Pharmacoepidemiology and Drug Safety最新文献

{"title":"Implementing Negative Control Outcomes to Assess Comparability of Treatments for Psoriasis and Psoriatic Arthritis.","authors":"Mary E Horner, Alexis Ogdie, Kate K Orroth, Shia T Kent, Kathy V Tran, Cynthia Deignan, Myriam Cordey, M Alan Brookhart","doi":"10.1002/pds.70156","DOIUrl":"10.1002/pds.70156","url":null,"abstract":"<p><strong>Purpose: </strong>Treatment selection is typically associated with prognosis, leading to potential confounding in comparative studies. We used negative control outcomes (NCOs) to identify potential residual confounding when comparing apremilast initiators to other psoriasis (PsO) or psoriatic arthritis (PsA) treatment initiators.</p><p><strong>Methods: </strong>Adults with PsO/PsA who initiated treatment from September 23/March 21, 2016, respectively, with apremilast, topicals, methotrexate, interleukin (IL)-17 inhibitor (i), IL-12/23i, or tumor necrosis factor inhibitor (TNFi) were identified in the OPTUM Clinformatics DataMart database. Follow-up ended at treatment switch/discontinuation, NCO, end of enrollment, or September 30, 2022. NCOs addressed confounding for healthy users (wellness visit, herpes zoster vaccine, colon cancer screening, pelvic screening), functional status (accidents), and channeling. The 1-year relative risk (RR) for each NCO was estimated for all treatment comparisons using an inverse probability of treatment and censoring weighted estimator.</p><p><strong>Results: </strong>In PsO, potential healthy user bias was detected in apremilast vs. IL-17i initiators, with a higher likelihood of herpes zoster vaccine and colon cancer screening (RR [95% CI]: 2.01 [1.41, 2.88] and 1.42 [1.13, 1.77], respectively). Wellness visits and pelvic exams were less likely among apremilast vs. topical initiators (0.84 [0.72, 0.98] and 0.83 [0.70, 0.98], respectively). The wellness visit RR was attenuated in individuals with ≥ 1 pre-index topical prescription (0.90 [0.78, 1.04]). In PsA, minimal residual confounding was observed between apremilast and other treatments.</p><p><strong>Conclusions: </strong>Eligibility criteria (prior topicals) and weighting reduced residual confounding when comparing apremilast vs. other treatments for PsO and PsA. Integration of NCOs into comparative effectiveness/safety studies of PsO/PsA treatments may help identify unmeasured confounding.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70156"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094545","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":"Safety Monitoring of Bivalent COVID-19 mRNA Vaccines Among Recipients 6 Months and Older in the United States.","authors":"Patricia C Lloyd, Elizabeth R Smith, Joann F Gruber, Michelle Ondari, Hui Lee Wong, Mao Hu, Tainya C Clarke, Rowan McEvoy, Kandace L Amend, Daniel C Beachler, Cheryl N McMahill-Walraven, John D Seeger, Alex Secora, Djeneba Audrey Djibo, Jennifer Song, Nandini Selvam, Jonathan P DeShazo, Robin Clifford, Eugenio Abente, Yoganand Chillarige, Richard A Forshee, Steven A Anderson, Azadeh Shoaibi","doi":"10.1002/pds.70151","DOIUrl":"https://doi.org/10.1002/pds.70151","url":null,"abstract":"<p><strong>Purpose: </strong>Active monitoring of health outcomes after COVID-19 vaccination provides early detection of rare outcomes post-licensure. We evaluated health outcomes following bivalent COVID-19 Pfizer-BioNTech (BNT162b2) and Moderna (mRNA-1273.222) vaccination in the United States.</p><p><strong>Methods: </strong>Multiple health outcomes were monitored monthly from August 2022 to July 2023 in four administrative claims databases (CVS Health, Carelon Research, Optum, and Medicare). The study included individuals 6 months and older who received a bivalent COVID-19 BNT162b2 or mRNA-1273.222 vaccination during the study period and met a minimum continuous enrollment requirement in a medical insurance plan prior to COVID-19 vaccination. Descriptive analyses monitored counts of vaccinations, outcomes, and concomitant COVID-19 and influenza vaccination. Maximized Sequential Probability Ratio Testing (MaxSPRT) tested for elevations in the observed incidence rate of outcomes post-vaccination compared to annual historical rates estimated from 2019 or 2020, adjusted for claims delay in the observed rate. Where case counts permitted, historical rates were standardized by age and/or sex for all persons, and race and/or nursing home residency status for Medicare persons only.