% confidence interval (CI), -5.80 to 49.91). However, there was a statistically significant difference between PDE-5 inhibitor and control groups in mean pulmonary artery pressure (mean difference = -3.83 mmHg, 95% CI, -5.93 to -1.74). Headaches were the most common adverse event, occurring significantly in the PDE-5 inhibitor intervention group (odds ratio 3.83, 95% CI, 1.49 to 9.86). This systematic review indicates that PDE-5 inhibitors do not improve exercise capacity despite some possible improvements in haemodynamic parameters in COPD patients.
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Affiliation(s)
- Nafeesah Isa
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Durrah Mudhafar
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Lok Yin Cheng
- Department of Respiratory Medicine, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
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45
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Chai Y, Luo H, Man KKC, Lau WCY, Wong ICK. Antidepressant Use and Risk of Suicidal Behavior in Older Persons With Depression: A Cohort Study in Hong Kong. Innov Aging 2021. [PMCID: PMC8969922 DOI: 10.1093/geroni/igab046.1706] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background: Depression is highly prevalent in older adults and requires treatment. However, debate persists on whether antidepressant use is associated with an elevated risk of suicidal behavior. This study aims to examine the short- and long-term risk of suicidal behavior by various classes of antidepressants in older persons with depression. Methods: Persons aged 40 years and above and received a clinical diagnosis of depression between January 1, 2001, and December 31, 2016 were identified from the Clinical Data Analysis and Reporting System in Hong Kong. The risk of suicidal behavior in persons who were prescribed antidepressants was compared with persons who were not prescribed any antidepressant drugs. Antidepressants were classified as tricyclic and related antidepressant drugs (TCAs), selective serotonin reuptake inhibitors (SSRIs), noradrenergic and specific serotonergic antidepressants (NaSSAs), serotonin–norepinephrine reuptake inhibitors (SNRIs) and others. Incidence and adjusted hazard ratio (aHR) of subsequent self-harm and suicide within one-year and the whole study period were estimated by age groups. Results: A total of 34,927 persons aged 40-64 years, and 19,300 persons aged 65+ years were included. In the younger age group, the highest short-term and long-term risks were found in others (aHR, 2.33; 1.02-5.34) and NaSSAs (2.88; 2.15-3.86), respectively. In the older age group, no significant association was observed between antidepressant use and suicidal behavior across all antidepressant classes. Conclusion: The self-harm and suicide associated risks vary across antidepressant classes and age groups. Cautions are always needed for antidepressant prescriptions.
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Affiliation(s)
- Yi Chai
- The University of Hong Kong, Hong Kong, Hong Kong
| | - Hao Luo
- The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Wallis C Y Lau
- University College London, London, England, United Kingdom
| | - Ian C K Wong
- The University of Hong Kong, Hong Kong, Hong Kong
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Brauer R, Alfageh B, Blais JE, Chan EW, Chui CSL, Hayes JF, Man KKC, Lau WCY, Yan VKC, Beykloo MY, Wang Z, Wei L, Wong ICK. Psychotropic medicine consumption in 65 countries and regions, 2008-19: a longitudinal study. Lancet Psychiatry 2021; 8:1071-1082. [PMID: 34801129 PMCID: PMC9766760 DOI: 10.1016/s2215-0366(21)00292-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/09/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The WHO Comprehensive Mental Health Action Plan 2013-2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region. METHODS In this longitudinal trends study, we used pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS). We analysed monthly sales data of psychotropic medicines between Jan 1, 2008, and Dec 31, 2019. Total psychotropic medicine consumption included sales of antidepressants, antipsychotics, tranquilisers, sedatives or hypnotics, and mood stabilisers. Population estimates of each country or region (eight lower-middle-income countries, 19 upper-middle-income countries, and 38 high-income countries) were based on the UN World Population Prospects 2019 report. Average annual sales trends of psychotropic medicines, expressed as defined daily dose (DDD) per 1000 inhabitants per day, were estimated using a random-effects model adjusted for income level and region. Relative changes in the annual consumption of psychotropic medicines by income, expressed as DDD per 1000 inhabitants per day, were assessed as percentage change for each medicine class. FINDINGS Psychotropic medicine sales increased from 28·54 DDD per 1000 inhabitants per day in 2008 to 34·77 DDD per 1000 inhabitants per day in 2019, corresponding to a 4·08% (95% CI 2·96-5·21) relative average increase annually. The absolute annual increase was greater in high-income countries (3·31 DDD per 1000 inhabitants per day, 95% CI 3·01-3·61) compared with upper-middle-income countries (1·94 DDD per 1000 inhabitants per day, 1·45-2·44) and low-middle-income countries (0·88 DDD per 1000 inhabitants per day, 0·62-1·13; p<0·0001). The relative average annual increase in psychotropic medicine sales from 2008 to 2019 was greater in upper-middle-income countries (7·88%, 95% CI 6·99-8·77) than in lower-middle-income countries (2·90%, 2·40-3·39) and high-income countries (1·02%, 0·80-1·24). In 2019, the regional consumption of psychotropic medicines varied greatly, with the highest sales of all psychotropic medicine classes reported in northern America (167·54 DDD per 1000 inhabitants per day) and lowest sales reported in Asia (5·59 DDD per 1000 inhabitants per day). 17 countries had very low consumption of psychotropic medicines in 2019, including high-income countries and countries with a high prevalence of mental disorders. INTERPRETATION The consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. FUNDING None.
