Pharmacoepidemiology and Drug Safety最新文献

{"title":"First-Recorded Alcohol Use Disorder Diagnosis as an Ascertainment Outcome: Implications for GLP-1 Target Trial Emulations.","authors":"Chien-Huei Sung, Lien-Chung Wei","doi":"10.1002/pds.70472","DOIUrl":"10.1002/pds.70472","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70472"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Proton Pump Inhibitor Use and Malnutrition Risk in the US General Population Using the GLIM Framework (NHANES 1999-2020).","authors":"F Orsini, A Novella, L Pasina","doi":"10.1002/pds.70451","DOIUrl":"10.1002/pds.70451","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) are the global gold standard for acid-related disorders; however, their proliferation into long-term, often non-indicated use raises significant concerns regarding qualitative nutrient depletion.</p><p><strong>Objective: </strong>This study primarily aimed to evaluate the independent association between PPI use and malnutrition risk according to the Global Leadership Initiative on Malnutrition (GLIM) criteria in a nationally representative US population.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of 23 363 adults from the NHANES 1999-2020 database. Malnutrition was operationalized via the GLIM approach, integrating phenotypic criteria (weight loss, low BMI, or DXA-derived reduced muscle mass) with etiologic criteria (inflammation or reduced calorie intake). Robust Poisson regression models estimated relative risks (RRs) for general malnutrition, while logistic regression estimated odds ratios (ORs) for severe malnutrition. Models were adjusted for sociodemographics, food security, comorbidities, and appetite-affecting medications.</p><p><strong>Results: </strong>The prevalence of malnutrition was 18.9% (95% CI: 18.4%-19.4%) and PPI use was associated with a 10% increased risk of malnutrition (RR 1.10; 95% CI: 1.01-1.19; p = 0.031) in the adjusted model. For severe malnutrition, PPI exposure was a robust independent predictor (OR 1.36; 95% CI: 1.13-1.63; p = 0.001). Notably, sex-stratified analysis revealed a RR associated with PPIs was significantly more pronounced in females (RR 1.37; 95% CI: 1.06-1.79; p = 0.018) than in males (RR 1.07; p = 0.11). In the geriatric population (≥ 65 years), chronic PPI use increased the odds of severe malnutrition by 57% (OR 1.57; 95% CI: 1.15-2.14; p = 0.004).</p><p><strong>Conclusion: </strong>Prolonged iatrogenic hypochlorhydria may represent an important contributor to malnutrition, particularly to its more severe forms and among older adults. These findings support the need for regular medication reviews to identify and discontinue unnecessary long-term PPI therapy. Preserving metabolic and nutritional health may therefore require the implementation of non-pharmacological approaches as first-line management options for acid-related disorders whenever clinically appropriate. Such strategies may help reduce unnecessary long-term PPI exposure and its potential adverse effects on nutritional status.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70451"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bladder Antimuscarinic Use and Cognitive Impairment in Adults Aged 75 Years or Older With Urinary Incontinence or Overactive Bladder Symptoms: A Population-Based Study.","authors":"Renjie Huang, Miao Huang, Rui Zhang","doi":"10.1002/pds.70479","DOIUrl":"10.1002/pds.70479","url":null,"abstract":"<p><strong>Purpose: </strong>To examine associations of current bladder antimuscarinic use with cognitive impairment in adults aged ≥ 75 years with urinary symptoms.</p><p><strong>Methods: </strong>We analyzed National Health and Nutrition Examination Survey 2011-2014 data. Current use was identified from medications reported during the previous 30 days. Cognitive impairment was defined as CERAD delayed recall < 5, animal fluency < 14, or digit symbol substitution test < 34 among available tests. Survey-weighted logistic models estimated overall and age-specific odds ratios (ORs); the primary model included demographic factors and KDM biological age acceleration. Missing KDM data were multiply imputed.</p><p><strong>Results: </strong>Among 537 participants representing 8 735 786 US adults, 34 reported current use and 375 met the cognitive-impairment definition (weighted prevalence, 62.5%). The primary overall OR was 2.18 (95% confidence interval [CI], 0.93-5.07; p = 0.069). The use-by-age interaction was imprecise (interaction OR, 0.21; 95% CI, 0.03-1.33; p = 0.093). Among adults aged 75-79 years, 10 of 12 users and 130 of 210 nonusers were impaired (weighted, 82.03% vs. 52.37%); the adjusted OR was 7.18 (95% CI, 1.11-46.40; p = 0.039). Among adults in the public-use group ≥ 80 years, the OR was 1.18 (95% CI, 0.44-3.12; p = 0.733).</p><p><strong>Conclusions: </strong>The overall estimate was positive but imprecise, and the age-specific contrast rested on sparse exposure. Because NHANES lacks prior-use and discontinuation histories, results may reflect prescribing selection and do not support causal or age-threshold treatment inferences.