</p><p><strong>Results: </strong>Overall, 13.9 million individuals 6 months and older received a bivalent COVID-19 vaccine. A statistical signal occurred for two outcomes in one database (significance level of 1%): anaphylaxis following both bivalent COVID-19 vaccines in persons 18-64 years and myocarditis/pericarditis following bivalent BNT162b2 vaccines in individuals 18-35 years. Among 642 142 vaccinated children 6 months-17 years, no signals were identified.</p><p><strong>Conclusions: </strong>Results were consistent with published COVID-19 vaccine safety studies and support the safety profile of bivalent COVID-19 mRNA vaccines.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70151"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Disease Management to Enhance Medication Adherence Trajectories in Long-Term Survivors of Stroke: A Population-Based Cohort Study.","authors":"Lachlan L Dalli, Monique F Kilkenny, Muideen T Olaiya, David Ung, Joosup Kim, Leonid Churilov, Dominique A Cadilhac, Vijaya Sundararajan, Amanda G Thrift, Mark R Nelson, Natasha A Lannin, Rebecca Barnden, Velandai Srikanth, Nadine E Andrew","doi":"10.1002/pds.70148","DOIUrl":"10.1002/pds.70148","url":null,"abstract":"<p><strong>Purpose: </strong>Although chronic disease management (CDM) has been reported to improve medication adherence after stroke or transient ischaemic attack (TIA), the impact on specific patterns of medication adherence is unclear. We aimed to evaluate the population effect of receiving a CDM claim on trajectories of medication adherence in long-term survivors of stroke/TIA.</p><p><strong>Methods: </strong>A cohort study was undertaken using observational data from PRECISE (42 Australian Stroke Clinical Registry hospitals [Victoria and Queensland; 2012-2015] linked with medication dispensing and primary care claims). Community-dwelling adults with ≥ 1 primary care visit were included. The exposure was a CDM claim (versus no claim) in primary care within 7-18 months post-stroke/TIA. Medication adherence (antihypertensive, antithrombotic, lipid-lowering) was assessed between 19 and 30 months post-stroke/TIA, using group-based trajectory models. Average treatment effects were estimated using multi-level logistic regression with inverse probability treatment weights.</p><p><strong>Results: </strong>Among 11 580 survivors of stroke/TIA (median age 70 years, 42% female; 45% with CDM claim), four distinct adherence patterns were identified: near-perfect adherence, high adherence, declining adherence, and non-use. After adjustment, having a CDM claim (vs no claim) promoted near-perfect adherence (odds ratio [OR]: 1.16 [95% CI 1.08-1.25]) for antithrombotic medications. Whereas, having a CDM claim (vs no CDM claim) promoted high adherence for antihypertensive (OR: 1.33 [95% CI 1.24-1.44]) or lipid-lowering (OR: 1.26 [95% CI 1.16-1.37]) medications. The odds of non-use were also reduced by 17%-23% in those with (vs without) a CDM claim.</p><p><strong>Conclusions: </strong>CDM claims were associated with favourable trajectories of medication adherence in long-term survivors of stroke/TIA.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70148"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986776","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":"Trends in Opioid and Gabapentinoid Utilization: A Time-Series Analysis Across 72 Countries From 2012 to 2023.","authors":"Yilei Liu, Scott D Rothenberger, Mina Tadrous, Bryant Shuey, Shanzeh Chaudhry, Katie J Suda","doi":"10.1002/pds.70149","DOIUrl":"https://doi.org/10.1002/pds.70149","url":null,"abstract":"<p><strong>Purpose: </strong>We compare trends in gabapentinoid and opioid utilization overall and by economic development category. We also sought to predict future trends and assess correlations in gabapentinoid and opioid utilization.