scholarly journals Co-prescription of gabapentinoids and opioids among adults with and without osteoarthritis in the United Kingdom between 1995 and 2017

Rheumatology ◽  
2020 ◽  
Author(s):  
Dahai Yu ◽  
Tom Appleyard ◽  
Elizabeth Cottrell ◽  
George Peat
Keyword(s):  
Event Rate ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The United Kingdom ◽  
Regional Estimates ◽  
Strong Opioids ◽  
The Uk ◽  
New Diagnosis

Abstract Objectives To produce national and regional estimates and trends for gabapentinoid–opioid co-prescribing rates in patients with OA, both in absolute terms and relative to matched controls without OA. Methods Using the UK Clinical Practice Research Datalink database we first constructed age–sex–practice–date 1:1 matched cohorts of patients aged ≥40 years with and without a new diagnosis of OA between 1995–2017 and estimated the relative incidence of a first gabapentinoid prescription. Incident gabapentinoid users in both cohorts were followed to estimate and compare the event rate of gabapentinoid–opioid co-prescription (prescription from both classes within the same 28-day window). Results The incidence of first gabapentinoid prescription was 3-fold higher in patients with OA than in matched controls [n = 215 357; incidence rate ratio (IRR) 2.93; 95% CI: 2.87, 3.00]. Among incident gabapentinoid users with OA (n = 27 374, median follow-up 3.9 years) the event rate of gabapentinoid–opioid co-prescription was 4.03 (4.02–4.05) per person-year. The rate was higher in OA patients classed as long-term gabapentinoid users (6.24; 6.22–6.26). These rates were significantly higher than in incident gabapentinoid users without OA [adjusted-IRR: 1.29 (1.28–1.30)]. This elevated risk was observed across age, sex, geographic regions, and calendar years, when restricted to strong opioids and to long-term gabapentinoid users, and when co-prescription was defined as within 14 days and same-day prescribing. Conclusions Patients with OA not only have a higher risk of being prescribed a gabapentinoid but, once prescribed a gabapentinoid, are also at greater risk of opioid co-prescription. Strict restriction of gabapentinoid–opioid co-prescription, and improved access to, and uptake of, effective non-pharmacological and surgical alternatives for OA are required.

Therapy persistence in newly diagnosed non-valvular atrial fibrillation treated with warfarin or NOAC

2016 ◽  
Vol 115 (01) ◽  
pp. 31-39 ◽  
Author(s):  
Anja Katholing ◽  
Christopher Wallenhorst ◽  
Saul Benedict Freedman ◽  
Carlos Martinez
Keyword(s):  
Atrial Fibrillation ◽  
Guideline Adherence ◽  
Practice Research ◽  
First Year ◽  
Clinical Practice Research Datalink ◽  
Supplementary Material ◽  
One Year ◽  
The Uk ◽  
Physician Adherence

SummaryEfforts to reduce stroke in atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines, but high early vitamin K antagonist (VKA) discontinuation is a limitation. We compared persistence of non-VKA OAC (NOAC) with VKA treatment in the first year after OAC inception for incident AF in real-world practice. We studied 27,514 anticoagulant-naïve patients with incident non-valvular AF between January 2011 and May 2014 in the UK primary care Clinical Practice Research Datalink, with full medication use linkage: mean age 74.2 ± 12.4, 45.7 % female, mean follow-up 1.9 ± 1.1 years. After treatment initiation and follow-up until 1/2015, the proportion remaining on OAC at one year (persistence) was estimated using competing risk survival analyses. OAC was commenced ≤90 days after incident AF in 13,221 patients (48.1 %): 12,307 VKA and 914 NOAC (apixaban, dabigatran, rivaroxaban). Amongst those treated with OAC, the proportion commencing NOAC increased from zero in 1/2011 to 27.0 % in 5/2014, and OAC prescriptions for CHA2DS2VASc score ≥2 (guideline adherence) increased from 41.2 % to 65.5 %. Persistence with OAC declined over 12 months to 63.6 % for VKA and 79.2 % for NOAC (p< 0.0001). Persistence for those with CHA2DS2VASc ≥2 was significantly greater for NOAC (83.0 %) than VKA (65.3 %, p< 0.0001) at one year and all earlier time points. Comparison of VKA and NOAC cohorts matched on individual CHA2DS2VASc components showed consistent results. In conclusion, persistence was significantly higher with NOAC than VKA, and could alone lead to fewer cardioembolic strokes. Increased guideline adherence following NOAC introduction could further decrease AF stroke burden.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Incidence of medically attended paediatric burns across the UK

2019 ◽  
Vol 26 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Katie Davies ◽  
Emma Louise Johnson ◽  
Linda Hollén ◽  
Hywel M Jones ◽  
Mark D Lyttle ◽  
...  
Keyword(s):  
At Risk ◽  
Health Services ◽  
Social Services ◽  
Hospital Admissions ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
National Statistics ◽  
The United Kingdom ◽  
Paediatric Burns ◽  
The Uk