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70479"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription Medication Use During Pregnancy and Postpartum in Sweden 2007 to 2022.","authors":"Essi Whaites Heinonen, Awad I Smew, Silvia Segovia Chacón, Ulrika Nörby, Olof Stephansson, Anne K Örtqvist, Cathrine Axfors, Pär Karlsson, Carolyn E Cesta","doi":"10.1002/pds.70473","DOIUrl":"10.1002/pds.70473","url":null,"abstract":"<p><strong>Purpose: </strong>Medication use during pregnancy has increased worldwide. The aim was to investigate patterns of prescription medication use during pregnancy and postpartum in Sweden 2007-2022.</p><p><strong>Methods: </strong>We conducted a population-based drug utilization study with linked data from the Swedish Medical Birth and Prescribed Drug Registers. From 90 days before pregnancy to 90 days after delivery, all dispensed prescriptions for each full-level ATC code were identified. The proportion of women, by year and age, with ≥ 1 dispensed medication was calculated, as well as the number of different medications and dispensed prescriptions of structural teratogens and specific medication groups.</p><p><strong>Results: </strong>Overall, 1 065 593 (60.5%) women were dispensed ≥ 1 medication during pregnancy and 900 536 (51.1%) within 3 months postpartum. The proportion of women with ≥ 1 dispensed prescription in the postpartum period was stable but increased during pregnancy from 57.1% in 2007 to 67.5% in 2022, with the largest increase in women ≥ 40 years. The proportion using ≥ 5 different medications increased, while the proportion with a recognized or suspected structural teratogen in the first trimester remained low (< 1%). There was a notable decrease in the use of antibiotics and prescribed analgesics, and an increase in antiemetics, psychotropics, acetylsalicylic acid, anticoagulants, antihypertensives, and antidiabetics.</p><p><strong>Conclusion: </strong>Medication use during pregnancy in Sweden increased from 2007 to 2022, particularly among women ≥ 40 years, while postpartum use remained stable. Shifts in the use of specific medication groups highlight evolving maternal characteristics and clinical practice, as well as the importance of continuous surveillance and investigation of medication safety.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70473"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148920727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unsupervised Ensemble Learning for Active Drug-Induced Liver Injury Surveillance: Integrating Pharmacokinetic Burden With Enzyme Trajectories.","authors":"Thawatchai Nakkaratniyom, Sanita Hirunrassamee, Thapana Boonchoo, Cha-Oncin Sooksriwong","doi":"10.1002/pds.70471","DOIUrl":"10.1002/pds.70471","url":null,"abstract":"<p><strong>Purpose: </strong>Traditional drug-induced liver injury (DILI) surveillance relying on static laboratory thresholds frequently misses early kinetic evolution. To address this, a fundamentally drug-agnostic unsupervised ensemble framework, integrating pharmacokinetic (WCEDR) and polypharmacy (HAMPIS) features, was developed for early DILI detection. Antiepileptic drugs (AEDs) were utilised as a proof-of-concept validation cohort.</p><p><strong>Methods: </strong>Using Thailand's national electronic health record database (2021-2024), a multi-view ensemble (Isolation Forest, Local Outlier Factor, One-Class Support Vector Machine) evaluated longitudinal physiological deviations. Feature engineering prioritised acute kinetic volatility to mitigate irregular sampling intervals. Diagnostic performance was benchmarked against standard criteria (ALT > 3 × ULN) and validated through blinded expert adjudication of 140 clinical episodes.</p><p><strong>Results: </strong>From 616 425 treatment episodes, the framework isolated 86 high-probability anomalies. Benchmarking revealed the model captured 80.2% of rule-based positives while proactively identifying 17 AI-only sub-threshold episodes (19.8%) exhibiting distinct enzymatic velocity; over half (52.9%) were clinically confirmed as DILI. Blinded adjudication yielded a clinical plausibility rate of 69.8% and a negative predictive value of 92.6%. Operationally, the framework achieved a number needed to review (NNR) of 1.43, substantially optimising triage efficiency. Digital phenotyping stratified alerts into three distinct archetypes: complex polypharmacy, atypical pharmacokinetic burden, and active idiosyncratic injury.</p><p><strong>Conclusion: </strong>By prioritising kinetic volatility and multidimensional pharmacological context, the unsupervised ensemble functions as a high-precision, complementary surveillance tool. It successfully detects early-onset idiosyncratic reactions frequently overlooked by rigid static thresholds, offering a scalable blueprint for proactive pharmacovigilance.