</p><p><strong>Methods: </strong>We conducted a repeated cross-sectional analysis of retail prescriptions for 72 countries from Q1 2012 to Q3 2023. We measured standardized units/1000 population for gabapentinoid and opioid sales, stratified by development category, and used time-series models to predict trends for the following 3 years. Granger causality tests examined predictive relationships between gabapentinoid and opioid sales.</p><p><strong>Results: </strong>Global gabapentinoid annual sales rose by 114.5% from 2012 to 2022, with a higher increase in developing (180.9%) than developed economies (110.0%). In contrast, annual opioid sales declined globally by 25.4%, with a 27.9% decrease in developed and a 16.8% increase in developing economies. Assuming current trends persist over the following 3 years, gabapentinoid quarterly sales are forecasted to rise by 7.7% in developed and 18.6% in developing economies, while opioid quarterly sales are expected to decrease by 9.5% and increase by 15.1%, respectively. Granger causality tests indicated that gabapentinoids may predict opioid sales globally for the following year, but opioids did not predict gabapentinoid sales.</p><p><strong>Conclusion: </strong>We evaluated the global trends in gabapentinoid and opioid sales, suggesting important differences in pain management practices across developed and developing economies. Our findings highlight the need to ensure the safe use of gabapentinoids and opioids while balancing proper pain management.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70149"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Effective Are Machine Learning and Doubly Robust Estimators in Incorporating High-Dimensional Proxies to Reduce Residual Confounding?","authors":"Mohammad Ehsanul Karim, Yang Lei","doi":"10.1002/pds.70155","DOIUrl":"10.1002/pds.70155","url":null,"abstract":"<p><strong>Background: </strong>Residual confounding presents a persistent challenge in observational studies, particularly in high-dimensional settings. High-dimensional proxy adjustment methods, such as the high-dimensional propensity score (hdPS), are widely used to address confounding bias by incorporating proxies for unmeasured confounders. Extensions of hdPS have integrated machine learning, such as LASSO and super learner (SL), and doubly robust estimators, such as targeted maximum likelihood estimation (TMLE). However, the comparative performance of these methods, especially under different learner configurations and high-dimensional proxies, remains unclear.</p><p><strong>Method: </strong>We conducted plasmode simulations to evaluate the performance of standard methods, SL, TMLE, and double cross-fit TMLE (DC-TMLE) under varying exposure and outcome prevalence scenarios. Learner libraries included: 1 learner (logistic regression), 3 learners (logistic regression, MARS, and LASSO), and 4 learners (adding XGBoost, a non-Donsker learner). Metrics included bias, coverage, and variability.</p><p><strong>Results: </strong>Methods without proxies exhibited the highest bias and poorest coverage, highlighting the critical role of proxies in confounding adjustment. Standard methods incorporating high-dimensional proxies showed robust performance, achieving low bias and near-nominal coverage. TMLE and DC-TMLE reduced bias but exhibited worse coverage compared to standard methods, particularly with larger learner libraries. Notably, DC-TMLE, expected to address under-coverage issues, failed to perform adequately in high-dimensional settings with non-Donsker learners, further emphasizing the instability introduced by complex libraries.</p><p><strong>Conclusion: </strong>Our findings underscore the utility of high-dimensional proxies in standard methods and the importance of tailoring learner configurations in SL and TMLE to ensure reliable confounding adjustment in high-dimensional contexts.