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Mubarik S, Luo L, Naeem S, Mubarak R, Iqbal M, Hak E, Yu C. Epidemiology and demographic patterns of cardiovascular diseases and neoplasms deaths in Western Europe: a 1990-2019 analysis. Public Health 2024; 231:187-197. [PMID: 38703493 DOI: 10.1016/j.puhe.2024.04.003] [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: 01/23/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Cardiovascular diseases (CVDs) and neoplasms have been considered as public health concerns worldwide. This study aimed to estimate the epidemiological patterns of death burden on CVDs and neoplasms and its attributable risk factors in Western Europe from 1990 to 2019 to discuss the potential causes of the disparities. STUDY DESIGN AND METHODS We collected data on CVDs and neoplasms deaths in 24 Western European countries from the Global Burden of Disease Study. We analyzed patterns by age, sex, country, and associated risk factors. The results include percentages of total deaths, age-standardized death rates per 100,000 population, and uncertainty intervals (UIs). Time trends were assessed using annual percent change. RESULTS In 2019, CVDs and neoplasms accounted for 33.54% and 30.15% of Western Europe's total deaths, with age-standardized death rates of 128.05 (95% UI: 135.37, 113.02) and 137.51 (95% UI: 142.54, 128.01) per 100,000. Over 1990-2019, CVDs rates decreased by 54.97%, and neoplasms rates decreased by 19.54%. Top CVDs subtypes were ischemic heart disease and stroke; top cancers for neoplasms were lung and colorectal. Highest CVD death burdens were in Finland, Greece, Austria; neoplasm burdens in Monaco, San Marino, Andorra. The major risk factors were metabolic (CVDs) and behavioral (neoplasms). Gender differences revealed higher CVDs death burden in males, while neoplasms burden varied by risk factors and age groups. CONCLUSION In 2019, CVDs and neoplasms posed significant health risks in Western Europe, with variations in death burdens and risk factors across genders, age groups, and countries. Future interventions should target vulnerable groups to lessen the impact of CVDs and neoplasms in the region.
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Affiliation(s)
- S Mubarik
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan 430071 China.
| | - L Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - S Naeem
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China.
| | - R Mubarak
- Department of Economics, PMAS, Arid Agriculture University, Rawalpindi, Pakistan.
| | - M Iqbal
- Department of Psychology, School of Philosophy, Wuhan University, Wuhan, China.
| | - E Hak
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands.
| | - C Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan 430071 China.
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Klont F, Hof MAJ, Nijdam FB, Touw DJ, Bakker SJL, Hopfgartner G, Kosterink JGW, Hak E. Pharmacometabolomics may be the next stamp in the pharmacogenetic passport. Pharmacol Res 2024; 204:107191. [PMID: 38677531 DOI: 10.1016/j.phrs.2024.107191] [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: 04/01/2024] [Revised: 04/20/2024] [Accepted: 04/21/2024] [Indexed: 04/29/2024]
Affiliation(s)
- Frank Klont
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, the Netherlands.
| | - Marieke A J Hof
- Department of Analytical Biochemistry, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands
| | - Fleur B Nijdam
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, the Netherlands; Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, the Netherlands
| | - Gérard Hopfgartner
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, Geneva 1211, Switzerland
| | - Jos G W Kosterink
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, the Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, Groningen 9713 AV, the Netherlands
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Gangapersad RN, Zhou G, Garcia-Gomez P, Bos J, Hak E, Koch BCP, Schuiling-Veninga CCM, Dierckx B. Correction to: Comparison of antipsychotic drug use in children and adolescents in the Netherlands before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02434-6. [PMID: 38642119 DOI: 10.1007/s00787-024-02434-6] [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: 04/22/2024]
Affiliation(s)
- Ravish N Gangapersad
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands.
| | - Guiling Zhou
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pilar Garcia-Gomez
- Erasmus School of Economics, Erasmus University, Rotterdam, The Netherlands
| | - Jens Bos
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmaco?Therapy, ?Epidemiology and ?Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
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Steenhuis D, Li X, Feenstra T, Hak E, de Vos S. The Association between Deductibles and Cardiovascular Medication Adherence: A Retrospective Inception Cohort Study. Drugs Real World Outcomes 2024; 11:99-108. [PMID: 37925375 DOI: 10.1007/s40801-023-00397-9] [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] [Accepted: 10/05/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE Drug non-adherence in primary preventive cardiovascular therapy is one of the most important modifiable drivers of cardiovascular events. The effect of deductibles in healthcare cost-sharing plans (the amount that has to be paid for healthcare services before the insurance company starts to pay) on such non-adherence in a European setting is unknown. Therefore, we estimated the association between deductibles and the adherence to primary preventive antihypertensive and antihyperlipidemic medication. METHODS Using the claims database of Menzis Health Insurer in the Netherlands, we applied ordered beta regression mixed modelling to estimate the association between deductibles and adherence taking several demographic and social-economic factors, repeated measurements and within-patient variation into account. RESULTS All in all, 106,316 patients starting primary preventive antihypertensive or antihyperlipidemic monotherapy were eligible for analysis. At index date, mean age of the study population was 58 years and 52% were male. Reaching the deductible limit and no need to pay for medication anymore increased the adherence [relative adherence ratio (RAR) 1.03, 95% confidence interval (95% CI): 1.00-1.05] for antihyperlipidemic therapy and 1.02 (95% CI: 1.00-1.04) for antihypertensive therapy. A larger deductible amount decreases the adherence of antihyperlipidemic and antihypertensive therapy (RAR 0.83; 95% CI: 0.69-1.00 and RAR 0.85, 95% CI: 0.74-0.98, respectively). CONCLUSION Independent of other risk factors for non-adherence, presence of deductibles in health insurance is associated with a small negative effect on the adherence to both primary preventive antihypertensive as well as antihyperlipidemic therapy. Further study is needed on the potential health-economic consequences.
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Affiliation(s)
- Dennis Steenhuis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
| | - Xuechun Li
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Talitha Feenstra
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Fens T, Moermond CTA, van der Maas P, Dantuma-Wering C, Lestestuiver GH, Szperl A, Schuiling LCM, Hak E, Taxis K. Reducing Pharmaceuticals in Water, a New Module Integrated in the Pharmacy Game: Evaluating the Module's Effects on Students' Knowledge and Attitudes. Pharmacy (Basel) 2024; 12:28. [PMID: 38392935 PMCID: PMC10892046 DOI: 10.3390/pharmacy12010028] [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: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
Pharmaceutical residues end up in surface waters, impacting drinking water sources and contaminating the aquatic ecosystem. Pharmacists can play a role in reducing pharmaceutical residues, yet this is often not addressed in pharmacy undergraduate education. Therefore, we developed the educational module "Reducing Pharmaceuticals in Water" for pharmacy students; this was integrated in our pharmacy simulation game for third year Master of Pharmacy students at the University of Groningen. In this study, we aim to evaluate the effects of the module on students' knowledge of pharmaceutical residues in water, to describe students' experiences in taking the module, and to explore their attitudes towards green pharmacy education in general. This mixed-methods study included quantitative measurements, before and after students took the module (intervention group) and in a control group which did not receive the module. Data were collected between February 2023 and June 2023. Overall, 29 students took the module and 36 students were in the control group. The knowledge score of students in the intervention group (N = 29) increased significantly from 9.3 to 12.9 out of 22 (p < 0.001). The knowledge score of the students in the control group was (8.9 out of 22). Students found the e-learning and the patient cases the most exciting part of this module. Students also recognized the need to including environmental issues in pharmacy education. In conclusion, the module contributes towards improved knowledge and increased awareness of the impact of pharmaceuticals found in water. It represents a promising strategy to strengthen pharmacist's role in mitigating the amount and the effect of pharmaceuticals on water and the environment in the future.
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Affiliation(s)
- Tanja Fens
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy and School of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands (E.H.); (K.T.)
| | - Caroline T. A. Moermond
- Center for Safety of Substances and Products, National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA Bilthoven, The Netherlands;
| | - Peter van der Maas
- Research Group Sustainable Water Systems, Van Hall Larenstein, University of Applied Sciences, Agora 1, 8901 BV Leeuwarden, The Netherlands
| | - Claudia Dantuma-Wering
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy and School of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands (E.H.); (K.T.)
| | - Geke H. Lestestuiver
- Unit of Safety and Environment, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Agata Szperl
- Centre for Learning and Teaching (CLT), School of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| | - Lisette C. M. Schuiling
- Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy and School of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands (E.H.); (K.T.)
| | - Katja Taxis
- Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy and School of Science and Engineering, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands (E.H.); (K.T.)
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Ochi T, de Vos S, Touw D, Denig P, Feenstra T, Hak E. Tailoring Type II Diabetes Treatment: Investigating the Effect of 5-HTT Polymorphisms on HbA1c Levels after Metformin Initiation. J Diabetes Res 2024; 2024:7922486. [PMID: 38288388 PMCID: PMC10824573 DOI: 10.1155/2024/7922486] [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] [Received: 01/27/2023] [Revised: 11/10/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Aims To investigate the effect of serotonin transporter (5-HTT) polymorphisms on change in HbA1c levels six months after metformin initiation in type 2 diabetes patients. Materials and Methods Participants of PROVALID (PROspective cohort study in patients with type 2 diabetes mellitus for VALidation of biomarkers) within the GIANTT (Groningen Initiative to ANalyse Type 2 Diabetes Treatment) cohort who initiated metformin were genotyped for combined 5-HTTLPR/rs25531 (L∗L∗, L∗S∗, and S∗S∗) and 5-HTT VNTR (STin 2.12, 12/-, and 10/-) polymorphisms, respectively. Multiple linear regression was applied to determine the change in HbA1c level from baseline date to six months across 5-HTTLPR/VNTR genotype groups, adjusted for baseline HbA1c, age, gender, triglyceride level, low-density lipoprotein level, and serum creatinine. Results 157 participants were included, of which 56.2% were male. The average age was 59.3 ± 9.23 years, and the mean baseline HbA1c was 7.49% ± 1.21%. 5-HTTLPR was characterized in 46 patients as L∗L∗, 70 patients as L∗S∗, and 41 patients as S∗S∗ genotypes. No significant association was found between 5-HTTLPR and 5-HTT VNTR genotypes and change in HbA1c after adjustments. Conclusions 5-HTT polymorphisms did not affect HbA1c levels six months after the start of metformin. Further long-term studies in large samples would be relevant to determine which polymorphisms can explain the variation in response to metformin treatment.
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Affiliation(s)
- Taichi Ochi
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
| | - Daan Touw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pharmacokinetics, Toxicology and Targeting, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Talitha Feenstra
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
- Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, Netherlands
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Gangapersad RN, Zhou G, Garcia-Gomez P, Bos J, Hak E, Koch BCP, Schuiling-Veninga CCM, Dierckx B. Comparison of antipsychotic drug use in children and adolescents in the Netherlands before and during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-023-02340-3. [PMID: 38183460 DOI: 10.1007/s00787-023-02340-3] [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: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/08/2024]
Abstract
This study aims to describe the patterns and trends in antipsychotic prescription among Dutch youth before and during the corona virus disease 2019 (COVID-19) pandemic (between 2017 and 2022). The study specifically aims to determine whether there has been an increase or decrease in antipsychotic prescription among this population, and whether there are any differences in prescription patterns among different age and sex groups. The study utilized the IADB database, which is a pharmacy prescription database containing dispensing data from approximately 120 community pharmacies in the Netherlands, to analyze the monthly prevalence and incidence rates of antipsychotic prescription among Dutch youth before and during the pandemic. The study also examined the prescribing patterns of the five most commonly used antipsychotics and conducted an autoregressive integrated moving average (ARIMA) analysis using data prior to the pandemic, to predict the expected prevalence rate during the pandemic. The prescription rate of antipsychotics for Dutch youth was slightly affected by the pandemic, with a monthly prevalence of 4.56 [4.50-4.62] per 1000 youths before COVID-19 pandemic and 4.64 [4.59-4.69] during the pandemic. A significant increase in prevalence was observed among adolescent girls aged 13-19 years. The monthly incidence rate remained stable overall, but rose for adolescent girls aged 13-19 years. Aripiprazole, and Quetiapine had higher monthly prevalence rates during the pandemic, while Risperidone and Pipamperon had lower rates. Similarly, the monthly incidence rates of Aripiprazole and Olanzapine went up, while Risperidone went down. Furthermore, the results from the ARIMA analysis revealed that despite the pandemic, the monthly prevalence rate of antipsychotic prescription was within expectation. The findings of this study suggest that there has been a moderate increase in antipsychotic prescription among Dutch youth during the COVID-19 pandemic, particularly in adolescent females aged 13-19 years. However, the study also suggests that factors beyond the pandemic may be contributing to the rise in antipsychotic prescription in Dutch youth.
