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Rebordosa C, Thomsen RW, Tave AK, Madsen M, Beachler DC, Martinez D, Garcia-Esteban R, Plana E, Tormos A, Farsani SF, Perez-Gutthann S, Pladevall-Vila M. Liver, renal, genitourinary and diabetic ketoacidosis risks among new users of empagliflozin versus dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes: Post-authorization safety study based on multinational cohorts. Diabetes Obes Metab 2024; 26:1291-1304. [PMID: 38234181 DOI: 10.1111/dom.15429] [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] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/07/2023] [Indexed: 01/19/2024]
Abstract
AIM To estimate risks of diabetic ketoacidosis (DKA), acute liver injury (ALI), acute kidney injury (AKI), chronic kidney disease (CKD), severe complications of urinary tract infection (UTI) and genital infection (GI) among patients with type 2 diabetes initiating empagliflozin versus those initiating a dipeptidyl peptidase-4 (DPP-4) inhibitor. MATERIALS AND METHODS In this large multinational, observational, new-user cohort study in UK, Danish and US healthcare data sources, patients initiated empagliflozin or a DPP-4 inhibitor between August 2014 and August 2019, were aged ≥18 years, and had ≥12 months' continuous health plan enrolment. Incidence rates by exposure and incidence rate ratios, adjusted for propensity-score deciles, were calculated. RESULTS In total, 64 599 empagliflozin initiators and 203 315 DPP-4 inhibitor initiators were included. There was an increased risk [pooled adjusted incidence rate ratios (95% confidence interval)] of DKA [2.19 (1.74-2.76)] and decreased risks of ALI [0.77 (0.50-1.19) in patients without predisposing conditions of liver disease; 0.70 (0.56-0.88) in all patients] and AKI [0.54 (0.41-0.73)]. In the UK data, there was an increased risk of GI [males: 4.04 (3.46-4.71); females: 3.24 (2.81-3.74)] and decreased risks of CKD [0.53 (0.43-0.65)] and severe complications of UTI [0.51 (0.37-0.72)]. The results were generally consistent in subgroup and sensitivity analyses. CONCLUSIONS Compared with DDP-4 inhibitor use, empagliflozin use was associated with increased risks of DKA and GI and decreased risks of ALI, AKI, CKD and severe complications of UTI. These associations are consistent with previous studies and known class effects of sodium-glucose cotransporter 2 inhibitors, including renoprotective effects and beneficial effects on alanine aminotransferase levels.
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Affiliation(s)
| | - Reimar W Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | | | | - Manel Pladevall-Vila
- RTI Health Solutions, Barcelona, Spain
- The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
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Danysh HE, Johannes CB, Beachler DC, Layton JB, Ziemiecki R, Arana A, Dinh J, Li L, Calingaert B, Pladevall-Vila M, Hunt PR, Chen H, Karlsson C, Johnsson K, Gilsenan A. Post-Authorization Safety Studies of Acute Liver Injury and Severe Complications of Urinary Tract Infection in Patients with Type 2 Diabetes Exposed to Dapagliflozin in a Real-World Setting. Drug Saf 2023; 46:175-193. [PMID: 36583828 PMCID: PMC9883309 DOI: 10.1007/s40264-022-01262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION At the time of dapagliflozin's approval in Europe (2012) to treat patients with type 2 diabetes mellitus, concerns regarding acute liver injury and severe complications of urinary tract infection (sUTI) led to two post-authorization safety (PAS) studies of these outcomes to monitor the safety of dapagliflozin in real-world use. OBJECTIVE To investigate the incidence of hospitalization for acute liver injury (hALI) or sUTI (pyelonephritis or urosepsis) among patients initiating dapagliflozin compared with other glucose-lowering drugs (GLDs). METHODS These two noninterventional cohort studies identified initiators of dapagliflozin and comparator GLDs in November 2012-February 2019 using data from three longitudinal, population-based data sources: Clinical Practice Research Datalink (UK), the HealthCore Integrated Research Database (USA), and the Medicare database (USA). Outcomes (hALI and sUTI) were identified with electronic algorithms. Incidence rates were estimated by exposure group. Incidence rate ratios (IRRs) were calculated comparing dapagliflozin to comparator GLDs, using propensity score trimming and stratification to address confounding. The sUTI analyses were conducted separately by sex. RESULTS In all data sources, hALI and sUTI incidence rates were generally lower in dapagliflozin initiators than comparator GLD initiators. The adjusted IRR (95% confidence interval) pooled across data sources for hALI was 0.85 (0.59-1.24) and for sUTI was 0.76 (0.60-0.96) in females and 0.74 (0.56-1.00) in males. Findings from sensitivity analyses were largely consistent with the primary analyses. CONCLUSIONS These real-world studies do not suggest increased risks of hALI or sUTI, and they suggest a potential decreased risk of sUTI with dapagliflozin exposure compared with other GLDs.