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Affiliation(s)
- Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Basmah Alfageh
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Joseph E Blais
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther W Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Celine S L Chui
- School of Nursing, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Vincent K C Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Maedeh Y Beykloo
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D(2)4H), Hong Kong Science Park, Hong Kong Special Administrative Region, China.
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Wang Z, Chan AYL, Coghill D, Ip P, Lau WCY, Simonoff E, Brauer R, Wei L, Wong ICK, Man KKC. Association Between Prenatal Exposure to Antipsychotics and Attention-Deficit/Hyperactivity Disorder, Autism Spectrum Disorder, Preterm Birth, and Small for Gestational Age. JAMA Intern Med 2021; 181:1332-1340. [PMID: 34398171 PMCID: PMC8369381 DOI: 10.1001/jamainternmed.2021.4571] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The risk of birth and neurodevelopmental complications with prenatal exposure to antipsychotics is unclear. OBJECTIVE To evaluate the association between prenatal antipsychotics exposure and the risk of birth and neurodevelopmental problems. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included children born between January 2001 and January 2015 with follow-up to December 2019 who were identified by the Hong Kong Clinical Data Analysis and Reporting System. Pregnancies with maternal antidepressant/lithium exposure were removed. Primary analyses compared gestationally exposed and gestationally nonexposed individuals with propensity score fine stratification. Additional analyses included gestationally exposed individuals vs those with past exposure and a sibling-matched analysis to evaluate the effect of confounding by indication. EXPOSURES Prenatal antipsychotic exposure. MAIN OUTCOMES AND MEASURES Preterm birth (<37 gestational weeks), small for gestational age (birth weight <2 standard deviations below the mean for gestational age), and first diagnosis of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in children. RESULTS The cohorts included 333 749 mother-child pairs for ADHD (mean [SD] maternal age at delivery, 31.46 [5.03] years) and 411 251 pairs for ASD, preterm birth, and small for gestational age analyses (mean [SD] maternal age at delivery, 31.56 [5.01] years). There were 13 196 children (3.95%) with a diagnosis of ADHD, 8715 (2.12%) with ASD, 33 891 (8.24%) preterm, and 7009 (1.70%) who were small for gestational age. The weighted hazard ratio (wHR) was 1.16 (95% CI, 0.83-1.61) for ADHD and 1.06 (95% CI, 0.70-1.60) for ASD, while the weighted odds ratio (wOR) was 1.40 (95% CI, 1.13-1.75) for preterm birth and 1.36 (95% CI, 0.86-2.14) for small for gestational age when comparing gestationally exposed with gestationally nonexposed individuals. Additional analyses showed no association when comparing gestationally exposed individuals with those with past exposure (ADHD: wHR, 0.99; 95% CI, 0.60-1.61; ASD: wHR, 1.10; 95% CI, 0.58-2.08; preterm birth: wOR, 0.93; 95% CI, 0.70-1.24; small for gestational age: wOR, 1.21; 95% CI, 0.66-2.20) and in a sibling-matched analysis (ADHD: wHR, 0.41; 95% CI, 0.04-4.93; ASD: wHR, 0.90; 95% CI, 0.40-2.01; preterm birth: wOR, 1.25; 95% CI, 0.85-1.82; small for gestational age: wOR, 0.86, 95% CI, 0.32-2.31). CONCLUSIONS AND RELEVANCE In this cohort study, the findings did not suggest that prenatal antipsychotics exposure increased the risk of ADHD, ASD, or small for gestational age. In the primary analysis, there was a small increased risk of preterm birth, but additional analyses comparing gestationally exposed individuals with those with past exposure and comparing gestationally exposed with gestationally nonexposed siblings did not support an increased risk. Given the benefits of treating psychosis during pregnancy, our findings do not support a recommendation for women to discontinue receipt of their regular antipsychotic treatment during pregnancy.