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70471"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementias in Older Women With Early-Stage HER2-Negative Breast Cancer Treated With Anthracycline Plus Taxane Versus Taxane-Based Chemotherapy Regimens.","authors":"Nguyen Le, Nirupama Anne, Chan Shen, Ratnakishore Pallapothu, Yan Liu, Chanhyun Park","doi":"10.1002/pds.70457","DOIUrl":"10.1002/pds.70457","url":null,"abstract":"<p><strong>Background: </strong>Anthracycline plus taxane (ATAX) regimens are associated with improved survival in HER2-negative breast cancer (HBC) compared to taxane-based (TAX) regimens. However, anthracyclines are known for their cardiotoxicity, which could increase the risk of neurocognitive deficits, raising concerns about neurocognitive safety, particularly in older adults. Limited evidence exists comparing neurocognitive outcomes between these two regimens.</p><p><strong>Objective: </strong>To compare the incidence of Alzheimer's disease and related dementias (ADRD) between ATAX and TAX regimens in neoadjuvant (Trial #1) and adjuvant (Trial #2) settings among older women with early-stage HBC.</p><p><strong>Methods: </strong>Using SEER-Medicare data (2010-2021), we identified women aged ≥ 66 years with newly diagnosed HBC and no prior neurocognitive conditions between 2011 and 2021. Patients were longitudinally tracked, and their eligibility for each regimen was evaluated. We applied the clone-censor-weight method and used weighted pooled logistic regression to estimate the 10-year risks of ADRD, Alzheimer's disease (AD), and vascular dementia (VD).</p><p><strong>Results: </strong>We identified 14 079 and 9321 eligible individuals in Trial #1 and Trial #2, respectively. For ADRD outcome, the 10-year risk difference (RD) was -6.91% (95% CI: -15.60% to 0.91%) for HR+/HER2- cohort and -2.14% (95% CI: -9.57% to 5.46%) for TNBC cohort in Trial #1. The 10-year RD was -1.42% (95% CI: -9.33% to 6.98%) for HR+/HER2- cohort and -2.91% (95% CI: -9.54% to 7.86%) for TNBC cohort in Trial #2.</p><p><strong>Conclusion: </strong>Our findings suggest that ATAX regimens were not associated with increased risks of ADRD, AD, and VD compared to TAX regimens in older women with HBC. However, the risks of AD and VD should be interpreted with caution due to sparse events. These findings may support the continued use of ATAX regimens in this population, while also informing more personalized, risk-adapted treatment strategies.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70457"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International Society for Pharmacoepidemiology in Action: Advancing Public Health Through Evidence-Based Advocacy.","authors":"G Sarri, J Diaz-Decaro, M Burcu, M Soriano Gabarró, R Gini, P Bahri, M E Ritchey","doi":"10.1002/pds.70466","DOIUrl":"10.1002/pds.70466","url":null,"abstract":"","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70466"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICD-10-CM-Based Algorithms to Identify Bacteremia Incorporating Pathogen-Specific Codes: A Validation Study.","authors":"Madison G Ponder, Alan C Kinlaw, Elizabeth S Dodds Ashley, Jennifer L Lund, Emily J Ciccone, Michele Jonsson Funk","doi":"10.1002/pds.70454","DOIUrl":"10.1002/pds.70454","url":null,"abstract":"<p><strong>Purpose: </strong>Studying patients with bacteremia in real-world data often requires using microbiologic data to confirm bacterial growth and species. When microbiologic data are unavailable, pathogen-specific diagnostic codes may be used to classify the bacteremia type. We developed and validated ICD-10-CM-based algorithms for identifying any bacteremia, Gram-negative bacteremia, and Enterobacteriaceae bacteremia.</p><p><strong>Methods: </strong>We identified patients ≥ 18 years with a hospitalization ≥ 2 days to any Duke Antimicrobial Stewardship Outreach Network hospital from January 1, 2021 to May 31, 2024. Blood culture results were the reference standard for classifying true cases of bacteremia. We evaluated 15 candidate algorithms developed based on previously published algorithms, in addition to the bacteremia ICD-10-CM code (R78.81) and pathogen-specific ICD-10-CM codes. We estimated sensitivity, specificity, positive predictive value (PPV), and negative predictive value with 95% confidence intervals using generalized estimating equations to account for correlated hospitalizations.</p><p><strong>Results: </strong>Among 907 958 hospital admissions (623 556 patients), algorithms with bacteremia and pathogen-specific codes had high specificity (range: 97.3%-100.0%) and low sensitivity (range: 4.9%-58.1%). Algorithms with bacteremia codes and no pathogen codes were more sensitive (range: 67.4%-68.6%) and less specific (range: 91.1%-91.2%). In subgroup analyses, PPV for any bacteremia was highest among patients alive at discharge, age ≥ 65, and discharged on antibiotics with Gram-negative coverage (68.9% [65.1%-72.7%]).