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 5","pages":"e70155"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027811","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 β-Adrenoreceptor Agonists and Antagonists and Parkinson's Disease: Systematic Review and Meta-Analysis.","authors":"Agnieszka Szmigiel, Miguel Monteiro da Rocha, Kate Browne, Daniel Morales, David Benee Olsen, Charlotte Warren-Gash, Ian Douglas, Krishnan Bhaskaran, Helena Carreira","doi":"10.1002/pds.70140","DOIUrl":"10.1002/pds.70140","url":null,"abstract":"<p><strong>Background: </strong>β-agonists and β-antagonists are among the most prescribed drugs worldwide. In 2018, studies suggesting a harmful association between propranolol and Parkinson's disease (PD) prompted a signal procedure by the European Medicines Agency's safety committee, which concluded with no update of product information. Several studies have been published since then. We aimed to systematically review, critically appraise, and meta-analyse all studies on the association between the use of β-antagonists (including propranolol) and β-agonists, and the risk of PD.</p><p><strong>Methods: </strong>We searched Embase and Medline up to December 2024 for observational and intervention studies that reported relative risk estimates of the association between use of these medicines and PD. Two reviewers screened the records, extracted the data, and assessed the risk of bias. The restricted maximum likelihood method was used to compute pooled effect estimates and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twenty-two studies were eligible. Overall, 20 had a high risk of bias in at least one domain. Twelve studies had medium to high risk of outcome misclassification. Of the 14 studies concerning β-antagonists, eleven had an unclear or high risk of protopathic bias, as propranolol is indicated for the treatment of essential tremor. Control for confounding by socio-economic status, area of residence (urban/rural), and smoking (a protective factor against PD) was deficient or lacking in 9/22, 15/22, and 12/22 studies, respectively. Lag times were applied in 9/22 studies. In meta-analysis, the summary relative risk (RR) of PD was 1.41 (95% CI: 1.18-1.68) for the class of β-antagonists (12 studies) and 0.93 (0.84-1.03) for β2-agonists (11 studies). Among specific β-antagonists, the summary RR of PD was 2.36 (1.66-3.36) for propranolol (7 studies), 0.84 (0.80-0.88) for carvedilol (3 studies) and 1.02 (0.87-1.18) for metoprolol (4 studies). For specific β2-agonists, summary RR was 0.88 (0.77-1.01) for salbutamol (7 studies), 0.91 (0.88-0.95) for short-acting β2-agonists (6 studies), and 0.85 (0.76-0.96) for long-acting β2 agonists (5 studies). Restricting to subgroups based on quality criteria resulted in weaker or non-statistically significant associations.</p><p><strong>Conclusion: </strong>The quality and quantity of the available evidence do not support a causal association between use of β-adrenoreceptor modulators and PD. Significant associations are most likely explained by protopathic bias and confounding.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70140"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811988","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":"Antibiotics and Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome: Analysis of Brazilian Pharmacovigilance Registries.","authors":"Marcelo Bueno de Camargo, Inês Ribeiro-Vaz, Cristiane de Cássia Bergamaschi, Marcus Tolentino Silva","doi":"10.1002/pds.70128","DOIUrl":"10.1002/pds.70128","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study investigated the association between the use of antibiotics and the occurrence of DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) syndrome, a rare and serious adverse event characterized by eosinophilia and acute skin rash. Without early diagnosis, the syndrome can lead to complications or even death.</p><p><strong>Methods: </strong>In 2020, the Brazilian National Health Surveillance Agency (Anvisa) made available a system for reporting adverse drug events, called VigiMed. Reports of adverse events registered on this system between December 1, 2018 and December 31, 2022, were analyzed. Reporting odds ratio (ROR), together with the respective 95% confidence intervals (95% CI), was calculated as a measure of the association between antibiotics and DRESS syndrome.