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Affiliation(s)
- Heather E. Danysh
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Catherine B. Johannes
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Daniel C. Beachler
- Department of Safety and Epidemiology, HealthCore, Inc., Wilmington, DE USA
| | - J. Bradley Layton
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC USA
| | - Ryan Ziemiecki
- Department of Biostatistics, RTI Health Solutions, Research Triangle Park, NC USA
| | - Alejandro Arana
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Jade Dinh
- Department of Research Operations, HealthCore, Inc., Wilmington, DE USA
| | - Ling Li
- Department of Safety and Epidemiology, HealthCore, Inc., Wilmington, DE USA
| | - Brian Calingaert
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC USA
| | - Manel Pladevall-Vila
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain ,The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI USA
| | - Phillip R. Hunt
- BioPharmaceuticals Business Unit, AstraZeneca, Gaithersburg, MD USA
| | - Hungta Chen
- BioPharmaceuticals Business Unit, AstraZeneca, Gaithersburg, MD USA
| | | | | | - Alicia Gilsenan
- Department of Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, NC USA
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Foreman PK, Margulis AV, Alexander K, Shediac R, Calingaert B, Harding A, Pladevall-Vila M, Landis S. Birth prevalence of phenylalanine hydroxylase deficiency: a systematic literature review and meta-analysis. Orphanet J Rare Dis 2021; 16:253. [PMID: 34082800 PMCID: PMC8173927 DOI: 10.1186/s13023-021-01874-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Phenylalanine hydroxylase (PAH) deficiency is an autosomal recessive disorder that results in elevated concentrations of phenylalanine (Phe) in the blood. If left untreated, the accumulation of Phe can result in profound neurocognitive disability. The objective of this systematic literature review and meta-analysis was to estimate the global birth prevalence of PAH deficiency from newborn screening studies and to estimate regional differences, overall and for various clinically relevant Phe cutoff values used in confirmatory testing. METHODS The protocol for this literature review was registered with PROSPERO (International prospective register of systematic reviews). Pubmed and Embase database searches were used to identify studies that reported the birth prevalence of PAH deficiency. Only studies including numeric birth prevalence reports of confirmed PAH deficiency were included. RESULTS From the 85 publications included in the review, 238 birth prevalence estimates were extracted. After excluding prevalence estimates that did not meet quality assessment criteria or because of temporal and regional overlap, estimates from 45 publications were included in the meta-analysis. The global birth prevalence of PAH deficiency, estimated by weighting regional birth prevalences relative to their share of the population of all regions included in the study, was 0.64 (95% confidence interval [CI] 0.53-0.75) per 10,000 births and ranged from 0.03 (95% CI 0.02-0.05) per 10,000 births in Southeast Asia to 1.18 (95% CI 0.64-1.87) per 10,000 births in the Middle East/North Africa. Regionally weighted global birth prevalences per 10,000 births by confirmatory test Phe cutoff values were 0.96 (95% CI 0.50-1.42) for the Phe cutoff value of 360 ± 100 µmol/L; 0.50 (95% CI 0.37-0.64) for the Phe cutoff value of 600 ± 100 µmol/L; and 0.30 (95% CI 0.20-0.40) for the Phe cutoff value of 1200 ± 200 µmol/L. CONCLUSIONS Substantial regional variation in the birth prevalence of PAH deficiency was observed in this systematic literature review and meta-analysis of published evidence from newborn screening. The precision of the prevalence estimates is limited by relatively small sample sizes, despite widespread and longstanding newborn screening in much of the world.