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Affiliation(s)
- Ravish N Gangapersad
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Guiling Zhou
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Pilar Garcia-Gomez
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jens Bos
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Birgit C P Koch
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Bram Dierckx
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
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Warreman EB, Nooteboom LA, Leenen PJM, Geurts HM, Terry MB, Bos JHJ, Hak E, Hoek HW, van Rossum EFC, Vermeiren RRJM, Ester WA. Metabolic syndrome in adults with autistic traits: associated psychological, behavioral, and biological factors in females and males - a PharmLines initiative. Front Psychiatry 2023; 14:1303840. [PMID: 38193131 PMCID: PMC10773724 DOI: 10.3389/fpsyt.2023.1303840] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Background While cardiovascular diseases is highly prevalent and an important cause of mortality in autistic adults, knowledge on their increased cardiovascular risk is limited. Hence, this study aimed to investigate psychological, behavioral, and physical factors associated with metabolic syndrome (MetS) in adults with autistic traits. Methods In total, 17,705 adults from the Lifelines Cohort were included and categorized using Autism Spectrum Quotient-10 sum-scores. The quartiles with highest (HQ-traits-group females: n = 2,635; males: n = 1803) and lowest levels of autistic traits (LQ-traits-group, n = idem) were analyzed. Using multivariable logistic regression, the associations between MetS and (self-reported and interviewed) psychological, behavioral, and physically measured factors in these stratified groups were investigated. Results Among females, MetS was more common in the HQ-traits-group than in the LQ-traits-group (10.0% versus 7.5%, p < 0.01), while this was not the case among males (HQ-traits-group 13.8% versus LQ-traits-group 13.1%, p = 0.52). In both the female and male HQ-traits-group, the presence of MetS was associated with poorer self-reported health, less daily physical activity, and altered leukocyte counts. Conclusion These findings underline the relevance of adequate cardiovascular prevention in adults with higher levels of autistic traits. Future research could gain more insight into the relationship between cardiovascular risk and autistic traits in females, and into tailored cardiovascular prevention.
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Affiliation(s)
- E. B. Warreman
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
| | - L. A. Nooteboom
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
| | - P. J. M. Leenen
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - H. M. Geurts
- Dutch Autism and ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Dr. Leo Kannerhuis, Youz, Parnassia Group, Amsterdam, Netherlands
| | - M. B. Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - J. H. J. Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - E. Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - H. W. Hoek
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
| | - E. F. C. van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Obesity Center CGG, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - R. R. J. M. Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
| | - W. A. Ester
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Center, Oegstgeest, Netherlands
- Parnassia Group, Youz, The Hague, Netherlands
- Sarr Autism Rotterdam, Youz, Parnassia Group, Rotterdam, Netherlands
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Alghamdi A, Bijlsma MJ, de Vos S, Schuiling-Veninga CC, Bos JHJ, Hak E. Association between Incidence of Prescriptions for Alzheimer's Disease and Beta-Adrenoceptor Antagonists: A Prescription Sequence Symmetry Analysis. Pharmaceuticals (Basel) 2023; 16:1694. [PMID: 38139820 PMCID: PMC10748070 DOI: 10.3390/ph16121694] [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: 10/02/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common cause of dementia, with a growing number of patients worldwide. The association between AD and treatment with drugs targeting the beta-adrenergic receptor is controversial. The aim of this study is to assess the association between the initiation of AD medication and beta-adrenoceptor antagonists (beta-blockers) in adults. MATERIALS AND METHODS We conducted a prescription sequence symmetry analysis using the University of Groningen IADB.nl prescription database. We determined the order of the first prescription for treating AD and the first prescription for beta-blockers, with the dispensing date of the first prescription for AD defined as the index date. Participants were adults over 45 years old starting any AD medication and beta-blockers within two years. We calculated adjusted sequence ratios with corresponding 95% confidence intervals. RESULTS We identified 510 users of both AD and beta-blockers, and 145 participants were eligible. The results were compatible with either a significant decrease in the incidence of AD after using beta-blockers (adjusted sequence ratio (aSR) = 0.52; 95% CI: 0.35-0.72) or, conversely, an increase in beta-blockers after AD medication (aSR = 1.96; 95% CI: 1.61-2.30). CONCLUSIONS There is a relationship between the use of beta-blockers and AD medications. Further research is needed with larger populations to determine whether drug therapy for AD increases the risk of hypertension or whether beta-blockers have potential protective properties against AD development.
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Affiliation(s)
- Ali Alghamdi
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
| | - Maarten J. Bijlsma
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
- Laboratory of Population Health, Max Planck Institute for Demographic Research, 18057 Rostock, Germany
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
| | - Catharina C.M. Schuiling-Veninga
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
| | - Jens H. J. Bos
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Pharmaco Therapy, Epidemiology & Economics, University of Groningen, 9713 AV Groningen, The Netherlands (S.d.V.); (C.C.M.S.-V.); (E.H.)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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10
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Oktora MP, de Vos S, de Vries ST, Hak E, Denig P. Sex disparities in treatment patterns after metformin initiation among patients with type 2 diabetes mellitus. Pharmacoepidemiol Drug Saf 2023; 32:1395-1405. [PMID: 37524658 DOI: 10.1002/pds.5672] [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] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess sex differences in treatment patterns after metformin initiation among type 2 diabetes mellitus (T2D) patients. METHODS A cohort study was conducted using the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients aged ≥18 years initiating metformin were followed 2-5 years. Markov modeling was conducted to estimate treatment transition rates and calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) comparing men with women adjusted for age, HbA1c level at initiation, and cardiovascular disease history. Kaplan-Meier analyses and Cox proportional-hazards models were used to determine the time to and likelihood of getting treatment intensification. HbA1c levels at initiation and intensification were compared using Mann-Whitney U tests. RESULTS In total, 11 508 metformin initiators were included (50.1% women). The most common transition after initiation was a dose increase (probability women 0.52, men 0.59, no significant difference). Women were more likely than men to switch to any other non-insulin hypoglycemic agent after initiation (aHR 1.66; 95% CI 1.31-2.12), after dose increase (aHR 1.48; 95% CI 1.10-1.98) and after dose decrease (aHR 2.64; 95% CI 1.28-5.46). Time to intensification was longer, time to switching was shorter, and HbA1c levels at initiation and intensification were lower for women than men. CONCLUSIONS Sex disparities were observed in treatment transitions after metformin initiation. Women more often switched treatment than men, which suggest that prescribers acknowledge more tolerance or other problems for metformin in women. Men intensified treatment earlier and at higher HbA1c levels, indicative of a higher need for treatment intensification.
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Affiliation(s)
- Monika P Oktora
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Sieta T de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Jean Baptiste AE, Wagai J, Hahné S, Adeniran A, Koko RI, de Vos S, Shibeshi M, Sanders EAM, Masresha B, Hak E. High-resolution geospatial mapping of zero-dose and under-immunized children following Nigeria's 2021 multiple indicator cluster survey/national immunization coverage survey (MICS/NICS). J Infect Dis 2023:jiad476. [PMID: 37930309 DOI: 10.1093/infdis/jiad476] [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: 07/30/2023] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The "zero-dose" children are those without any routine vaccination or lacking the first dose of the diphtheria-tetanus-pertussis-containing vaccine. As per 2022 WHO/UNICEF estimates, globally, Nigeria has the highest number of zero-dose with over 2.3 million unvaccinated. METHODS We used data from the 2021 Nigeria Multiple Indicator Cluster Survey - National Immunisation Coverage Survey to identify zero-dose and under-immunized children. Geospatial modelling techniques were employed to determine the prevalence of zero-dose children and predict risk areas with under-immunized at a high resolution of 1x1 km. RESULTS Both zero-dose and under-immunized children are more prevalent in socially deprived groups. Univariate and multivariate Bayesian analyses showed positive correlations between the prevalence of zero-dose and under-immunized children with factors like stunting, contraceptive prevalence, and literacy. The prevalence of zero-dose and under-immunized children varies significantly by region and ethnicity, with higher rates observed in the country's northern parts. Significant heterogeneity in the distribution of under-vaccinated children was observed. CONCLUSIONS Nigeria needs to enhance its immunization system and coverage. Geospatial modelling can help deliver vaccines effectively to underserved communities. By adopting this approach, countries can ensure equitable vaccine access and contribute to global vaccination objectives.
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Affiliation(s)
| | - John Wagai
- World Health Organization, Country Office, Abuja, Nigeria
| | - Susan Hahné
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | | | | | - Stijn de Vos
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Messeret Shibeshi
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - E A M Sanders
- Institute of Public Health and The Environment, Bilthoven, Netherlands
- Department of Paediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, The Netherlands
| | - Balcha Masresha
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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12
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Alfian SD, Khoiry QA, Andhika A Pratama M, Pradipta IS, Kristina SA, Zairina E, Hak E, Abdulah R. Knowledge, perception, and willingness to provide telepharmacy services among pharmacy students: a multicenter cross-sectional study in Indonesia. BMC Med Educ 2023; 23:800. [PMID: 37884985 PMCID: PMC10601297 DOI: 10.1186/s12909-023-04790-4] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic accelerated the provision of telepharmacy services. However, little is known about the knowledge, perception, and willingness of pharmacy students as future key players in telepharmacy adoption to provide such a service, particularly in a setting without well-established telepharmacy services before the COVID-19 pandemic. OBJECTIVE With this survey we aimed to assess the level of knowledge, perception, and willingness to provide telepharmacy services and to identify associated factors among pharmacy students in Indonesia. METHODS We applied a multicenter cross-sectional study design with convenience sampling technique among pharmacy students in three public universities in Bandung City, Surabaya City, and Special Region of Yogyakarta, Indonesia. The knowledge, perception, and willingness to provide telepharmacy services were assessed using an online questionnaire. Ordinal regression analysis was performed to determine factors associated with a high knowledge level, whereas binary logistic regression analyses were performed to determine factors associated with a positive perception of telepharmacy services. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. RESULTS Among 313 respondents, 83.4% were female, and the mean age was 20 years. Although only 13.2% showed a high knowledge level, 66.5% showed a positive perception of telepharmacy services and 97.4% were willing to provide telepharmacy services in the future. An increase in age (OR 1.33; 95% CI 1.14-1.54) and being advance in smartphone usage (OR 5.21; 95% CI 2.03-13.42) are associated with an increased likelihood of having a high knowledge level about telepharmacy services. Male students had a lower likelihood of having a positive perception of telepharmacy services than females (OR 0.46; 95% CI 0.24-0.85). CONCLUSION Despite limited knowledge of telepharmacy, the majority of pharmacy students reported a positive perception and willingness to provide telepharmacy services in their future careers. Therefore, telepharmacy practice models must be included as a subject course in the curriculum, better preparing future pharmacists to perform their roles effectively. Furthermore, student-specific factors such as age and expertise in smartphone usage that associated with knowledge and gender that associated with perception should be considered to facilitate telepharmacy adoption in Indonesia.
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Affiliation(s)
- Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia.
- Center for Health Technology Assessment, Universitas Padjadjaran, Jatinangor, Indonesia.
| | - Qisty A Khoiry
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Mochammad Andhika A Pratama
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Susi A Kristina
- Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
- Innovative Pharmacy Practice and Integrated Outcome Research (INACORE) Group, Universitas Airlangga, Surabaya, Indonesia
- Center of Excellence for Patient Safety and Quality, Universitas Airlangga, Surabaya, Indonesia
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Centre of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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Elling T, Hak E, Bos JH, Tichelaar VYIG, Veeger NJGM, Meijer K. Effect of Previous INR Control during VKA Therapy on Subsequent DOAC Adherence and Persistence, in Patients Switched from VKA to DOAC. Thromb Haemost 2023. [PMID: 37673103 DOI: 10.1055/a-2168-9378] [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] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Current guideline suggests a switch from vitamin K antagonist (VKA) to direct oral anticoagulant (DOAC) in patients with low time in therapeutic range (TTR < 70%). Poor international normalized ratio (INR) control may be the result of poor compliance, and might therefore be associated with subsequent DOAC intake. Therefore, this study evaluates the effect of previous TTR and other measures of INR control on DOAC nonadherence and nonpersistence, in patients who switched from VKA to DOAC. METHODS A total of 437 patients who switched from VKA to DOAC between 2012 and 2019 were included using data from Certe Thrombosis Service, IADB.nl pharmacy community database University Groningen, and Statistics Netherlands. DOAC prescriptions were used to determine nonadherence and nonpersistence. INR control (i.e., TTR, time under therapeutic range [TUR], and INR variability) was assessed during the last 180 days of VKA use. Multivariable regression models were applied to determine the association between INR control and DOAC nonpersistence/nonadherence. RESULTS On VKA, 67.7% of the patients had a TTR below 70%. DOAC nonpersistence was 39.8% (95% confidence interval [CI]: 33.4-45.5%) during a median follow-up of 34.4 months (interquartile range: 19.1-49.2). Approximately 80% of persistent patients were DOAC-adherent. Low TTR was not associated with DOAC nonpersistence (hazard ratio: 1.14, 95% CI: 0.69-1.87) and DOAC nonadherence (odds ratio: 1.38, 95% CI: 0.67-2.84), nor were TUR and INR variability. CONCLUSION Previous INR control during VKA therapy is not associated with subsequent DOAC nonadherence and nonpersistence. This study suggests that INR control on VKA cannot, and therefore should not, be used for predicting DOAC adherence or persistence.