</p><p><strong>Results: </strong>A total of 160,101 reports of adverse drug events were analyzed, with 136 suspected cases of DRESS syndrome. Compared with other drugs, the following frequencies of suspected DRESS syndrome were observed for the use of any antibiotic (ROR: 4.8; 95% CI: 3.3-7.0), meropenem (ROR: 13.0; 95% CI: 8.0-21.0), vancomycin (ROR: 11.5; 95% CI: 7.4-17.6), ampicillin (ROR: 6.8; 95% CI: 2.1-21.8), amoxicillin (ROR: 4.7; 95% CI: 1.5-15.0), cefepime (ROR: 4.3; 95% CI: 1.3-13.6), piperacillin + tazobactam (ROR: 2.5; 95% CI: 1.1-5.8) and ceftriaxone (ROR: 2.4; 95% CI: 1.1-5.1). The ROR for DRESS syndrome and the use of oxacillin was 2.7 with a wide 95% CI (0.7-11.1).</p><p><strong>Conclusions: </strong>An association was observed between reports of DRESS syndrome and the use of antibiotics, particularly those routinely used in a hospital setting. Although there is a potential risk of underreporting or unattributed causality, the information obtained in this study is valuable for the analysis of rare adverse reactions. Given the seriousness of the findings, further studies should be conducted to obtain more accurate information about this adverse reaction.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70128"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Diagnostic Coding for Acute Kidney Injury in Japan-Analysis of a Japanese Hospital-Based Database.","authors":"Satoru Mitsuboshi, Shungo Imai, Masami Tsuchiya, Hayato Kizaki, Satoko Hori","doi":"10.1002/pds.70146","DOIUrl":"https://doi.org/10.1002/pds.70146","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the accuracy of diagnostic coding for acute kidney injury (AKI) in Japan.</p><p><strong>Methods: </strong>The data analyzed were obtained from the JMDC hospital-based administrative claims database from cases registered between April 2014 and August 2022. Only patients who underwent serum creatinine measurements two or more times with intervals of 7 days or less were eligible for inclusion. AKIs were identified by International Classification of Diseases 10th Revision (ICD-10) codes N14 and N17. These were assessed according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria.</p><p><strong>Results: </strong>A total of 467 019 patients (median age, 74 [range, 20-99] years; male, 50.9%) were eligible for inclusion. Among these patients, 1849 (0.4%) were assigned ICD-10 codes for AKI. Among these 1849 patients, the code was assigned within 7 days of the occurrence of AKI (as defined by the KDIGO criteria) in 212 patients, within 14 days in 294 patients, and within 30 days in 386 patients. The positive predictive values and 95% confidence intervals of the ICD-10 code for AKI at these timepoints were as follows: within 7 days, 11.5% (10.1%-13.0%); within 14 days, 15.9% (14.3%-17.6%); and within 30 days, 20.9% (19.1%-22.8%).</p><p><strong>Conclusions: </strong>The ICD-10 codes for AKI showed poor positive predictive values for AKI as defined by the KDIGO criteria, suggesting that it may be difficult to identify AKI using ICD-10 codes alone in the Japanese context.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70146"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036371","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":"Comparative Effectiveness and Safety of Torsemide Versus Furosemide in Older Adults With Heart Failure.","authors":"Amina A Alkhalaf, Rishi J Desai, Julie C Lauffenburger","doi":"10.1002/pds.70130","DOIUrl":"10.1002/pds.70130","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence on the real-world comparative effectiveness and safety of commonly used loop diuretics for heart failure is mixed, particularly among older adults who are at a higher risk of adverse outcomes. Thus, we aimed to compare the outcomes and safety profiles of torsemide and furosemide.</p><p><strong>Methods: </strong>We conducted a new user, active comparator retrospective cohort study comparing torsemide to furosemide in Medicare fee-for-service beneficiaries with heart failure in claims data (2008-2020). Effectiveness outcomes were a composite of heart failure hospitalization or death and urgent outpatient visits requiring intravenous diuretics; safety outcomes included acute kidney injury, hypovolemia, and hypokalemia. We used 1:4 propensity score (PS) matching to adjust for confounding. We calculated PS-matched hazard ratios using Cox proportional hazard models.