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Affiliation(s)
- Pamela K Foreman
- BioMarin Pharmaceutical Inc, 770 Lindaro Street, San Rafael, CA, 94901, USA
| | - Andrea V Margulis
- RTI Health Solutions, Barcelona, Av. Diagonal 605, 9-4, 08028, Barcelona, Spain
| | - Kimberly Alexander
- BioMarin Pharmaceutical Inc, 770 Lindaro Street, San Rafael, CA, 94901, USA
| | - Renee Shediac
- BioMarin Pharmaceutical Inc, 770 Lindaro Street, San Rafael, CA, 94901, USA
| | - Brian Calingaert
- RTI Health Solutions, North Carolina, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Abenah Harding
- RTI Health Solutions, North Carolina, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Sarah Landis
- BioMarin (U.K.) Limited, 10 Bloomsbury Way, London, WC1A 2SL, UK.
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Pladevall-Vila M, Pottegård A, Schink T, Reutfors J, Morros R, Poblador-Plou B, Timmer A, Forns J, Hellfritzsch M, Reinders T, Hägg D, Giner-Soriano M, Prados-Torres A, Cainzos-Achirica M, Hallas J, Brandt L, Cortés J, Aguado J, Perlemuter G, Falissard B, Castellsagué J, Jacquot E, Deltour N, Perez-Gutthann S. Risk of Acute Liver Injury in Agomelatine and Other Antidepressant Users in Four European Countries: A Cohort and Nested Case-Control Study Using Automated Health Data Sources. CNS Drugs 2019; 33:383-395. [PMID: 30830574 PMCID: PMC6441103 DOI: 10.1007/s40263-019-00611-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Agomelatine is a melatonin receptor agonist and serotonin 5-HT2C receptor antagonist indicated for depression in adults. Hepatotoxic reactions like acute liver injury (ALI) are an identified risk in the European risk management plan for agomelatine. Hepatotoxic reactions have been reported for other antidepressants, but population studies quantifying these risks are scarce. Antidepressants are widely prescribed, and users often have risk factors for ALI (e.g. metabolic syndrome). OBJECTIVE The goal was to estimate the risk of ALI associated with agomelatine and other antidepressants (fluoxetine, paroxetine, sertraline, escitalopram, mirtazapine, venlafaxine, duloxetine, and amitriptyline) when compared with citalopram in routine clinical practice. METHOD A nested case-control study was conducted using data sources in Denmark, Germany, Spain, and Sweden (study period 2009-2014). Three ALI endpoints were defined using International Classification of Diseases (ICD) codes: primary (specific codes) and secondary (all codes) endpoints used only hospital discharge codes; the tertiary endpoint included both inpatient and outpatient settings (all codes). Validation of endpoints was implemented. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for current use were estimated for each data source and combined. RESULTS We evaluated 3,238,495 new antidepressant and 74,440 agomelatine users. For the primary endpoint, the OR for agomelatine versus citalopram was 0.48 (CI 0.13-1.71). Results were also < 1 when no exclusion criteria were applied (OR 0.37; CI 0.19-0.74), when all exclusion criteria except alcohol and drug abuse were applied (OR 0.47; CI 0.20-1.07), and for the secondary (OR 0.40; CI 0.05-3.11) and tertiary (OR 0.79; CI 0.50-1.25) endpoints. Regarding other antidepressants versus citalopram, most OR point estimates were also below one, although with varying widths of the 95% CIs. The result of the tertiary endpoint and the sensitivity analyses of the primary endpoint were the most precise. CONCLUSION In this study, using citalopram as a comparator, agomelatine was not associated with an increased risk of ALI hospitalisation. The results for agomelatine should be interpreted in the context of the European risk minimisation measures in place. Those measures may have induced selective prescribing and could explain the lower risk of ALI for agomelatine when compared with citalopram. Most other antidepressants evaluated had ORs suggesting a lower risk than citalopram, but additional studies are required to confirm or refute these results.