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Affiliation(s)
- Tessa Elling
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economy, University of Groningen, Groningen, The Netherlands
| | - Jens H Bos
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economy, University of Groningen, Groningen, The Netherlands
| | - Vladimir Y I G Tichelaar
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Certe Thrombosis Service, Groningen, The Netherlands
| | - Nic J G M Veeger
- Department of Epidemiology, University of Groningen, University Medical Centre, Groningen, The Netherlands
| | - Karina Meijer
- Department of Hematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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14
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Robiyanto R, Roos M, Bos JHJ, Hak E, van Puijenbroek EP, Schuiling-Veninga CCM. Switching pattern and dose adjustment of antidepressants before and during pregnancy. Arch Womens Ment Health 2023; 26:685-696. [PMID: 37542677 PMCID: PMC10491541 DOI: 10.1007/s00737-023-01355-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/25/2023] [Indexed: 08/07/2023]
Abstract
The purpose of the study is to examine the switching pattern and dose adjustment of antidepressants (ADs) prescribed to women from six months before to six months during pregnancy in the Netherlands. The recorded dispenses or refills were collected from the University of Groningen IADB.nl pregnancy subset for all singleton pregnancies in which the mother received ≥ 1 prescription of an AD dispensed before pregnancy and was present in the database at least six months after conception. The rates of continuation, discontinuation, and switching between 2001 and 2020 were assessed for the ADs studied. The mean number of Defined Daily Doses (DDDs) of the most frequently continued ADs used was calculated both before and during pregnancy, and a paired t-test was used to test for significant changes. The continuation rates for AD users, especially for SSRI and SNRI continued users, increased over time from 27% and 19% (2001-2005) to 65% and 65% (2016-2020). The switching rate between ADs remained consistently low from the start of the study (2001-2005) at 2.0% to the end of the study (2016-2020) at 2.3%. Most women who switched between antidepressants during pregnancy received a different SSRI monotherapy (85%), followed by an SNRI (6%), a TCA (4%), and an "other AD" (4%). In most cases observed, the dose adjustment for the mean DDDs during pregnancy compared to the mean DDDs before pregnancy only changed little (less than 10%). Continued use of SSRIs among singleton pregnancies doubled over the study period. The low rate of AD switching and little changes in the DDD adjustment for most AD continuers indicate that pregnant women prefer to continue their prepregnancy medication rather than switch it. Most observed findings cohere with the Dutch national guidelines for antidepressant use during pregnancy.
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Affiliation(s)
- Robiyanto Robiyanto
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Program Studi Farmasi, Fakultas Kedokteran, Universitas Tanjungpura, Pontianak, Indonesia
| | - Marjolein Roos
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of PharmacoTherapy, Epidemiology, & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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15
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Zhou G, de Vos S, Schuiling-Veninga CCM, Bos J, Oude Rengerink K, Pasmooij AMG, Mol PGM, de Bock GH, Hak E. Community Use of Repurposed Drugs Before and During COVID-19 Pandemic in the Netherlands: An Interrupted Time-Series Analysis. Clin Epidemiol 2023; 15:923-937. [PMID: 37694159 PMCID: PMC10488695 DOI: 10.2147/clep.s418069] [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: 04/20/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Abstract
Background Repurposing registered drugs could reduce coronavirus disease (COVID-19) burden before novel drugs are authorized. Little is known about how the pandemic and imposed restrictions changed their dispensing. We aimed to investigate the impact of COVID-19 pandemic on repurposed drugs dispensing in the Netherlands. Methods We performed interrupted time-series study using University of Groningen prescription database IADB.nl to evaluate dispensing trends of 24 repurposed drugs before (2017-February 2020) and after (March 2020-2021) the pandemic' start. Primary outcomes were monthly prevalence and incidence rates. An autoregressive integrated moving average model assessed the effect of pandemic and stringency index (measuring strictness of government's restriction policies). Results Annual number of IADB.nl population ranged from 919,697 to 952,400. Generally, dispensing of common long-term-used drugs was not significantly affected by pandemic. The prevalence of antibacterials (-4.20 users per 1000 people), antivirals (-0.04), corticosteroids (-1.29), prednisolone (-1.32), calcium channel blocker (-0.41), and diuretics (-1.29) was lower than expected after the pandemic's start, while the prevalence of ivermectin (0.07), sulfonylureas (0.15), sodium-glucose co-transporter-2 (SGLT2) inhibitor (0.17), and anticoagulants (1.95) was higher than expected. The pandemic was associated with statistically significant decreases in the incidence of antibacterials (-1.21), corticosteroids (-0.60), prednisolone (-0.64) and anticoagulants (-0.02), and increases in ivermectin (0.02), aggregated antidiabetic drugs (0.13), and SGLT2 inhibitors (0.06). These trends were positively associated with pandemic and negatively associated with stringency index. Conclusion Dispensing of most drugs was not significantly associated with pandemic and government's response. Despite some statistically significant disruptions, these were not necessarily clinically relevant due to small absolute differences observed.
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Affiliation(s)
- Guiling Zhou
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Stijn de Vos
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Jens Bos
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | | | | | - Peter G M Mol
- Medicines Evaluation Board, Utrecht, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTEE), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
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16
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Mubarik S, Malik SS, Yanran Z, Hak E, Nawsherwan, Wang F, Yu C. Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus. BMC Med 2023; 21:299. [PMID: 37653535 PMCID: PMC10472654 DOI: 10.1186/s12916-023-03004-4] [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: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. METHODS In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. RESULTS Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented. CONCLUSIONS The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.
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Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Saima Shakil Malik
- Center for Biotechnology & Genomic Medicine (CBGM) Medical College of Georgia Augusta University, 1462 Laney Walker Blvd, Augusta, GA, 30912-4810, USA
| | - Zhang Yanran
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Research Center for Infectious Diseases; Wuhan Research Center for Communicable Disease Diagnosis and Treatment, Chinese Academy of Medical Sciences; Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Eelko Hak
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, 361000, China
| | - Fang Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China.
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Li X, Bijlsma MJ, Bos JHJ, Schuiling-Veninga CCM, Hak E. Long-term comparative effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events: a population-based retrospective inception cohort study in the Netherlands. BMJ Open 2023; 13:e068721. [PMID: 37558444 PMCID: PMC10414115 DOI: 10.1136/bmjopen-2022-068721] [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: 09/29/2022] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the long-term effectiveness of antihypertensive monotherapies in primary prevention of cardiovascular events. DESIGN Retrospective inception cohort study covering a 25-year study period. SETTING University Groningen IADB.nl pharmacy prescription database with data from 1996 to 2020. PARTICIPANTS Patients aged 18 years or older, free of any cardiovascular disease (CVD) drug therapies prior to initiation of a preventive antihypertensive monotherapy (ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), beta-blockers (BBs), calcium channel blockers (CCBs) and thiazides). OUTCOME MEASURES Primary outcome was the time to first prescription of acute cardiac drug therapy (CDT) measured by valid drug proxies to identify a first major CVD event in patients without a history of CVD. RESULTS Among 33 427 initiators, 5205 (15.6%) patients experienced an acute CDT. The average follow-up time was 7.9±5.5 years. The 25-year incidence rate per 1000 person-years were 25.3, 22.4, 18.2, 24.4 and 22.0 for ACEI, ARB, BB, CCB and thiazide starters, respectively. Inverse probability of treatment-weighted Cox regression showed that thiazide starters had lower hazards than the reference BB starters (HR: 0.88, 95% CI: 0.81 to 0.95). Among patients on diabetes drugs, risks were lower (HR: 0.49, 95% CI: 0.28 to 0.85). CCB starters had higher hazards than reference BB (HR: 1.21, 95% CI: 1.07 to 1.36). The overall estimated number needed to treat for thiazides compared with BBs to prevent one acute CDT in 25 years was 26, and four among patients on diabetes drugs. CONCLUSIONS After adjustments for confounders, patients starting on monotherapy with thiazides had a lower incidence of CDT compared with those starting on BBs, notably among patients on diabetes drugs. Conversely, patients who began CCB monotherapy had a higher incidence of CDT compared with those starting on BBs. Other monotherapies had comparable incidence of cardiovascular disease compared with BBs.
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Affiliation(s)
- Xuechun Li
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Maarten J Bijlsma
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany
| | - Jens H J Bos
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Zhou G, Verweij S, Bijlsma MJ, de Vos S, Oude Rengerink K, Pasmooij AMG, van Baarle D, Niesters HGM, Mol P, Vonk JM, Hak E. Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis. BMJ Open Respir Res 2023; 10:e001674. [PMID: 37640510 PMCID: PMC10462970 DOI: 10.1136/bmjresp-2023-001674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults. DESIGN Systematic review. ELIGIBILITY Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease. DATA SOURCE PubMed and Embase (1 January 2020-28 September 2022). RISK OF BIAS Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies. DATA ANALYSIS Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available. RESULTS In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies. CONCLUSIONS Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection. PROSPERO REGISTRATION NUMBER CRD42021292797.
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Affiliation(s)
- Guiling Zhou
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stefan Verweij
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
| | - Maarten J Bijlsma
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | | | | | - Debbie van Baarle
- Virology and Immunology Research Group, Department of Medical Microbiology and Infection Prevention, University Medical Centre, Groningen, The Netherlands
| | - Hubert G M Niesters
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter Mol
- Dutch Medicines Evaluation Board, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre, Groningen, The Netherlands
| | - Judith M Vonk
- Groningen Research Institute for Asthma and COPD, University Medical Centre, Groningen, The Netherlands
- Department of Epidemiology, University Medical Centre, Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Steenhuis D, de Vos S, Bos JH, Hak E. Risk factors for drug-treated major adverse cardio-cerebrovascular events in patients on primary preventive statin therapy: A retrospective cohort study. Prev Med Rep 2023; 34:102258. [PMID: 37292425 PMCID: PMC10244680 DOI: 10.1016/j.pmedr.2023.102258] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 06/10/2023] Open
Abstract
We aim to identify risk factors of major adverse cardio-cerebrovascular events (MACCE) using a proxy of drug treatment for a MACCE after the start of statin therapy in the primary cardiovascular prevention group, taking drug dose, persistency and adherence into account. We conducted a retrospective inception cohort study using data from the University of Groningen prescription database IADB.nl, covering patients in the Northern part of the Netherlands. We identified adult starters on primary preventive statin therapy as patients without any statin or cardiovascular drug prescription in the two years before the first statin dispensing and used a weighted Cox proportional hazard model to estimate hazard ratios (HR) with their 95 % confidence intervals (95 %CI). Among 39,487 primary preventive statin starters, 23% received drug treatment for a MACCE within a median follow-up period of four years. Increasing age, male gender and presence of diabetes drug treatment were significantly associated with the outcome (HR: 1.03; 95 %CI: 1.02-1.04; HR: 1.27; 95 %CI: 1.12-1.44 and HR: 1.39; 95 %CI: 1.24-1.56, respectively). If patients remained statin therapy persistent, adherence was no longer associated with drug treatment for a MACCE. In 23 % of the statin therapy initiators, incident drug treatment for a MACCE occurred with a median of four years. To reduce event rates in this group, older patients, males and diabetes patients should be closely monitored. Non-adherence in the early stage of treatment should be avoided to prevent non-persistence.
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Mommers I, van Boven JFM, Schuiling-Veninga CCM, Bos JHJ, Koetsier M, Hak E, Bijlsma MJ. Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study. Clin Epidemiol 2023; 15:721-732. [PMID: 37337562 PMCID: PMC10276997 DOI: 10.2147/clep.s410036] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm. Patients and Methods We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot. Results At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up. Conclusion The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.
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Affiliation(s)
- Irene Mommers
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Jens H J Bos
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Marten Koetsier
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Maarten J Bijlsma
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
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Jean Baptiste AE, Van der Schans J, Bawa S, Masresha B, Wagai J, Oteri J, Dieng B, Soyemi M, Eshuchi R, Yehualashet YG, Afolabi O, Braka F, Bita A, Hak E. The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy. Health Econ Rev 2023; 13:36. [PMID: 37310530 PMCID: PMC10262122 DOI: 10.1186/s13561-023-00441-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] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 04/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of "non-selective" measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign. METHODS We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs. RESULTS The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs. CONCLUSIONS Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.