</p><p><strong>Results: </strong>Across 328 640 matched beneficiaries, compared with furosemide, torsemide was associated with a similar, though statistically significantly lower, risk of the composite effectiveness outcome (hazard ratio [HR] = 0.97, 95% CI:0.95,0.99; incidence rate difference (IRD) = -3.79, 95% CI:-9.38,1.81 events per 1000 person-years) and lower risk for urgent visits with intravenous loop diuretics (HR = 0.88, 95% CI:0.84,0.92; IRD = -7.03, 95% CI:-9.79,-4.26 events per 1000 person-years). Torsemide was also associated with an increased risk of acute kidney injury (HR = 1.12, 95% CI:1.10,1.15; IRD = 36.89, 95% CI:31.51,42.64 events per 1000 person-years) with no observed difference in hypokalemia (HR = 1.02, 95% CI:0.91,1.14; IRD = 0.46, 95% CI:-0.51,1.42 events per 1000 person-years) and hypovolemia (HR = 1.03, 95% CI:0.98,1.09; IRD = 2.36, 95% CI:0.15,4.56 events per 1000 person-years).</p><p><strong>Conclusions: </strong>Compared with furosemide, initiation of torsemide was associated with a slightly lower risk of a composite of all-cause mortality or heart failure hospitalization and urgent visits with intravenous diuretics, but a slightly higher risk of acute kidney injury. In older adults, clinicians must balance torsemide's potential benefits with the acute kidney injury risk.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70130"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence Trends and Patterns of Perinatal ADHD Stimulant Medication Use in British Columbia, Canada.","authors":"Amanda Nitchske, Ali Salmanpour, Paramdeep Kaur, Helena Abreu do Valle, Chelsea Elwood, Anne Gadermann, Martin Guhn, Catriona Hippman, Angie Ip, Jalisa L Karim, Tim F Oberlander, Peter M Socha, Gillian E Hanley","doi":"10.1002/pds.70129","DOIUrl":"10.1002/pds.70129","url":null,"abstract":"<p><strong>Purpose: </strong>Given the increase in attention-deficit/hyperactivity disorder (ADHD) diagnoses and stimulant medication use among female adults, this study describes the prevalence trends of perinatal ADHD stimulant medication use in British Columbia, Canada, along with characteristics and patterns of use.</p><p><strong>Methods: </strong>Using linked population-based administrative data, we included all pregnant people with deliveries between January 2000 and December 2021. ADHD stimulant medication use was defined as filled prescriptions for dextro-/amphetamine, methylphenidate, or lisdexamfetamine. Prevalence trends were examined by medication type and age group. Characteristics were compared between those with and without prenatal stimulant medication dispensations. Patterns of use and discontinuation were assessed from 1 year preconception to 1 year postpartum.</p><p><strong>Results: </strong>Our cohort included 899,679 pregnancies. Prenatal ADHD stimulant medication use increased by 3.9 users per 1000 pregnancies (from 0.4 to 4.3/1000), primarily driven by dextro-/amphetamine. Medication use increased among all age groups, but was highest among pregnant people under 20 years old. Pregnant people taking stimulant medications were more likely to be nulliparous and lower in income, have hypertension and higher BMI, smoke during pregnancy, use other psychotropic medications, and deliver by cesarean section. Among those who used stimulant medications within 1 year preconception, 77% discontinued treatment before or during pregnancy. While use increased again within 12 months postpartum, it remained 45% lower than preconception levels.</p><p><strong>Conclusion: </strong>The 11-fold increase in ADHD stimulant medication use during pregnancy and the high rate of discontinuation highlight the need for more research on the risks and benefits of medication for parent and child health.</p>","PeriodicalId":19782,"journal":{"name":"Pharmacoepidemiology and Drug Safety","volume":"34 4","pages":"e70129"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693094","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}