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Affiliation(s)
- Manel Pladevall-Vila
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain.
- The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
- Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | - Antje Timmer
- Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University, Oldenburg, Germany
| | - Joan Forns
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
| | - Maja Hellfritzsch
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tammo Reinders
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - David Hägg
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragon, REDISSEC ISCIII, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lena Brandt
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jordi Cortés
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Barcelona, Spain
- Universitat Politècnica de Catalunya, Departament d'Estadística i Investigació Operativa, Barcelona, Spain
| | - Jaume Aguado
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
| | - Gabriel Perlemuter
- AP-HP, Hôpital Antoine Béclère, Service d'Hépato-gastroentérologie, 92140, Clamart, France
- Univ Paris-Sud/Paris-Saclay, Faculté de Médecine, Paris-Sud, 94270, Kremlin-Bicêtre, France
- INSERM U996, Clamart, 92140, France
| | - Bruno Falissard
- CESP INSERM U1018, Université Paris-Saclay, Université Paris-Sud, UVSQ, APHP, Paris, France
| | - Jordi Castellsagué
- Epidemiology, RTI Health Solutions, Av. Diagonal 605, 9-1, 08028, Barcelona, Spain
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Cainzos-Achirica M, Bilal U, Al Rifai M, McEvoy JW, Blumenthal RS, Kapoor K, Martinez-Sanchez JM, Comin-Colet J, Pladevall-Vila M, Blaha MJ. Communication issues in nutritional observational research. Prev Med 2018; 115:76-82. [PMID: 30145349 DOI: 10.1016/j.ypmed.2018.08.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 12/12/2022]
Abstract
Observational epidemiological studies involving foods and nutrients often attract great attention from both the press and the public as they involve substances that are part of the daily lives of millions of individuals. In the digital era, findings of this research can be disseminated to very large audiences almost instantaneously, informing health beliefs and potentially triggering lifestyle changes. In this context, communication of results from observational nutritional epidemiology often involves specific issues that may limit the accuracy of the information ultimately being delivered to the public. In this narrative review we discuss some of these issues, with a special attention to the selective reporting of research studies by the media, the presentation of study findings as if they were free of bias, the reporting of inconsistent study results, and the issues related to the real-life uptake of research findings presented in the press. Collaborative efforts by all stakeholders involved in the dissemination process may help ameliorate this situation, and with this purpose we discuss some innovative approaches that may help reduce these issues.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
| | - Mahmoud Al Rifai
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Karan Kapoor
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Josep Comin-Colet
- Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Manel Pladevall-Vila
- RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain; The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Cainzos-Achirica M, Varas-Lorenzo C, Pottegård A, Asmar J, Plana E, Rasmussen L, Bizouard G, Forns J, Hellfritzsch M, Zint K, Perez-Gutthann S, Pladevall-Vila M. Methodological challenges when evaluating potential off-label prescribing of drugs using electronic health care databases: A case study of dabigatran etexilate in Europe. Pharmacoepidemiol Drug Saf 2018; 27:713-723. [DOI: 10.1002/pds.4416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Anton Pottegård
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | | | - Estel Plana
- Epidemiology; RTI Health Solutions; Barcelona Spain
| | - Lotte Rasmussen
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | | | - Joan Forns
- Epidemiology; RTI Health Solutions; Barcelona Spain
| | - Maja Hellfritzsch
- Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Kristina Zint
- Global Epidemiology; Boehringer Ingelheim GmbH; Ingelheim Germany
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7
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Cainzos-Achirica M, Pladevall-Vila M, Bilal U. Coffee Drinking and Mortality in 10 European Countries. Ann Intern Med 2018; 168:379-380. [PMID: 29507961 DOI: 10.7326/l17-0687] [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: 11/22/2022] Open
Affiliation(s)
| | | | - Usama Bilal
- Drexel Dornsife School of Public Health, Philadelphia, Pennsylvania (U.B.)