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Affiliation(s)
| | - Jurjen Van der Schans
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Samuel Bawa
- World Health Organization, Country Office, Abuja, Nigeria
| | - Balcha Masresha
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - John Wagai
- World Health Organization, Country Office, Abuja, Nigeria
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations (GAVI), Abuja, Nigeria
| | - Margaret Soyemi
- United Nations Children's Fund (UNICEF) - Country Office for Nigeria, Abuja, Nigeria
| | - Rufus Eshuchi
- United Nations Children's Fund (UNICEF) - Country Office for Nigeria, Abuja, Nigeria
| | | | | | - Fiona Braka
- World Health Organization, Country Office, Abuja, Nigeria
| | - André Bita
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Edens MA, van Dijk PR, Hak E, Bilo HJG. Determinants of excessive weight gain after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 60). Diabetes Res Clin Pract 2023; 200:110719. [PMID: 37196706 DOI: 10.1016/j.diabres.2023.110719] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/20/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
AIMS To explore determinants of excessive weight gain after initiation of insulin therapy in type 2 diabetes mellitus (T2DM), in particular variables identified in the pre-insulin phase. METHODS We performed a retrospective observational intervention cohort study, by means of a new user design/ inception cohort concerning n=5086 patients. We studied determinants of excessive weight gain (5 kg or more) in the first year after initiation of insulin therapy, using both visualization and logistic regression analysis with subsequent receiver operation characteristic (ROC) analyses. Potential determinants pre-, at- and post-insulin initiation were included. RESULTS One out of 10 patients (10.0%) gained 5 kg weight or more. The earliest determinants of excessive weight gain were weight change (inversely) and HbA1c change in the two years prior to insulin therapy (p<0.001). Patients that lost weight parallel with HbA1c rise in the two-years pre-insulin, showed the most pronounced weight gain. Of these patients, roughly one out of five (20.3%) gained 5 kg weight or more. CONCLUSIONS Clinicians and patients should be alert for excessive weight gain after initiation of insulin, in the case of weight loss prior to insulin therapy initiation, particularly with increasing and prolonged high HbA1c at (and after) insulin initiation.
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Affiliation(s)
- Mireille A Edens
- Diabetes Research Center, Dokter van Deenweg 1, 8025 BP Zwolle, the Netherlands; Epidemiology Unit, Department Innovation and Science, Isala Hospital, Dokter van Deenweg 1, 8025 BP Zwolle, the Netherlands.
| | - Peter R van Dijk
- Diabetes Research Center, Dokter van Deenweg 1, 8025 BP Zwolle, the Netherlands; Department of Endocrinology, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands.
| | - Henk J G Bilo
- Diabetes Research Center, Dokter van Deenweg 1, 8025 BP Zwolle, the Netherlands; Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
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Haisma MS, Greven N, Logendran M, Bos J, van der Vegt B, Horváth B, De Vos S, De Bock GH, Hak E, Rácz E. Chronic Use of Hydrochlorothiazide and Risk of Skin Cancer in Caucasian Adults: A PharmLines Initiative Inception Cohort Study. Acta Derm Venereol 2023; 103:adv3933. [PMID: 37014269 PMCID: PMC10108616 DOI: 10.2340/actadv.v103.3933] [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: 06/30/2022] [Accepted: 01/11/2023] [Indexed: 04/05/2023] Open
Abstract
Photosensitizing properties of hydrochlorothiazide may increase skin cancer risk. To date, study findings on the association between hydrochlorothiazide use and skin cancer risk are inconsistent, notably regarding confounding and dose-response. The aim of this study was to investigate the association between hydrochlorothiazide use and incidence of skin cancer in a cohort of unselected Caucasian adults, taking dosing into account. As part of the PharmLines Initiative, which links data from the Lifelines Cohort Study and prescription database IADB.nl, patients aged ≥ 40 years were included from Lifelines, a prospective population-based cohort study in the north of the Netherlands. Skin cancer incidence was compared between subjects starting hydrochlorothiazide treatment (n = 608), subjects starting treatment with other antihypertensives (n = 508), and non-antihypertensive long-term medication users (n = 1,710). Cox regression analyses were performed to obtain hazard ratios, adjusted for potential confounders. The risk of any skin cancer, keratinocyte carcinoma, basal cell carcinoma and squamous cell carcinoma was not significantly increased in general hydrochlorothiazide users. A clear association was observed between high cumulative hydrochlorothiazide use (≥ 5,000 defined daily dose; ≥ 125,000 mg) and the risk of any skin cancer (adjusted hazard ratio 5.32, 95% confidence interval (95% CI) 2.40-11.81), keratinocyte carcinoma (adjusted hazard ratio 7.31, 95% CI 3.12-17.13), basal cell carcinoma (adjusted hazard ratio 7.72, 95% CI 3.11-19.16) and squamous cell carcinoma (adjusted hazard ratio 19.63, 95% CI 3.12-123.56). These findings should lead to awareness with high use of hydrochlorothiazide in Caucasian adults.
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Affiliation(s)
- Marjolijn S Haisma
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nathalie Greven
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathanhy Logendran
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jens Bos
- Groningen Research Institute of Pharmacy, Unit PharmacoTherapy, -Epidemiology &-Economics, University of Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stijn De Vos
- Groningen Research Institute of Pharmacy, Unit PharmacoTherapy, -Epidemiology &-Economics, University of Groningen, Groningen, The Netherlands
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit PharmacoTherapy, -Epidemiology &-Economics, University of Groningen, Groningen, The Netherlands
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Knobbe TJ, Kremer D, Douwes RM, Eisenga MF, Gomes-Neto AW, Annema C, Swarte JC, Klont F, Navis G, Berger SP, Bakker SJL, Bodewes FAJA, de Boer MT, Damman K, de Borst MH, Diepstra A, Dijkstra G, Doorenbos CSE, Erasmus ME, Gan CT, Hak E, Hepkema BG, Leuvenink HGD, Lexmond WS, de Meijer VE, Niesters HGM, Pelt LJV, Pol RA, Porte RJ, Ranchor AV, Sanders JSF, Siebelink MJ, Slart RJHJA, Touw DJ, van den Heuvel MC, van Leer-Buter C, van Londen M, Verschuuren EAM, Vos MJ, Weersma RK. Proton Pump Inhibitor Use, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Study. Am J Kidney Dis 2023:S0272-6386(23)00532-2. [PMID: 36801431 DOI: 10.1053/j.ajkd.2022.12.012] [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: 07/01/2022] [Accepted: 12/21/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE Prior studies report that the use of proton pump inhibitors (PPIs) can adversely affect gut microbiota and gastrointestinal uptake of micronutrients, in particular iron and magnesium, and are used frequently by kidney transplant recipients. Altered gut microbiota, iron deficiency, and magnesium deficiency have been implicated in the pathogenesis of chronic fatigue. Therefore, we hypothesized that PPI use may be an important and underappreciated cause of fatigue and reduced health-related quality of life (HRQoL) in this population. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Kidney transplant recipients (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Study. EXPOSURE PPI use, PPI type, PPI dosage, and duration of PPI use. OUTCOME Fatigue and HRQoL, assessed using the validated Checklist Individual Strength 20 Revised questionnaire and Short Form-36 questionnaire. ANALYTICAL APPROACH Logistic and linear regression. RESULTS We included 937 kidney transplant recipients (mean age 56±13 years, 39% female) at a median of 3 (1-10) years after transplantation. PPI use was associated with fatigue severity (regression coefficient 4.02, 95% CI, 2.18 to 5.85, P<0.001), a higher risk of severe fatigue (OR 2.05, 95% CI, 1.48 to 2.84, P<0.001), lower physical HRQoL (regression coefficient-8.54, 95% CI, -11.54 to-5.54, P<0.001), and lower mental HRQoL (regression coefficient-4.66, 95% CI, -7.15 to-2.17, P<0.001). These associations were independent of potential confounders including age, time since transplantation, history of upper gastrointestinal disease, antiplatelet therapy, and the total number of medications. They were present among all individually assessed PPI types and were dose dependent. Duration of PPI exposure was only associated with fatigue severity. LIMITATIONS Residual confounding and inability to assess causal relationships. CONCLUSIONS PPI use is independently associated with fatigue and lower HRQoL among kidney transplant recipients. PPI use might be an easily accessible target for alleviating fatigue and improving HRQoL among kidney transplant recipients. Further studies examining the effect of PPI exposure in this population are warranted.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen.
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Rianne M Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen
| | - J Casper Swarte
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Frank Klont
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen; Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
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Oktora MP, Yuniar CT, Amalia L, Abdulah R, Hak E, Denig P. Attitudes towards deprescribing and patient-related factors associated with willingness to stop medication among older patients with type 2 diabetes (T2D) in Indonesia: a cross-sectional survey study. BMC Geriatr 2023; 23:21. [PMID: 36635653 PMCID: PMC9835373 DOI: 10.1186/s12877-022-03718-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Deprescribing of preventive medication is recommended in older patients with polypharmacy, including people with type 2 diabetes (T2D). It seems that many patients in low-middle-income countries are not willing to have their medicines deprescribed. This study aims to assess attitudes of Indonesian patients with T2D towards deprescribing in general and regarding specific cardiometabolic medicines, and factors influencing their willingness to stop medicines. METHODS Primary care patients with T2D of ≥60 years in Indonesia completed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Attitudes in general and for cardiometabolic medicines were reported descriptively. Proportions of patients willing to stop one or more medicines when recommended by different healthcare professionals were compared with Chi-square test. Multiple regression analysis was used to analyse the influence between patient-related factors and the willingness to stop medicines. RESULTS The survey was completed by 196 participants (median age 69 years, 73% female). The percentages willing to stop medicines were 69, 67, and 41%, when the general practitioner (GP), the specialist, or the pharmacist initiates the process (p-value < 0.001). Higher perceived burden of medicines (p-value = 0.03) and less concerns about stopping (p-value < 0.001) were associated with a higher willingness to stop medicines if proposed by the GP. Patients using multiple glucose-regulating medicines were less willing to stop (p-value = 0.02). Using complementary or alternative medicines was not associated with the willingness to stop. If proposed by their pharmacist, patients without substantial education were more willing to stop than educated patients. CONCLUSIONS Only two-thirds of older people with T2D in Indonesia were willing to stop one or more of their medicines if the GP or specialist recommended this, and even less when the pharmacist proposed this. Attention should be given to concerns about stopping specific medicines, especially among patients using multiple glucose-lowering medicines, who may be more eligible but were less willing to accept deprescribing.
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Affiliation(s)
- Monika Pury Oktora
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
| | - Cindra Tri Yuniar
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Lia Amalia
- grid.434933.a0000 0004 1808 0563School of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Institut Teknologi Bandung (ITB), Bandung, Indonesia
| | - Rizky Abdulah
- grid.11553.330000 0004 1796 1481Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, Universitas Padjadjaran (UNPAD), Bandung, Indonesia
| | - Eelko Hak
- grid.4830.f0000 0004 0407 1981Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -Epidemiology and –Economics, University of Groningen, Groningen, The Netherlands
| | - Petra Denig
- grid.4830.f0000 0004 0407 1981University Medical Center Groningen (UMCG), Department of Clinical Pharmacy and Pharmacology, University of Groningen, Groningen, The Netherlands
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Robiyanto R, Schuiling-Veninga CCM, Bos JHJ, Hak E, van Puijenbroek EP. Exposure to psychotropic drugs before and during pregnancy: what has changed over the last two decades? Arch Womens Ment Health 2023; 26:39-48. [PMID: 36640183 PMCID: PMC9908723 DOI: 10.1007/s00737-023-01290-8] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
Trends in prescribing psychotropic drugs before and during pregnancy may have changed over the years, but actual information is lacking. We therefore compared and assessed the exposure and acceptance rates of classes of antipsychotic (+ lithium), anxiolytic, sedative/hypnotic, antidepressant, and psychostimulant before and during pregnancy in the past two decades. All singleton pregnancies with ≥1 prescription of psychotropic drug from six months before pregnancy until child's birthdate were identified in the pregnancy subset of the IADB.nl prescription database. The prescription patterns of psychotropics were distinguished as continuation rate (CR), initiation rate (IR), discontinuation rate (DR), total exposure rate (TER), and acceptance rate. Singleton pregnancies exposed to psychotropic drugs before and during pregnancy increased from 118.4 to 136.5 (per 1000 singleton pregnancies) between decades. Changing trends were observed in decade 2, including a high increase in the TER of antipsychotic class (3.3 to 6.8) and antidepressant class (23.0 to 40.6). A marked increase for individual drugs was seen for sertraline (TER: 0.6 to 6.6 and PAT: 35.3% to 82.5%), citalopram (TER: 2.3 to 10.0 and PAT: 51.1% to 74.6%), and quetiapine (TER: 0.4 to 3.1 and PAT: 57.1% to 66.0%). Although the total exposure rates of five classes of psychotropics in singleton pregnancies increased in decade 2, only antidepressant class had a higher acceptance rate during pregnancy. Certain SSRI antidepressants and atypical antipsychotics were more frequently prescribed in decade 2 than in decade 1, reflecting that treatment options were preferred for safer treatment choices.