</p><p><strong>Conclusions: </strong>We developed and internally validated algorithms to identify bacteremia, Gram-negative bacteremia, and Enterobacteriaceae bacteremia in adult patients. Studies seeking to maximize specificity could consider algorithms that include bacteremia and pathogen-specific codes, whereas studies seeking to maximize sensitivity could consider algorithms only requiring a bacteremia code.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70454"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Process of Deprescribing in Older Adults With Potentially Inappropriate Medication or Polypharmacy: A Scoping Review.","authors":"Mengnan Zhao, Zhaoyan Chen, Ying Zhang, Fangyuan Tian","doi":"10.1002/pds.70467","DOIUrl":"10.1002/pds.70467","url":null,"abstract":"<p><strong>Objectives: </strong>Deprescribing is increasingly recognized as an effective strategy for reducing potentially inappropriate medication (PIM) use and polypharmacy in older adults. However, existing deprescribing frameworks often lack detailed operational guidance, which may hinder their routine implementation in clinical practice. To systematically map and characterize the reported deprescribing processes in older adults with PIM use or polypharmacy and identify gaps in their operationalization.</p><p><strong>Methods: </strong>PubMed, Embase (Ovid), and Web of Science were comprehensively searched for studies describing deprescribing processes in older adults with PIM use or polypharmacy. The reported processes were evaluated against Reeve's patient-centered deprescribing framework, which comprises five sequential steps.</p><p><strong>Results: </strong>A total of 92 studies describing deprescribing processes were included. Although 91 studies (98.91%) provided at least a partial description of the deprescribing process, only 1 study reported all five steps of Reeve's framework in detail. The step of planning and initiating medication withdrawal was the most frequently and thoroughly described (63/92, 68.97%). In contrast, operational guidance for determining whether a medication could be ceased and prioritizing medications for discontinuation was rarely reported, with only 7 studies (7.61%) providing sufficient detail. Patient involvement in developing the deprescribing plan was also inconsistently reported, with nearly half of the studies inadequately addressing this aspect.</p><p><strong>Conclusions: </strong>Deprescribing processes are incompletely and inconsistently operationalized in the literature. In particular, guidance on cessation decisions, medication prioritization, and patient engagement remains limited. Future deprescribing frameworks should provide explicit, stepwise, and patient-centered operational guidance to facilitate consistent implementation in routine clinical practice.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70467"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corticosteroid Use and In-Hospital Mortality in Patients With Brain Abscess: A Target Trial Emulation.","authors":"Takayuki Anno, Toshiki Fukasawa, Koji Kawakami","doi":"10.1002/pds.70468","DOIUrl":"10.1002/pds.70468","url":null,"abstract":"<p><strong>Purpose: </strong>Corticosteroids are sometimes administered to patients with severe brain edema associated with brain abscess. However, no studies have used methods that appropriately account for time-varying covariates and immortal time to evaluate the impact of intravenous corticosteroid use on in-hospital mortality. Therefore, we aimed to address these limitations and estimate the impact on in-hospital mortality using a target trial emulation framework.</p><p><strong>Methods: </strong>We identified patients admitted with brain abscess, not caused by head trauma or neurosurgical interventions, from two large-scale hospital-based databases in Japan between 2014 and 2024. We compared two treatment strategies: Strategy 1 was initiation of intravenous dexamethasone or betamethasone administration within 7 days after admission and continuing for at least 3 consecutive days; Strategy 2 was no intravenous corticosteroid use throughout hospitalization. Using a clone-censor-weight approach, we estimated the 60-day in-hospital mortality.</p><p><strong>Results: </strong>A total of 627 patients met the eligibility criteria. Overall, 34 patients (5.4%) died within 60 days. The estimated total effect of treatment strategy on 60-day all-cause in-hospital death was 4.8% (95% CI, 1.1-9.2) for Strategy 1, and 4.6% (95% CI, 2.9-6.6) for Strategy 2, corresponding to a risk ratio of 1.04 (95% CI, 0.26-2.08) and risk difference of 0.2% (95% CI, -3.3 to 4.3).</p><p><strong>Conclusions: </strong>No clear difference in 60-day in-hospital mortality between the two treatment strategies; however, the wide confidence intervals indicate that clinically important benefit or harm could not be excluded. This study's framework may guide future studies using more granular data.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"35 9","pages":"e70468"},"PeriodicalIF":2.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}