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Willame C, Rosillon D, Zima J, Angelo MG, Stuurman AL, Vroling H, Boggon R, Bunge EM, Pladevall-Vila M, Baril L. Risk of new onset autoimmune disease in 9- to 25-year-old women exposed to human papillomavirus-16/18 AS04-adjuvanted vaccine in the United Kingdom. Hum Vaccin Immunother 2016; 12:2862-2871. [PMID: 27428517 PMCID: PMC5137515 DOI: 10.1080/21645515.2016.1199308] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To assess the risk of autoimmune disease (AD) in 9-25 year-old women within 1 year after the first AS04-HPV-16/18vaccine dose, a retrospective, observational database cohort study was conducted using CPRD GOLD. From CPRD GOLD 4 cohorts (65,000 subjects each) were retrieved: 1 exposed female cohort (received ≥1 AS04-HPV-16/18 vaccine dose between Sep2008-Aug2010) and 3 unexposed cohorts: historical female (Sep2005-Aug2007), concurrent male, and historical male. Co-primary endpoints were confirmed neuroinflammatory/ophthalmic AD and other AD, secondary endpoints were confirmed individual AD. Risk of new onset of AD was compared between cohorts (reference: historical cohort) using Poisson regression. The main analysis using confirmed cases showed no neuroinflammatory/ophthalmic AD cases in the female exposed cohort. Incidence rate ratio (IRR) (95% CI) of other AD was 1.41 (0.86 to 2.31) in female and 1.77 (0.94 to 3.35) in male cohorts when compared to the female and male historical cohort, respectively. Secondary endpoints were evaluated for diseases with >10 cases, which were Crohn's disease (IRR: 1.21 [0.37 to 3.95] for female and 4.22 [0.47 to 38.02] for male cohorts), autoimmune thyroiditis (IRR: 3.75 [1.25 to 11.31] for female and no confirmed cases for male cohorts) and type 1 diabetes (IRR: 0.30 [0.11 to 0.83] for female and 2.46 [1.08 to 5.60] for male cohorts). Analysis using confirmed and non-confirmed cases showed similar results, except for autoimmune thyroiditis in females, IRR: 1.45 (0.79 to 2.64). There was no evidence of an increased risk of AD in women aged 9 to 25 years after AS04-HPV-16/18 vaccination.
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Affiliation(s)
- Corinne Willame
- a Business & Decision Life Sciences on behalf of GSK Vaccines , Wavre , Belgium
| | | | | | | | - Anke L Stuurman
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | - Hilde Vroling
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | | | - Eveline M Bunge
- c Pallas Health Research and Consultancy , Rotterdam , the Netherlands
| | - Manel Pladevall-Vila
- e RTI Health Solutions , Barcelona , Spain.,f Center for Health Policy and Health Services Research , Henry Ford Health System , Detroit , MI , USA
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9
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Mitchell S, Roso S, Samuel M, Pladevall-Vila M. Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies. BMC Cardiovasc Disord 2016; 16:74. [PMID: 27114245 PMCID: PMC4845323 DOI: 10.1186/s12872-016-0241-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/08/2016] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies. Methods Electronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions. Results Seventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program–Adult Treatment Panel III’s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal <70 mg/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of <100 mg/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals. Conclusion In patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0241-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Mitchell
- RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK.