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Affiliation(s)
- Robiyanto Robiyanto
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands. .,Program Studi Farmasi, Fakultas Kedokteran, Universitas Tanjungpura, Pontianak, Indonesia.
| | - Catharina C M Schuiling-Veninga
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Eugène P van Puijenbroek
- Unit of Pharmacotherapy, -Epidemiology, & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands ,Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, The Netherlands
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27
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Hartwig CAM, Robiyanto R, de Vos S, Bos JHJ, van Puijenbroek EP, Hak E, Schuiling-Veninga CCM. In utero antidepressant exposure not associated with ADHD in the offspring: A case control sibling design. Front Pharmacol 2022; 13:1000018. [PMID: 36438827 PMCID: PMC9684082 DOI: 10.3389/fphar.2022.1000018] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022] Open
Abstract
Recent studies have reported an association between antidepressant (AD) use during pregnancy and the risk to develop attention-deficit/hyperactivity disorder (ADHD) in the offspring. However, the association might be confounded by risk factors in the pregnant parent. To control for unmeasured factors between pregnancies carried by the same parent, we set up a case-control sibling study using the University of Groningen prescription database IADB.nl. Children receiving medication for ADHD (cases) before the age of 16 years were matched to siblings not receiving such medication (controls). Exposure was defined as at least two prescriptions for any AD during pregnancy, i.e., the period of 39 weeks before the birth date of the offspring. Secondary analyses were performed to assess the effects of the degree of exposure (the amount of Defined Daily Doses) and the type of AD exposed to. Univariate and multivariate logistic regression was used to estimate odds ratios (ORs) with corresponding 95% confidence intervals (CI). In total, 2,833 children (1,304 cases and 1,529 controls) were included in the analysis. Exposure rate to ADs among cases and controls was 2.2% and 2.4%, respectively. After adjusting for the birth date of the child (as a proxy for the date of pregnancy), age of the pregnant parent at birth, use of psychostimulants, opioids, and antiepileptic drugs by the pregnant parent in the 15 months before birth of the child, an adjusted OR of 1.11 (95% CI 0.67–1.83) was found for the risk of ADHD in the offspring when exposed in utero to ADs. This indicates no increased risk of ADHD in offspring following in utero exposure to ADs. The secondary analyses revealed no statistically significant associations either. The present study provides further evidence that an association between in utero AD exposure and ADHD in offspring might not exist. This perceived association may be caused (at least partially) by confounding by indication. The extent to which depression in the pregnant parent could cause mental disorders such as ADHD in offspring, and the mechanisms involved, should be investigated in further studies.
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Affiliation(s)
- C. A. M. Hartwig
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - R. Robiyanto
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
- Program Studi Farmasi, Fakultas Kedokteran, Universitas Tanjungpura, Pontianak, Indonesia
- *Correspondence: R. Robiyanto,
| | - S. de Vos
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - J. H. J. Bos
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - E. P. van Puijenbroek
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
- Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch, Netherlands
| | - E. Hak
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - C. C. M. Schuiling-Veninga
- PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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Klont F, Sosnowski P, Kremer D, Knobbe TJ, Bonner R, Blokzijl H, Weersma RK, Bakker SJL, Investigators T, Hak E, Touw DJ, Hopfgartner G. Assessing the Potential of Untargeted SWATH Mass Spectrometry-Based Metabolomics to Differentiate Closely Related Exposures in Observational Studies. Metabolites 2022; 12:metabo12100942. [PMID: 36295843 PMCID: PMC9611019 DOI: 10.3390/metabo12100942] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
Mass spectrometry (MS) is increasingly used in clinical studies to obtain molecular evidence of chemical exposures, such as tobacco smoke, alcohol, and drugs. This evidence can help verify clinical data retrieved through anamnesis or questionnaires and may provide insights into unreported exposures, for example those classified as the same despite small but possibly relevant chemical differences or due to contaminants in reported exposure compounds. Here, we aimed to explore the potential of untargeted SWATH metabolomics to differentiate such closely related exposures. This data-independent acquisition MS-based profiling technique was applied to urine samples of 316 liver and 570 kidney transplant recipients from the TransplantLines Biobank and Cohort Study (NCT03272841), where we focused on the immunosuppressive drug mycophenolate, which is either supplied as a morpholino-ester prodrug or as an enteric-coated product, the illicit drug cocaine, which is usually supplied as an adulterated product, and the proton pump inhibitors omeprazole and esomeprazole. Based on these examples, we found that untargeted SWATH metabolomics has considerable potential to identify different (unreported) exposure or co-exposure metabolites and may determine variations in their abundances. We also found that these signals alone may sometimes be unable to distinguish closely related exposures, and enhancement of differentiation, for example by integration with pharmacogenomics data, is needed.
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Affiliation(s)
- Frank Klont
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, 1211 Geneva, Switzerland
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
- Correspondence: (F.K.); (G.H.)
| | - Piotr Sosnowski
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, 1211 Geneva, Switzerland
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Tim J. Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Ron Bonner
- Ron Bonner Consulting, Newmarket, ON L3Y 3C7, Canada
| | - Hans Blokzijl
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Rinse K. Weersma
- Department of Gastroenterology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - TransplantLines Investigators
- Group of Authors on Behalf of the Transplant Lines Biobank and Cohort Study, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Daan J. Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Gérard Hopfgartner
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, 1211 Geneva, Switzerland
- Correspondence: (F.K.); (G.H.)
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29
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Klont F, Stepanović S, Kremer D, Bonner R, Touw DJ, Hak E, Bakker SJ, Hopfgartner G. Untargeted ‘SWATH’ mass spectrometry-based metabolomics for studying chronic and intermittent exposure to xenobiotics in cohort studies. Food Chem Toxicol 2022; 165:113188. [DOI: 10.1016/j.fct.2022.113188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Hutten DR, Bos JHJ, de Vos S, Hak E. Targeting the Beta-2-Adrenergic Receptor and the Risk of Developing Alzheimer's Disease: A Retrospective Inception Cohort Study. J Alzheimers Dis 2022; 87:1089-1101. [PMID: 35466934 PMCID: PMC9198755 DOI: 10.3233/jad-215057] [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] [Indexed: 11/29/2022]
Abstract
Background: Animal studies suggested that β2-Adrenergic receptors (β2AR) may be a potential target for the treatment of Alzheimer’s disease (AD). Objective: This retrospective inception cohort study aimed to assess the association between antagonists and agonists of the β2AR and the risk of starting treatment for AD in older adults. Methods: A retrospective inception cohort study was conducted among older adults who initiated either non-selective βAR antagonists or selective β2AR agonists using the University Groningen IADB.nl prescription database (study period 1994–2019). For each exposed cohort, two reference cohorts (A and B) were matched on age at index date. The main outcome was defined as at least two prescriptions for cholinesterase inhibitors (rivastigmine, galantamine, and donepezil) and/or memantine. Cox proportional hazard regression models were used to estimate hazard ratios (HR). Results: The risk of developing AD was elevated among patients exposed to non-selective βAR antagonists (A: aHR 3.303, 95% CI 1.230–8.869, B: aHR 1.569, 95% CI 0.560–4.394) and reduced among patients exposed to selective β2AR agonists (A: aHR 0.049, 95% CI 0.003–0.795, B: aHR 0.834, 95% CI 0.075–9.273) compared to reference patients. Conclusion: These findings suggest that exposure to non-selective βAR antagonists is associated with an increased risk for developing AD whereas there may be a decreased risk for developing AD after exposure to selective β2AR agonists.
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Affiliation(s)
- Danique R Hutten
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
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31
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Pradipta IS, Idrus LR, Probandari A, Puspitasari IM, Santoso P, Alffenaar JWC, Hak E. Barriers to Optimal Tuberculosis Treatment Services at Community Health Centers: A Qualitative Study From a High Prevalent Tuberculosis Country. Front Pharmacol 2022; 13:857783. [PMID: 35401200 PMCID: PMC8990794 DOI: 10.3389/fphar.2022.857783] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Community health centers (CHCs) are a backbone healthcare facility for tuberculosis (TB) services. Identifying barriers amongst TB service providers at the CHC level is required to help them deliver successful TB treatment.Aims: The current study aimed to analyze barriers to successful TB treatment from the perspective of TB service providers at the CHC level in a high prevalent TB country.Methods: A qualitative study was conducted using in-depth interviews and focus group discussions in a province of Indonesia with a high TB prevalence. Two districts representing rural and urban areas were selected to obtain information from TB service providers (i.e., physicians and nurses) at the CHC level. In addition, key informant interviews with TB patients, hospital TB specialists, pharmacists, and activists were conducted. The trustworthiness and credibility of the information were established using information saturation, participant validation, and triangulation approaches. The interviews were also transcribed for the inductive analysis using Atlas.ti 8.4 software.Results: We identified 210 meaning units from 48 participants and classified them into two main themes: organizational capacity and TB program activities. We identified the inadequacy of human resources, facility, and external coordination as the main barriers to organizational capacity. Furthermore, the barriers were identified regarding TB program activities, that is, inadequate TB case finding, diagnosis, drug supply chain and dispensing management, treatment and monitoring, case recording and reporting, and public-private collaboration.Conclusion: Strengthening CHCs in the management of TB is critical to reaching the national and global goals of TB eradication by 2035. These findings can be considered to develop evaluation strategies to improve the successful TB treatment in high prevalent TB countries, especially Indonesia.
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Affiliation(s)
- Ivan S. Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- *Correspondence: Ivan S. Pradipta,
| | - Lusiana R. Idrus
- Unit of Pharmaco-Therapy, Pharmaco-Epidemiology and Pharmaco-Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
- Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
- Disease Control Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Irma Melyani Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Drug Utilization and Pharmacoepidemiology Research Group, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Prayudi Santoso
- Division of Respirology and Critical Care Medicine, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Jan-Willem C. Alffenaar
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
- Werstmead Hospital, Sydney, NSW, Australia
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy, Pharmaco-Epidemiology and Pharmaco-Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
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Ridho A, Alfian SD, van Boven JFM, Levita J, Yalcin EA, Le L, Alffenaar JW, Hak E, Abdulah R, Pradipta IS. Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2022; 24:e33062. [PMID: 35195534 PMCID: PMC8908199 DOI: 10.2196/33062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023] Open
Abstract
Background Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. Objective This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. Methods A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. Results In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. Conclusions It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB.
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Affiliation(s)
- Abdurahman Ridho
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Doctor Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Center of the Northern Netherlands, Groningen, Netherlands
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Esin Aki Yalcin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Ly Le
- Vingroup Big Data Institute, Hanoi, Vietnam
| | - Jan-Willem Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Sydney Institute for Infectious Diseases, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - Eelko Hak
- Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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Hunt NB, Emmens JE, Irawati S, de Vos S, Bos JH, Wilffert B, Hak E, de Boer RA. Sex disparities in the effect of statins on lipid parameters: The PharmLines Initiative. Medicine (Baltimore) 2022; 101:e28394. [PMID: 35029178 PMCID: PMC8758030 DOI: 10.1097/md.0000000000028394] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
Real-world evidence on a potential statin effect modification by sex is inconclusive, especially for the primary prevention of cardiovascular disease (CVD). We aimed to quantify the differences in the effect of statins on lipid parameters between men and women.The PharmLines Initiative linked the Lifelines Cohort Study and the IADB.nl prescription database. This database covers a representative population from the Netherlands. We selected participants aged ≥40 years at the index date: the date of the first prescription of any statin monotherapy in the study period 2006 to 2017. Multivariate regression modeling was used to compare the difference of the mean percentage change of lipid parameters (% mean difference [MD]) from baseline to follow-up measurement between the sexes.Out of 5366 statin users from approximately 50,000 participants available in the final linked database, 685 were statin initiators. At baseline, women had significantly higher levels of mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) than men (all P values <.01). At follow-up, women had a significantly higher mean percentage change of HDL-C compared to men (adjusted % MD 5.59, 95% confidence interval [CI] 2.42-8.75, P < .01). There was no significant sex difference in other parameters, nor in the proportion of men and women who achieved LDL-C ≤2.5 mmol/L.Statins appear to have a greater effect on increasing HDL-C levels in women than men while showing similar effect on other lipid parameters in both sexes. Men should not be treated differently than women.