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Affiliation(s)
- Zixuan Wang
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Adrienne Y L Chan
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China.,Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, the Netherlands
| | - David Coghill
- Department of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, England
| | - Ruth Brauer
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England
| | - Ian C K Wong
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
| | - Kenneth K C Man
- Research Department of Practice and Policy, UCL School of Pharmacy, London, England.,Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China
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48
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Ho FK, Man KKC, Toshner M, Church C, Celis-Morales C, Wong ICK, Berry C, Sattar N, Pell JP. Thromboembolic Risk in Hospitalized and Nonhospitalized COVID-19 Patients: A Self-Controlled Case Series Analysis of a Nationwide Cohort. Mayo Clin Proc 2021; 96:2587-2597. [PMID: 34607634 PMCID: PMC8282478 DOI: 10.1016/j.mayocp.2021.07.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the associations between coronavirus disease 2019 (COVID-19) infection and thromboembolism including myocardial infarction (MI), ischemic stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE). PATIENTS AND METHODS A self-controlled case-series study was conducted covering the whole of Scotland's general population. The study population comprised individuals with confirmed (positive test) COVID-19 and at least one thromboembolic event between March 2018 and October 2020. Their incidence rates during the risk interval (5 days before to 56 days after the positive test) and the control interval (the remaining periods) were compared intrapersonally. RESULTS Across Scotland, 1449 individuals tested positive for COVID-19 and experienced a thromboembolic event. The risk of thromboembolism was significantly elevated over the whole risk period but highest in the 7 days following the positive test (incidence rate ratio, 12.01; 95% CI, 9.91 to 14.56) in all included individuals. The association was also present in individuals not originally hospitalized for COVID-19 (incidence rate ratio, 4.07; 95% CI, 2.83 to 5.85). Risk of MI, stroke, PE, and DVT were all significantly higher in the week following a positive test. The risk of PE and DVT was particularly high and remained significantly elevated even 56 days following the test. CONCLUSION Confirmed COVID-19 infection was associated with early elevations in risk with MI, ischemic stroke, and substantially stronger and prolonged elevations with DVT and PE both in hospital and community settings. Clinicians should consider thromboembolism, especially PE, among people with COVID-19 in the community.
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Affiliation(s)
- Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.
| | - Kenneth K C Man
- School of Pharmacy, University College London, London, England, UK; Centre for Safe Medication Practice and Research, Department of Pharmacy and Pharmacology, University of Hong Kong, Hong Kong, China
| | - Mark Toshner
- Department of Medicine, School of Clinical Medicine, University of Cambridge, England, UK
| | - Colin Church
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Carlos Celis-Morales
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Ian C K Wong
- School of Pharmacy, University College London, London, England, UK; Centre for Safe Medication Practice and Research, Department of Pharmacy and Pharmacology, University of Hong Kong, Hong Kong, China
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
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49
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Leung MTY, Wong KH, Ho PWH, Ip P, Wei L, Wong ICK, Man KKC. Gestational exposure to antidepressants and risk of seizure in offspring: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 131:345-359. [PMID: 34571118 DOI: 10.1016/j.neubiorev.2021.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
In spite of the preliminary evidence suggesting a link between gestational use of antidepressant and neurodevelopmental disorders in their offspring, the association between maternal use of antidepressants during pregnancy and the risk of neurologically-related adverse outcomes such as neonatal seizure is still unclear. This study summarises the available evidence on the association between gestational exposure to any antidepressants and the risk of seizure in neonates and children. We found that gestational antidepressant exposure is associated with a 2.3-fold higher incidence of seizure in offspring. Although a causal relationship cannot be confirmed in view of other potential confounders, our findings warrant future research on related clinical aspects, and possibly more careful monitoring of foetal neurodevelopment in pregnant women taking antidepressants during pregnancy. However, this does not suggest the abrupt withdrawal of antidepressants during pregnancy for all cases at risk of seizure in offspring as this must be balanced with the risk of negative consequences caused by untreated maternal depression, and decision-making should be individualised for each patient.
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Affiliation(s)
- Miriam T Y Leung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Kirstie H Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Phoebe W H Ho
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Ian C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
| | - Kenneth K C Man
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong; Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
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50
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Ma TT, Wong ICK, Whittlesea C, Man KKC, Lau W, Wang Z, Brauer R, MacDonald TM, Mackenzie IS, Wei L. Correction to: Impact of multiple cardiovascular medications on mortality after an incidence of ischemic stroke or transient ischemic attack. BMC Med 2021; 19:226. [PMID: 34509176 PMCID: PMC8435091 DOI: 10.1186/s12916-021-02113-2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Tian-Tian Ma
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Cate Whittlesea
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wallis Lau
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK.,Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Zixuan Wang
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK
| | - Thomas M MacDonald
- Medicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK
| | - Isla S Mackenzie
- Medicines Monitoring Unit (MEMO Research) and Hypertension Research Centre, University of Dundee, Dundee, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University, College London, London, UK.
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