| | - S Roso
- Pfizer Ltd., Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, KT20 7NS, UK
| | - M Samuel
- NUS Yong Loo Lin School of Medicine, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - M Pladevall-Vila
- RTI Health Solutions, Trav. Gracia 56 Atico 1 08006, Barcelona, Spain.,The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
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Mitchell SE, Roso S, Samuel M, Woods MS, Pladevall-Vila M. Targeted Literature Review Of Unmet Need In The Hyperlipidaemia Population With High Risk Of Cardiovascular Disease. Value Health 2014; 17:A476. [PMID: 27201375 DOI: 10.1016/j.jval.2014.08.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - M Samuel
- RTI Health Solutions, Manchester, UK
| | - M S Woods
- RTI Health Solutions, Manchester, UK
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Brown TM, Siu K, Walker D, Pladevall-Vila M, Sander S, Mordin M. Development of a conceptual model of adherence to oral anticoagulants to reduce risk of stroke in patients with atrial fibrillation. J Manag Care Pharm 2012; 18:351-62. [PMID: 22663168 PMCID: PMC10437571 DOI: 10.18553/jmcp.2012.18.5.351] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oral anticoagulant (OA) medication is the recommended therapy for reducing the risk of thromboembolic complications in patients with atrial fibrillation (AF), and warfarin is the medication most frequently used. However, nonadherence associated with OA medications may lead to considerable health risks. A conceptual model of OA medication adherence in patients with AF could clarify factors affecting adherence, thereby assisting in the development and structuring of adherence-promotion programs. To our knowledge, such a model, driven by information obtained directly from patients, has never been developed. OBJECTIVE To develop a conceptual model of adherence to OA medication based on a literature review and patient feedback via qualitative research among patients with AF. METHODS A literature search was conducted of English-language articles published between the years 2005 and 2010 that related to factors affecting OA medication adherence, excluding articles pertaining to AF associated with mechanical heart valve replacement. To expand on the literature review findings, 4 focus groups totaling 38 participants aged 60 years or older, diagnosed with nonvalvular AF, and currently taking any OA medication were conducted in 2011. Participants completed the Modified Morisky Scale (MMS), with subscales measuring motivation and knowledge, and were asked about daily processes and behaviors related to taking OA medication. The identification of focus group themes was based on the frequency of participant report and endorsement; themes were spontaneously mentioned or supported by at least 2 people in each of at least 3 focus groups. Model concepts, based on focus group themes and factors identified in the literature review, were determined by the consensus of 3 authors. RESULTS 181 publications were identified; 30 were selected for full-text review. The focus group participants had a mean age of 69.9 years. Most participants reported a diagnosis of hypertension (86.8%, n=33), high cholesterol (50.0%, n=19), heart disease or chronic heart failure (31.6%, n=12), or diabetes (28.9%, n=11). Most (89.5%, n=34) were taking warfarin. About one-half (52.6%, n=20) had been taking an OA medication for less than 5 years. On the MMS, 78.9% of participants reported high levels of motivation, and 100% reported high levels of knowledge. Four concepts emerged from the focus groups and were supported by the literature for inclusion in the model: (a) knowledge base of the disease and continued reinforcement (i.e., health care professional reinforcement); (b) short-term and long-term motivation (e.g., avoidance of negative health consequences); (c) personalized system, habit formation, and system adaptation (e.g., developing a routine or external reminders); and (d) self-efficacy loop (i.e., the personalized system and its adaptability are reinforced as patients become more consistent, confident, and adherent). The literature review also suggested other factors that may also affect patient adherence (e.g., demographic, psychosocial, cognitive). CONCLUSION Adherence in patients with AF is complex and involves multiple factors, some specific to each individual and others more general. This model identifies an adherence process that can guide opportunities for effective interventions, such as educational and behavioral programs targeted at these processes, to improve patient adherence to OA medication.
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Affiliation(s)
- T. Michelle Brown
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
| | - Kimberly Siu
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
| | - David Walker
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
| | - Manel Pladevall-Vila
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
| | - Stephen Sander
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
| | - Margaret Mordin
- Health Solutions, 200 Park Offices, Rm. 251, Research Triangle Park, NC 27709, USA.