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Affiliation(s)
- Nicholas B. Hunt
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Johanna E. Emmens
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sylvi Irawati
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- Centre for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Jens H.J. Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- University of Groningen, Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Wang Y, Pera V, Boezen HM, Alffenaar JWC, Wilffert B, Groenwold RHH, Hak E. Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative. Respiration 2022; 101:553-564. [PMID: 34979502 DOI: 10.1159/000520884] [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: 02/14/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. OBJECTIVES This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. METHODS A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14-30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. RESULTS Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40-0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28-0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78-2.84]). The risk of and time to the next exacerbation was similar for both groups. CONCLUSION Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Victor Pera
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia.,Westmead Hospital, Sydney, New South Wales, Australia.,Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Irawati S, Emmens JE, de Vos S, Bos JHJ, de Boer RA, Hak E. Association between adherence to statin therapy and low-density lipoprotein cholesterol (LDL-c) response in first-time users of standard-dose and low-dose statins: the PharmLines initiative. Curr Med Res Opin 2022; 38:1-6. [PMID: 34555980 DOI: 10.1080/03007995.2021.1984222] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether statin adherence (defined as proportion days covered, PDC) is associated with LDL-c response in statin initiators on standard and low starting doses of statins, and to detect a possible interaction with sex. METHODS An inception cohort study was conducted using the PharmLines Initiative, a linkage between the Lifelines Cohort Study and the University of Groningen's IADB.nl (prescription database). First-time statin users were followed from baseline to follow-up measurement. We matched participants (1:1) between the standard-dose and the low-dose group of statin users on the duration of follow-up. Multiple linear regression analysis was used to model the association. RESULTS In univariate analysis, PDC was significantly associated with LDL-c response similarly (slope = -0.021), in both the standard-dose group (N = 115, p < .001) and the low-dose group (N = 115, p = .003). In the standard-dose group, the same level of PDC appeared to be significantly associated with a greater LDL-c level reduction in women (slope = -0.027, N = 48, p < .001) than in men (slope = -0.017, N = 67, p < .001). Meanwhile, in the low-dose group, the reduction of LDL-c level from baseline seemed to be greater in men (slope = -0.023, N = 56, p < .001) than in women (slope = -0.020, N = 59, p < .001) for the same level of PDC. In multiple regression analysis, the significant association between PDC and LDL-c with a similar pattern to the univariate result was maintained only in the standard-dose group. CONCLUSIONS Adherence is significantly associated with LDL-c response to statins at follow-up. Sex appears to significantly modify this association. At a similar adherence level, women seem to experience a better LDL-c response to standard-dose statins compared to men in a real-world setting.
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Affiliation(s)
- Sylvi Irawati
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
- Centre for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, Indonesia
| | - Johanna E Emmens
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stijn de Vos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, University of Groningen, Groningen, The Netherlands
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Alfian SD, Annisa N, Iskandarsyah A, Perwitasari DA, Denig P, Hak E, Abdulah R. Emotional Distress is Associated with Lower Health-Related Quality of Life Among Patients with Diabetes Using Antihypertensive and/or Antihyperlipidemic Medications: A Multicenter Study in Indonesia. Ther Clin Risk Manag 2021; 17:1333-1342. [PMID: 34908842 PMCID: PMC8665871 DOI: 10.2147/tcrm.s329694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the associations between different types of diabetes distress and health-related quality of life (HRQOL) among patients with type 2 diabetes (T2DM) using antihypertensive and/or antihyperlipidemic medications in Indonesia and to explore the differences between those using only antihypertensive, only antihyperlipidemic, or both medications. Methods A multicenter cross-sectional study was conducted in Community Health Centers in three cities in Indonesia among patients with T2DM aged at least 18 years who were using antihypertensive and/or antihyperlipidemic medications. Diabetes distress subscales (emotional, regimen-related, interpersonal, and physician-related distress) and HRQOL were assessed using a validated diabetes distress scale-17 and EQ-5D-5L scale, respectively. Multiple linear regression models were used to evaluate the associations between different types of diabetes distress and HRQOL adjusting for confounders. Results Most of the 503 participants were females (67.6%) and aged 60–69 years (40.8%). Emotional distress was negatively associated with HRQOL among the whole group of patients (β: −0.08; 95% confidence interval (CI): −0.10, −0.05; p < 0.001). This association was similar across all therapeutic subgroups. Regimen-related distress (β: −0.06; 95% CI: −0.09, −0.03; p < 0.001) and interpersonal distress (β: −0.02; 95% CI: −0.05, −0.01; p = 0.022) were negatively associated, whereas physician-related distress (β: 0.04; 95% CI: 0.01, 0.07; p = 0.037) was positively associated with HRQOL among the whole group. These associations were also observed among those using only antihypertensive medication. Conclusion Emotional distress affects HRQOL in T2DM patients treated for cardiovascular comorbidities, independent of antihypertensive and/or antihyperlipidemic medication use.
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Affiliation(s)
- Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Nurul Annisa
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Unit of Clinical Pharmacy and Community, Faculty of Pharmacy, Universitas Mulawarman, Samarinda, Indonesia
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Dyah A Perwitasari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Unit of Pharmaco-Therapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
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37
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Pradipta IS, Idrus LR, Probandari A, Lestari BW, Diantini A, Alffenaar JWC, Hak E. Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient's perspective. BMC Public Health 2021; 21:1903. [PMID: 34670527 PMCID: PMC8529853 DOI: 10.1186/s12889-021-12005-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/12/2020] [Accepted: 10/11/2021] [Indexed: 02/07/2023] Open
Abstract
Background Previously treated tuberculosis (TB) patients are a widely reported risk factor for multidrug-resistant tuberculosis. Identifying patients’ problems during treatment is necessary to control TB, especially in a high-burden setting. We therefore explored barriers to successful TB treatment from the patients’ perspective, aiming to identify potential patient-centred care strategies to improve TB treatment outcome in Indonesia. Methods A qualitative study was conducted in a province of Indonesia with high TB prevalence. Participants from various backgrounds (i.e., TB patients, physicians, nurses, pharmacists, TB activist, TB programmers at the district and primary care levels) were subject to in-depth interviews and focus group discussions (FGDs). All interviews and FGDs were transcribed verbatim from audio and visual recordings and the respective transcriptions were used for data analysis. Barriers were constructed by interpreting the codes’ pattern and co-occurrence. The information’s trustworthiness and credibility were established using information saturation, participant validation and triangulation approaches. Data were inductively analysed using the Atlas.ti 8.4 software and reported following the COREQ 32-items. Results We interviewed 63 of the 66 pre-defined participants and identified 15 barriers. The barriers were classified into three themes, i.e., socio-demography and economy; knowledge and perception and TB treatment. Since the barriers can be interrelated, we determined five main barriers across all barrier themes, i.e., lack of TB knowledge, stigmatisation, long distance to the health facility, adverse drug reaction and loss of household income. Conclusion The main treatment barriers can be considered to strengthen patient-centred care for TB patients in Indonesia. A multi-component approach including TB patients, healthcare providers, broad community and policy makers is required to improve TB treatment success. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12005-y.
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Affiliation(s)
- Ivan S Pradipta
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands. .,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia. .,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia.
| | - Lusiana R Idrus
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands.,Bekasi General Hospital, West Java Local Government, Bekasi, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia.,Disease Control Research Group, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Bony W Lestari
- Department of Public Health, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Jan-Willem C Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, Groningen, The Netherlands.,Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Werstmead Hospital, Sydney, Australia
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmaco-Therapy, -Epidemiology and -Economics (PTE2), University of Groningen, Antonius Deusinglaan 1, 9713, AV, Groningen, The Netherlands
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Wang Y, van Boven JFM, Bos JHJ, Schuiling-Veninga CCM, Boezen HM, Wilffert B, Hak E. Risk of neuropsychiatric adverse events associated with varenicline treatment for smoking cessation among Dutch population: A sequence symmetry analysis. Pharmacoepidemiol Drug Saf 2021; 31:158-166. [PMID: 34464494 PMCID: PMC9292305 DOI: 10.1002/pds.5351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/12/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose Varenicline is an effective treatment for smoking cessation. While clinical trials did not confirm a causal role, case reports suggested a possible link of varenicline with neuropsychiatric adverse drug events (NPAEs). This study aims to investigate the risk of NPAEs associated with varenicline initiation among the general population in a real‐world setting. Methods We conducted a sequence symmetry analysis (SSA) based on the University of Groningen IADB.nl prescription database. We selected incident users of both varenicline and marker drugs for NPAEs, including depression, anxiety and sleep disorder within different time‐intervals. Adjusted sequence ratios (aSR) were calculated for each time‐interval. Results Within 365‐days' time‐interval 1066 patients were incident users of both varenicline and NPAE marker drugs. In total, 505 patients were prescribed varenicline before NPAE marker drugs and 561 vice versa (crude sequence ratio [cSR] 0.90, 95% CI: 0.80–1.02). After adjustments for trends in prescriptions, overall a null association was found (aSR 1.00, 95% CI: 0.89–1.13). Regarding specific NPAEs, no increased risks were found for depression nor anxiety within any time‐interval. A small transient increased risk was found for sleep disorders, particularly in earlier time‐intervals 3 and 6 months (aSRs 1.52, 95% CI: 1.10–2.11 and 1.45, 95% CI: 1.15–1.83, respectively). Subgroup and sensitivity analyses showed similar findings. Conclusions Varenicline initiation was unlikely to be associated with an increased risk of taking anti‐depressants nor anti‐anxiety drugs. Yet a small, but statistically significant, transient association with drugs for sleep disorders was noticed, possibly associated with withdrawal symptoms caused by smoking cessation.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.,Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Akkerman-Nijland AM, Möhlmann JE, Akkerman OW, Vd Vaart H, Majoor CJ, Rottier BL, Burgerhof JGM, Hak E, Koppelman GH, Touw DJ. The long-term safety of chronic azithromycin use in adult patients with cystic fibrosis, evaluating biomarkers for renal function, hepatic function and electrical properties of the heart. Expert Opin Drug Saf 2021; 20:959-963. [PMID: 34030570 DOI: 10.1080/14740338.2021.1932814] [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: 10/21/2022]
Abstract
Background: Azithromycin maintenance therapy is widely used in cystic fibrosis (CF), but little is known about its long-term safety. We investigated whether chronic azithromycin use is safe regarding renal function, hepatic cell toxicity and QTc-interval prolongation.Methods: Adult CF patients (72 patients using azithromycin for a cumulative period of 364.8 years and 19 controls, 108.8 years) from two CF-centers in the Netherlands with azithromycin (non)-use for at least three uninterrupted years were studied retrospectively.Results: There was no difference in mean decline of estimated glomerular filtration rate (eGFR), nor in occurrence of eGFR-events. No drug-induced liver injury could be attributed to azithromycin. Of the 39 azithromycin users of whom an ECG was available, 4/39 (10.3%) had borderline and 4/39 (10.3%) prolonged QTc-intervals, with 7/8 patients using other QTc-prolonging medication. Of the control patients 1/6 (16.7%) had a borderline QTc-interval, without using other QTc-prolonging medication. No cardiac arrhythmias were observed.Conclusion: We observed no renal or hepatic toxicity, nor cardiac arrythmias during azithromycin use in CF patients for a mean study duration of more than 5 years. One should be aware of possible QTc-interval prolongation, in particular in patients using other QTc-interval prolonging medication.
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Affiliation(s)
- A M Akkerman-Nijland
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J E Möhlmann
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
| | - O W Akkerman
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - H Vd Vaart
- University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, University of Groningen, Groningen, Netherlands
| | - C J Majoor
- Amsterdam University Medical Centers, Department of Respiratory Medicine, University of Amsterdam, Amsterdam, The Netherlands
| | - B L Rottier
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - J G M Burgerhof
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands
| | - E Hak
- University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen, The Netherlands.,Department of Pharmacotherapy, -epidemiology and economics, Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, -epidemiology & -economics, University of Groningen, Groningen, The Netherlands
| | - G H Koppelman
- University Medical Center Groningen, Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands.,Department of Pediatric Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
| | - D J Touw
- University Medical Center Groningen, Department of Clinical Pharmacy & Pharmacology, University of Groningen, Groningen, The Netherlands
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40
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Wang Y, Bos JH, Schuiling-Veninga CCM, Boezen HM, van Boven JFM, Wilffert B, Hak E. Neuropsychiatric safety of varenicline in the general and COPD population with and without psychiatric disorders: a retrospective cohort study in a real-world setting. BMJ Open 2021; 11:e042417. [PMID: 34035088 PMCID: PMC8154988 DOI: 10.1136/bmjopen-2020-042417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the real-world association between varenicline and neuropsychiatric adverse events (NPAEs) in general and chronic obstructive pulmonary disease (COPD) population with and without psychiatric disorders compared with nicotine replacement therapy (NRT) to strengthen the knowledge of varenicline safety. DESIGN A retrospective cohort study. SETTING Prescription database IADB.nl, the Netherlands. PARTICIPANTS New users of varenicline or NRT among general (≥18 years) and COPD (≥40 years) population. Psychiatric subcohort was defined as people prescribed psychotropic medications (≥2) within 6 months before the index date. OUTCOME MEASURES The incidence of NPAEs including depression, anxiety and insomnia, defined by new or naive prescriptions of related medications in IADB.nl within 24 weeks after the first treatment initiation of varenicline or NRT. RESULTS For the general population in non-psychiatric cohort, the incidence of total NPAEs in varenicline (4480) and NRT (1970) groups was 10.5% and 12.6%, respectively (adjusted OR (aOR) 0.85, 95% CI 0.72 to 1.00). For the general population in psychiatric cohort, the incidence of total NPAEs was much higher, 75.3% and 78.5% for varenicline (1427) and NRT (1200) groups, respectively (aOR 0.82, 95% CI 0.68 to 0.99). For the COPD population (1598), there were no differences in the incidence of NPAEs between comparison groups in both the psychiatric cohort (aOR 0.97, 95% CI 0.66 to 1.44) and non-psychiatric cohort (aOR 0.81, 95% CI 0.54 to 1.20). Results from subgroup or sensitivity analyses also did not reveal increased risks of NPAEs but showed decreased risk of some subgroup NPAEs associated with varenicline. CONCLUSIONS In contrast to the concerns of a possible increased risk of NPAEs among varenicline users, we found a relative decreased risk of total NPAEs in varenicline users of the general population in psychiatric or non-psychiatric cohorts compared with NRT and no difference for NPAEs between varenicline and NRT users in smaller population with COPD.
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Affiliation(s)
- Yuanyuan Wang
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H Bos
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - H Marike Boezen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institutte of Pharmacy, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Alfian SD, van Boven JFM, Iskandarsyah A, Abdulah R, Hak E, Denig P. Process Evaluation of Implementing a Pharmacist-Led Intervention to Improve Adherence to Antihypertensive Drugs Among Patients with Type 2 Diabetes in Indonesian Community Health Centers. Front Pharmacol 2021; 12:652018. [PMID: 34025419 PMCID: PMC8131821 DOI: 10.3389/fphar.2021.652018] [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: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: A pharmacist-led intervention in Community Health Centers (CHCs) in Indonesia targeted at patients with type 2 diabetes non-adherent to antihypertensive drugs resulted in a significant improvement in adherence to these drugs. The aim of this study was to evaluate the process of implementation this intervention intended to improve adherence to antihypertensive drugs from both the pharmacist and the patient perspective. Methods: Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, we conducted a focus group among pharmacists (N = 5) and a survey among patients with complete follow-up (N = 44) participating in the intervention group. Results: All pharmacists adopted the provided training and found support tools useful. The pharmacists implemented the intervention as intended (adequate intervention fidelity >69%). Factors relevant for implementation included having sufficient time and confidence, home visits for specific patients, multidisciplinary collaboration, and availability of a personal counseling room. To maintain the intervention, the need for practical guidance and support from health care authorities was mentioned. Most patients (96%) were satisfied with the information provided by the pharmacists and they believed the tailored counselling was helpful. Most patients (84%) reported that the duration of counselling was sufficient. The large majority of patients would like to receive the counselling regularly. Conclusion: Positive effects of the pharmacist-led intervention can be explained by adequate levels of reach, adoption and implementation in the participating CHCs. For successful implementation and maintenance in Indonesia or other low-and middle-income countries, sufficient training, resources, multidisciplinary collaboration, guidance and support from health care authorities are expected to be important.
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Affiliation(s)
- Sofa D Alfian
- Unit Pharmaco-Therapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia.,Centre of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Eelko Hak
- Unit Pharmaco-Therapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Centre of the Northern Netherlands (MAECON), Groningen, Netherlands
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Varma VR, Wang Y, An Y, Varma S, Bilgel M, Doshi J, Legido-Quigley C, Delgado JC, Oommen AM, Roberts JA, Wong DF, Davatzikos C, Resnick SM, Troncoso JC, Pletnikova O, O’Brien R, Hak E, Baak BN, Pfeiffer R, Baloni P, Mohmoudiandehkordi S, Nho K, Kaddurah-Daouk R, Bennett DA, Gadalla SM, Thambisetty M. Bile acid synthesis, modulation, and dementia: A metabolomic, transcriptomic, and pharmacoepidemiologic study. PLoS Med 2021; 18:e1003615. [PMID: 34043628 PMCID: PMC8158920 DOI: 10.1371/journal.pmed.1003615] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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] [Received: 02/07/2020] [Accepted: 04/06/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND While Alzheimer disease (AD) and vascular dementia (VaD) may be accelerated by hypercholesterolemia, the mechanisms underlying this association are unclear. We tested whether dysregulation of cholesterol catabolism, through its conversion to primary bile acids (BAs), was associated with dementia pathogenesis. METHODS AND FINDINGS We used a 3-step study design to examine the role of the primary BAs, cholic acid (CA), and chenodeoxycholic acid (CDCA) as well as their principal biosynthetic precursor, 7α-hydroxycholesterol (7α-OHC), in dementia. In Step 1, we tested whether serum markers of cholesterol catabolism were associated with brain amyloid accumulation, white matter lesions (WMLs), and brain atrophy. In Step 2, we tested whether exposure to bile acid sequestrants (BAS) was associated with risk of dementia. In Step 3, we examined plausible mechanisms underlying these findings by testing whether brain levels of primary BAs and gene expression of their principal receptors are altered in AD. Step 1: We assayed serum concentrations CA, CDCA, and 7α-OHC and used linear regression and mixed effects models to test their associations with brain amyloid accumulation (N = 141), WMLs, and brain atrophy (N = 134) in the Baltimore Longitudinal Study of Aging (BLSA). The BLSA is an ongoing, community-based cohort study that began in 1958. Participants in the BLSA neuroimaging sample were approximately 46% male with a mean age of 76 years; longitudinal analyses included an average of 2.5 follow-up magnetic resonance imaging (MRI) visits. We used the Alzheimer's Disease Neuroimaging Initiative (ADNI) (N = 1,666) to validate longitudinal neuroimaging results in BLSA. ADNI is an ongoing, community-based cohort study that began in 2003. Participants were approximately 55% male with a mean age of 74 years; longitudinal analyses included an average of 5.2 follow-up MRI visits. Lower serum concentrations of 7α-OHC, CA, and CDCA were associated with higher brain amyloid deposition (p = 0.041), faster WML accumulation (p = 0.050), and faster brain atrophy mainly (false discovery rate [FDR] p = <0.001-0.013) in males in BLSA. In ADNI, we found a modest sex-specific effect indicating that lower serum concentrations of CA and CDCA were associated with faster brain atrophy (FDR p = 0.049) in males.Step 2: In the Clinical Practice Research Datalink (CPRD) dataset, covering >4 million registrants from general practice clinics in the United Kingdom, we tested whether patients using BAS (BAS users; 3,208 with ≥2 prescriptions), which reduce circulating BAs and increase cholesterol catabolism, had altered dementia risk compared to those on non-statin lipid-modifying therapies (LMT users; 23,483 with ≥2 prescriptions). Patients in the study (BAS/LMT) were approximately 34%/38% male and with a mean age of 65/68 years; follow-up time was 4.7/5.7 years. We found that BAS use was not significantly associated with risk of all-cause dementia (hazard ratio (HR) = 1.03, 95% confidence interval (CI) = 0.72-1.46, p = 0.88) or its subtypes. We found a significant difference between the risk of VaD in males compared to females (p = 0.040) and a significant dose-response relationship between BAS use and risk of VaD (p-trend = 0.045) in males.Step 3: We assayed brain tissue concentrations of CA and CDCA comparing AD and control (CON) samples in the BLSA autopsy cohort (N = 29). Participants in the BLSA autopsy cohort (AD/CON) were approximately 50%/77% male with a mean age of 87/82 years. We analyzed single-cell RNA sequencing (scRNA-Seq) data to compare brain BA receptor gene expression between AD and CON samples from the Religious Orders Study and Memory and Aging Project (ROSMAP) cohort (N = 46). ROSMAP is an ongoing, community-based cohort study that began in 1994. Participants (AD/CON) were approximately 56%/36% male with a mean age of 85/85 years. In BLSA, we found that CA and CDCA were detectable in postmortem brain tissue samples and were marginally higher in AD samples compared to CON. In ROSMAP, we found sex-specific differences in altered neuronal gene expression of BA receptors in AD. Study limitations include the small sample sizes in the BLSA cohort and likely inaccuracies in the clinical diagnosis of dementia subtypes in primary care settings. CONCLUSIONS We combined targeted metabolomics in serum and amyloid positron emission tomography (PET) and MRI of the brain with pharmacoepidemiologic analysis to implicate dysregulation of cholesterol catabolism in dementia pathogenesis. We observed that lower serum BA concentration mainly in males is associated with neuroimaging markers of dementia, and pharmacological lowering of BA levels may be associated with higher risk of VaD in males. We hypothesize that dysregulation of BA signaling pathways in the brain may represent a plausible biologic mechanism underlying these results. Together, our observations suggest a novel mechanism relating abnormalities in cholesterol catabolism to risk of dementia.
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Affiliation(s)
- Vijay R. Varma
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
| | - Youjin Wang
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Yang An
- Brain Aging and Behavior Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
| | - Sudhir Varma
- HiThru Analytics, Laurel, Maryland, United States of America
| | - Murat Bilgel
- Brain Aging and Behavior Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
| | - Jimit Doshi
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - João C. Delgado
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Anup M. Oommen
- Glycoscience Group, NCBES National Centre for Biomedical Engineering Science, National University of Ireland Galway, Galway, Ireland
| | - Jackson A. Roberts
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
| | - Dean F. Wong
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Christos Davatzikos
- Section for Biomedical Image Analysis, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Susan M. Resnick
- Brain Aging and Behavior Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
| | - Juan C. Troncoso
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Olga Pletnikova
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Richard O’Brien
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Brenda N. Baak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Ruth Pfeiffer
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Priyanka Baloni
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Siamak Mohmoudiandehkordi
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Kwangsik Nho
- Department of Radiology and Imaging Sciences and the Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Shahinaz M. Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Madhav Thambisetty
- Clinical and Translational Neuroscience Section, Laboratory of Behavioral Neuroscience, National Institute on Aging (NIA), National Institutes of Health (NIH), Baltimore, Maryland, United States of America
- * E-mail:
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Chimeh RA, Gafar F, Pradipta IS, Akkerman OW, Hak E, Alffenaar JWC, van Boven JFM. Clinical and economic impact of medication non-adherence in drug-susceptible tuberculosis: a systematic review. Int J Tuberc Lung Dis 2021; 24:811-819. [PMID: 32912386 DOI: 10.5588/ijtld.19.0754] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Despite considerable efforts to globally eradicate TB, and the availability of effective antibiotics, TB elimination goals are falling behind. While non-adherence to TB drug regimens may compromise effective treatment, its full impact is still unknown.OBJECTIVE: To determine the clinical and economic impact of non-adherence to TB medication on treatment outcomes in drug-susceptible TB patients (DS-TB).METHODS: A systematic review was performed using PubMed and Embase for studies published between 2009 and 2019 reporting associations between adherence and WHO-defined TB treatment outcomes and economic outcomes in DS-TB patients.RESULTS: A total of 14 studies were included. Eight focused on the association between non-adherence and death, 2 on treatment failure, 1 study on successful treatment outcome, 1 study on both successful and unsuccessful treatment outcomes and 2 on cost outcomes. Most studies (71.4%) were retrospective cohort or case-control studies. The results showed that non-adherence to TB drug regimens was associated with death, treatment failure and lower cure rates.CONCLUSION: Non-adherence to TB drugs has a profound impact on both clinical and economic TB outcomes. To reach WHO TB elimination goals, preventing non-adherence and the implementation of cost-effective intervention programmes should receive the highest priority.
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Affiliation(s)
- R A Chimeh
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen
| | - F Gafar
- Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - I S Pradipta
- Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands, Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Jawa Barat, Indonesia
| | - O W Akkerman
- Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, TB Center Beatrixoord, University Medical Center Groningen, University of Groningen, Haren
| | - E Hak
- Unit of PharmacoTherapy, Epidemiology, and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
| | - J-W C Alffenaar
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW, Marie Bashir Institute for Infectious Diseases and Biosecurity, Sydney, NSW, Australia
| | - J F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
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Jean Baptiste AE, Masresha B, Wagai J, Luce R, Oteri J, Dieng B, Bawa S, Ikeonu OC, Chukwuji M, Braka F, Sanders EAM, Hahné S, Hak E. Trends in measles incidence and measles vaccination coverage in Nigeria, 2008-2018. Vaccine 2021; 39 Suppl 3:C89-C95. [PMID: 33875267 DOI: 10.1016/j.vaccine.2021.03.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 02/21/2021] [Accepted: 03/31/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9-59 months), and intensified measles case-based surveillance system. METHODS We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017-18. Additionally, we analyzed measles case-based surveillance reports from 2008-2018 to determine annual, regional and age-specific incidence rates. FINDINGS Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9-11 months (524.0 per million) and 12-59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million). CONCLUSION The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals.
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Affiliation(s)
| | - Balcha Masresha
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - John Wagai
- World Health Organization, Country Office, Abuja, Nigeria
| | - Richard Luce
- World Health Organization, Inter-country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations, Nigeria
| | - Samuel Bawa
- World Health Organization, Country Office, Abuja, Nigeria
| | | | | | - Fiona Braka
- World Health Organization, Country Office, Abuja, Nigeria
| | - E A M Sanders
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, the Netherlands
| | - Susan Hahné
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, the Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
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Edens MA, van Dijk PR, Hak E, Bilo HJG. Course of body weight before and after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 58). Endocrinol Diabetes Metab 2021; 4:e00212. [PMID: 33855214 PMCID: PMC8029529 DOI: 10.1002/edm2.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
Aims The aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account. Materials and methods We performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five years post insulin therapy. We applied linear regression analysis on weight change in the first year after insulin therapy (T0 to T+1), with matched group as primary determinant adjusted for pre-insulin weight change and additional covariates. Results Estimated mean weight increased in the five consecutive years prior to insulin therapy (-0.23 kg in year T-5 to T-4, 0.01 kg in year T-4 to T-3, 0.07 kg in year T-3 to T-2, 0.24 kg in year T-2 to T-1, and 0.46 kg in year T-1 to T0) and continued to increase in the first year after, that is T0 to T+1, at a slightly lower rate (0.31 ± 3.9 kg). Pre-insulin weight change had the highest explained variance and was inversely and independently associated with weight change (p < .001). Starting insulin was associated with weight increase, independent of pre-insulin weight change (β-adjusted 1.228, p < .001). Stratification revealed that despite having a more or less similar baseline BMI, patients with substantial weight increase showed higher estimated mean BMI's followed by weight loss pre-insulin. In matched references, estimated mean weight changes were negative in all years concerning the study period, indicating consistent weight loss. Conclusions Initiation of insulin therapy was independently associated with weight increase; however, overall effect on weight was small and subject to substantial variation. Pre-insulin weight change is identified as a relatively strong inverse determinant of weight change after insulin initiation.