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Abstract
BACKGROUND Environmental tobacco smoke is a health hazard. Reducing exposure to tobacco smoke in public places is a widespread public health goal. There is, however, considerable variation in the extent to which this goal has been achieved in different settings and societies. There is therefore a need to identify effective strategies for reducing tobacco consumption in public places. OBJECTIVES To evaluate the effectiveness of interventions to reduce tobacco consumption in public places. SEARCH STRATEGY We searched the Tobacco Addiction Review Group trials register, Medline, EMBASE, HEALTHSTAR, PAIS, and CDP File (National Centre for Chronic Disease Prevention and Health Promotion, CDC) "Smoking and Health database". We handsearched a key journal and abstracts from international conferences on tobacco. We checked the bibliographies of identified studies and reviews for additional references. SELECTION CRITERIA We considered randomized and controlled trials, controlled before and after studies and interrupted time series, and uncontrolled before and after studies. We considered strategies aimed at populations, including education campaigns, written material, non-smoking and warning signs, and comprehensive strategies. We also considered strategies aimed at individual smokers. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and content of all kinds of interventions, participants, outcomes and methods of the study was abstracted by one reviewer and checked by two others. Studies were combined using qualitative narrative synthesis. MAIN RESULTS Eleven of 22 studies reporting information about interventions to reduce smoking in public places met all the inclusion criteria. All included studies were uncontrolled before and after studies. The most effective strategies used comprehensive, multicomponent approaches to implement policies banning smoking within institutions. Less comprehensive strategies, such as posted warnings and educational material had a moderate effect. Five studies showed that prompting individual smokers had an immediate effect, but such strategies are unlikely to be acceptable as a public health intervention. REVIEWER'S CONCLUSIONS Carefully planned and resourced, multicomponent strategies effectively reduced smoking within public places. Less comprehensive strategies were less effective. All the studies used relatively weak experimental designs. Most studies were done in the USA, and there is a need to identify ways in which these strategies can be adopted and used in countries with different attitudes to tobacco use. Future studies should also consider the use of more rigorous experimental designs.
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Affiliation(s)
- C Serra
- Spanish Cochrane Centre, Institut Universitari Fundació Parc Taulí, Parc Taulí s/n, Sabadell, Barcelona, Spain, 08208.
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Pladevall-Vila M, Delclos GL, Varas C, Guyer H, Brugués-Tarradellas J, Anglada-Arisa A. Controversy of oral contraceptives and risk of rheumatoid arthritis: meta-analysis of conflicting studies and review of conflicting meta-analyses with special emphasis on analysis of heterogeneity. Am J Epidemiol 1996; 144:1-14. [PMID: 8659479 DOI: 10.1093/oxfordjournals.aje.a008846] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [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] [Indexed: 02/01/2023] Open
Abstract
The authors analyze the heterogeneity present in the combined results of past observational studies that investigated the association between oral contraceptive use and rheumatoid arthritis. The authors also evaluate discrepancies among meta-analyses that focus on the same relation. Of the 15 initially reviewed studies, 10 were selected for this meta-analysis, which also includes a qualitative summary of study characteristics and a critical appraisal of study quality. The authors used the direct method to combine the study results when there was no evidence of heterogeneity and the DerSimonian-Laird method when heterogeneity was present. Using a meta-regression to assess the sources of heterogeneity, the authors weighted summary estimates by sample size and undertook a sensitivity analysis. There was a strong indication of heterogeneity when combining all studies (x2 = 29.34, p = 0.00060) with the source of controls explaining most of the heterogeneity. The most important factor in explaining the differences among the overall summary estimates given by the meta-analyses is that different effect estimates had been selected for the same studies. There is no conclusive evidence of a protective effect of oral contraceptives on the risk of developing rheumatoid arthritis. Consensus is needed on how meta-analyses of observational studies should be conducted.
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Affiliation(s)
- M Pladevall-Vila
- University of Texas Health Science Center at Houston, School of Public Health, USA
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