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Affiliation(s)
- Mireille A. Edens
- Diabetes Research CenterZwollethe Netherlands
- Epidemiology UnitDepartment Innovation and ScienceIsala HospitalZwollethe Netherlands
| | - Peter R. van Dijk
- Diabetes Research CenterZwollethe Netherlands
- Department of EndocrinologyUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
| | - Eelko Hak
- Groningen Research Institute of PharmacyUniversity of GroningenGroningenthe Netherlands
| | - Henk J. G. Bilo
- Diabetes Research CenterZwollethe Netherlands
- Department of Internal MedicineUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
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Jean Baptiste AE, Wagai J, Luce R, Masresha B, Klinkenberg D, Veldhuijzen I, Oteri J, Dieng B, Ikeonu OC, Meleh S, Musa A, Braka F, Hahné S, Sanders EAM, Hak E. Measles outbreak in complex emergency: estimating vaccine effectiveness and evaluation of the vaccination campaign in Borno State, Nigeria, 2019. BMC Public Health 2021; 21:437. [PMID: 33663439 PMCID: PMC7931537 DOI: 10.1186/s12889-021-10436-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND From January to May 2019, large measles outbreaks affected Nigeria. Borno state was the most affected, recording 15,237 suspected cases with the state capital of Maiduguri having 1125 cases investigated and line-listed by March 2019. In Borno state, 22 of the 27 Local Government Areas (LGAs or Districts), including 37 internally displaced persons (IDPs) camps were affected. In response to the situation, an outbreak response immunization (ORI) campaign was conducted in the 13 most affected LGAs. In addition to conventional vaccination teams, special teams were deployed in security compromised areas, areas with migrants, and for nomadic and IDPs. Here we describe the outbreak and the ORI campaign. We also assess the measles-containing vaccine (MCV) coverage and vaccine effectiveness (VE) in order to quantify the population-level impact. METHODS We reviewed the ORI activities, and conducted an analysis of the surveillance and the outbreak investigation reports. We assessed VE of MCV by applying the screening-method. Sensitivity analyses were also conducted to assess the effect of final classification of cases on the VE of MCV. The MCV coverage was assessed by a post-campaign coverage survey after completion of the ORI through a quantitative survey in the 12 LGAs that were accessible. RESULTS Of the total 15,237 reported measles cases, 2002 cases were line-listed and investigated, and 737 were confirmed for measles by week 9 of 2019. Of the investigated cases 67.3% (n = 1348) were between 9 and 59 months of age. Among the 737 confirmed cases, only 9% (n = 64) stated being vaccinated with at least 1 dose of MCV. The overall VE for MCV was 98.4% (95%CI: 97.8-98.8). No significant differences were observed in the VE estimates of lab-confirmed and epi-linked cases when compared to the original estimates. The aggregated weighted vaccination coverage was 85.7% (95% CI: 79.6-90.1). CONCLUSION The experience in Borno demonstrates that adequate VE can be obtained in conflict-affected areas. In complex emergencies affected by measles outbreaks, health authorities may consider integration with other health strategies and the engagement of security personnel as part of the ORI activities.
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Affiliation(s)
| | - John Wagai
- World Health Organization (WHO), Country Office, Abuja, Nigeria
| | - Richard Luce
- World Health Organization (WHO), Inter-country Support Team for West Africa, Ouagadougou, Burkina Faso
| | - Balcha Masresha
- World Health Organization (WHO), African Regional Office, Brazzaville, Congo
| | - Don Klinkenberg
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | - Irene Veldhuijzen
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations, Abuja, Nigeria
| | | | - Sule Meleh
- State Primary Health Care Development Agency, Maiduguri, Borno State, Nigeria
| | - Audu Musa
- World Health Organization (WHO), Country Office, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization (WHO), Country Office, Abuja, Nigeria
| | - Susan Hahné
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | - E A M Sanders
- National Institute for Public Health and The Environment, Bilthoven, Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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47
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Klont F, Kremer D, Gomes Neto AW, Berger SP, Touw DJ, Hak E, Bonner R, Bakker SJL, Hopfgartner G. Metabolomics data complemented drug use information in epidemiological databases: pilot study of potential kidney donors. J Clin Epidemiol 2021; 135:10-16. [PMID: 33577985 DOI: 10.1016/j.jclinepi.2021.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/08/2021] [Accepted: 02/03/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether clinical metabolomics, which is increasingly applied in population-based and epidemiological studies, can be used to provide analytical evidence of exposures, and whether such information can be useful to strengthen and/or complement corresponding clinical database entries, taking drug use as an example. STUDY DESIGN AND SETTING Liquid chromatography-mass spectrometry (LC-MS) metabolomics analyses were performed on urine from 100 randomly-selected control subjects (50% females) from the TransplantLines Food and Nutrition Biobank and Cohort Study (NCT identifier 'NCT02811835'), and drugs were identified through spectral library searching and targeted signal extraction. RESULTS In 83 subjects for whom drug use information was available, 22 expected and 26 unexpected prescription-only drugs were identified, while 28 expected prescription-only drugs remained undetected. In addition, 7 prescription-only drugs were found in 17 subjects for whom drug use information was unavailable, and 58 over-the-counter drugs were identified in all 100 subjects. CONCLUSION Molecular evidence for many drugs could be retrieved from LC-MS metabolomics data, which could be useful to complement and strengthen epidemiological databases given that considerable discrepancies were found between analytically-identified drugs and drugs listed in the available clinical database.
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Affiliation(s)
- Frank Klont
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, 1211 Geneva, Switzerland
| | - Daan Kremer
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Antonio W Gomes Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Stefan P Berger
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Daan J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Ron Bonner
- Ron Bonner Consulting, Newmarket, Ontario, L3Y 3C7, Canada
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands
| | - Gérard Hopfgartner
- Life Sciences Mass Spectrometry, Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest Ansermet 24, 1211 Geneva, Switzerland.
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48
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Sluiter MN, de Vries YA, Koning LG, Hak E, Bos JHJ, Schuiling-Veninga CCM, Batstra L, Doornenbal JM, de Jonge P. A Prescription Trend Analysis of Methylphenidate: Relation to Study Reports on Efficacy. Adm Policy Ment Health 2021; 47:291-299. [PMID: 31620909 DOI: 10.1007/s10488-019-00983-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Use of methylphenidate in children has increased substantially, despite conflicting evidence regarding efficacy. In this study, prescription data were analyzed in relation to the publication of new evidence regarding efficacy. Incidence rates and prescribed doses of methylphenidate increased, with a decline during the last few years. Duration of use is still increasing. In half of the cases, starting dosages are higher than recommended in guidelines. There was little evidence that publication of new evidence directly influenced the use of methylphenidate. Recent and critical study findings should receive more attention to contribute to the development and use of treatment guidelines for ADHD and evidence-based methylphenidate use.
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Affiliation(s)
- Maruschka N Sluiter
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands.
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands.
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Lotte G Koning
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
| | - Eelko Hak
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Catharina C M Schuiling-Veninga
- PharmacoTherapy, - Epidemiology & -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Laura Batstra
- Department of Special Needs Education and Child Care, University of Groningen, Groningen, The Netherlands
| | - Jeannette M Doornenbal
- Youth, Education and Society, Hanze University of Applied Sciences, Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9721 TS, Groningen, The Netherlands
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49
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Groothof D, Flores-Guerrero JL, Nolte IM, Bouma HR, Gruppen EG, Bano A, Post A, Kootstra-Ros JE, Hak E, Bos JHJ, de Borst MH, Gans ROB, Links TP, Dullaart RPF, Bakker SJL. Thyroid function and risk of all-cause and cardiovascular mortality: a prospective population-based cohort study. Endocrine 2021; 71:385-396. [PMID: 32632723 PMCID: PMC7881952 DOI: 10.1007/s12020-020-02397-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/18/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Although thyroid hormones are irrefutably implicated in cardiovascular physiology, the impact of within-reference range variations of thyroid function on cardiovascular disease (CVD) remains unclear. Elucidating this is important, since it could foster preventive treatment and reduce global CVD burden. We therefore investigated the impact of within-reference range variations of thyroid function on all-cause and cardiovascular mortality. METHODS We included community-dwelling individuals aged 28-75 years from a prospective cohort study, without known use of thyroid-affecting therapy and with thyrotropin within reference range. Associations of thyroid function with mortality were quantified using Cox models and adjusted for sociodemographic and cardiovascular risk factors. RESULTS Mean (SD) age of the 6,054 participants (52.0% male) was 53.3 (12.0) years. During 47,594 person-years of follow-up, we observed 380 deaths from all causes and 103 from CVDs. Although higher thyrotropin was not associated with all-cause mortality (adjusted HR 1.02, 95% CI 0.92-1.14), point estimates for cardiovascular mortality diverged toward increased risk in younger (<72 years) participants (1.31, 1.00-1.72) and decreased risk in elderly (≥72 years) (0.77, 0.56-1.06). Higher free thyroxine (FT4) was associated with all-cause mortality (1.18, 1.07-1.30) and with cardiovascular mortality only in elderly (1.61, 1.19-2.18), but not in younger participants (1.03, 0.78-1.34). Higher free triiodothyronine (FT3) was associated with all-cause mortality in females only (1.18, 1.02-1.35). FT3 was not associated with cardiovascular mortality (0.91, 0.70-1.18). CONCLUSIONS Community-dwelling elderly individuals with high-normal thyroid function are at increased risk of all-cause and cardiovascular mortality, reinforcing the need of redefining the current reference ranges of thyroid function.
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Affiliation(s)
- Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Jose L Flores-Guerrero
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Internal Medicine, Division of Acute Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eke G Gruppen
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjola Bano
- Institute of Social and Preventive Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jenny E Kootstra-Ros
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology, and Economics, University of Groningen, Groningen, The Netherlands
| | - Jens H J Bos
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology, and Economics, University of Groningen, Groningen, The Netherlands
| | - Martin H de Borst
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Reinold O B Gans
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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50
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Oktora MP, Kerr KP, Hak E, Denig P. Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: A scoping review. Diabet Med 2021; 38:e14408. [PMID: 32969063 PMCID: PMC7891362 DOI: 10.1111/dme.14408] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Individualizing goals for people with type 2 diabetes may result in deintensification of medication, but a comprehensive picture of deprescribing practices is lacking. AIMS To conduct a scoping review in order to assess the rates, determinants and success of implementing deprescribing of glucose-, blood pressure- or lipid-lowering medications in people with diabetes. METHODS A systematic search on MEDLINE and Embase between January 2007 and January 2019 was carried out for deprescribing studies among people with diabetes. Outcomes were rates of deprescribing related to participant characteristics, the determinants and success of deprescribing, and its implementation. Critical appraisal was conducted using predefined tools. RESULTS Fourteen studies were included; eight reported on rates, nine on determinants and six on success and implementation. Bias was high for studies on success of deprescribing. Deprescribing rates ranged from 14% to 27% in older people with low HbA1c levels, and from 16% to 19% in older people with low systolic blood pressure. Rates were not much affected by age, gender, frailty or life expectancy. Rates were higher when a reminder system was used to identify people with hypoglycaemia, which led to less overtreatment and fewer hypoglycaemic events. Most healthcare professionals accepted the concept of deprescribing but differed on when to conduct it. Deprescribing glucose-lowering medications could be successfully conducted in 62% to 75% of participants with small rises in HbA1c . CONCLUSIONS Deprescribing of glucose-lowering medications seems feasible and acceptable, but was not widely implemented in the covered period. Support systems may enhance deprescribing. More studies on deprescribing blood pressure- and lipid-lowering medications in people with diabetes are needed.
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Affiliation(s)
- M. P. Oktora
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - K. P. Kerr
- School of Biomedical Sciences and PharmacyFaculty of Health and MedicineUniversity of NewcastleNewcastleNSWAustralia
| | - E. Hak
- Unit of PharmacoTherapy, Epidemiology and EconomicsGroningen Research Institute of PharmacyUniversity of GroningenGroningenThe Netherlands
| | - P. Denig
- Department of Clinical Pharmacy and PharmacologyUniversity of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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