ObjectiveChildhood burns represent a burden on health services, yet the full extent of the problem is difficult to quantify. We estimated the annual UK incidence from primary care (PC), emergency attendances (EA), hospital admissions (HA) and deaths.MethodsThe population was children (0–15 years), across England, Wales, Scotland and Northern Ireland (NI), with medically attended burns 2013–2015. Routinely collected data sources included PC attendances from Clinical Practice Research Datalink 2013–2015), EAs from Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI, 2014) and National Health Services Wales Informatics Services, HAs from Hospital Episode Statistics, National Services Scotland and Social Services and Public Safety (2014), and mortality from the Office for National Statistics, National Records of Scotland and NI Statistics and Research Agency 2013–2015. The population denominators were based on Office for National Statistics mid-year population estimates.ResultsThe annual PC burns attendance was 16.1/10 000 persons at risk (95% CI 15.6 to 16.6); EAs were 35.1/10 000 persons at risk (95% CI 34.7 to 35.5) in England and 28.9 (95% CI 27.5 to 30.3) in Wales. HAs ranged from 6.0/10 000 person at risk (95% CI 5.9 to 6.2) in England to 3.1 in Wales and Scotland (95% CI 2.7 to 3.8 and 2.7 to 3.5, respectively) and 2.8 (95% CI 2.4 to 3.4) in NI. In England, Wales and Scotland, 75% of HAs were aged <5 years. Mortality was low with 0.1/1 000 000 persons at risk (95% CI 0.06 to 0.2).ConclusionsWith an estimated 19 574 PC attendances, 37 703 EAs (England and Wales only), 6639 HAs and 1–6 childhood deaths annually, there is an urgent need to improve UK childhood burns prevention.

P4759Factors associated with inappropriate under-dosing of non-vitamin k antagonist oral anticoagulants (NOACs) by labelling criterion in patients with non-valvular atrial fibrillation in the UK

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L A Garcia Rodriguez ◽  
P Vora ◽  
G Brobert ◽  
Y Lenz ◽  
A Ruigomez
Keyword(s):  
Strong Predictor ◽  
Oral Anticoagulants ◽  
Routine Care ◽  
Practice Research ◽  
Health Improvement ◽  
Clinical Practice Research Datalink ◽  
Factors Associated ◽  
The United Kingdom ◽  
History Of ◽  
The Uk

Abstract Background Current labelling for NOACs considers dose adjustments based on renal function and for some also patients' age, weight, comorbidities, and concomitant treatments. There is limited data on factors associated with inappropriately underdosing of NOACs according to the label in routine care. Purpose To assess factors associated with inappropriate underdosing among patients initiating treatment with NOACs for NVAF in the United Kingdom (UK) general practice by applying respective EU labelling criterion. Methods This retrospective cohort study utilized data from The Health Improvement Network and Clinical Practice Research Datalink in the UK. New users of NOACs aged ≥18 years with ≥1-year enrolment in the databases from Jan 2011 - Dec 2016 were included. Three mutually exclusive cohorts of new users of apixaban, dabigatran and rivaroxaban with NVAF were identified with the date of prescription being the index date. Patients with any recent record (within 3 months) of other indications (DVT, PE or hip/knee surgery) were excluded. Appropriate and inappropriate underdosing were defined based on the criterion in the EU label of individual NOACs. Results There were 30,467 new users of NOACs with NVAF during the study period. Of these, 23,444 new users of NOACs received an appropriate dose based on label recommendations. They were 4,953 new users who were inappropriately under-dosed (29.4% in apixaban, 8.7% in dabigatran and 9.1% in rivaroxaban. Older age (70+) was a strong predictor of inappropriate underdosing among apixaban (odds ratio (OR) 7.3; 95% CI: 5.6–9.6) and rivaroxaban (OR 2.8; 95% CI: 2.1–5.4) but not for dabigatran users (OR 0.4; 95% CI: 0.3–0.6). Female apixaban and rivaroxaban users were at greater risk of inappropriate underdosing. For all three NOACs, inappropriate underdosing was less frequent in recent years. Inappropriate underdosing was more frequent among new users with antecedents of intracranial bleed. Inappropriate underdosing was more frequent in apixaban users with a history of ischaemic stroke and rivaroxaban users with history of Ischaemic heart disease. There was no inappropriate underdosing among all new users of NOACs with eGFR under 30. 25.5% of apixaban users and less than 0.5% of rivaroxaban new users with eGFR between 30 and 50 were inappropriately under-dosed. Frailty was a predictor of inappropriate underdosing among apixaban and rivaroxaban new users and the risk increased with greater level of frailty. CHA2DS2VASc score of ≥4 in apixaban users and increasing HAS-BLED scores in apixaban and dabigatran users were significantly associated with inappropriate underdosing but not in rivaroxaban. Conclusions Apixaban had the highest proportion of patients who were inappropriately under-dosed compared to other NOACs. Different factors associated with inappropriate dosing from this study would inform about the factors that are taken into consideration before prescribing different doses of NOACs. Acknowledgement/Funding The study is funded by Bayer AG

scholarly journals Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study

2021 ◽  
pp. BJGP.2020.0870
Author(s):  
Monica SM Persson ◽  
Karen E Harman ◽  
Kim S Thomas ◽  
Joanne Chalmers ◽  
Yana Vinogradova ◽  
...  
Keyword(s):  
Primary Care ◽  
Bullous Pemphigoid ◽  
Secondary Care ◽  
Oral Prednisolone ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
High Dose ◽  
The Uk

Background: Oral prednisolone is the mainstay treatment for bullous pemphigoid, an auto-immune blistering skin disorder affecting older people. Moderate to high dose treatment is often initiated in secondary care, but then continued in primary care. Aim: To describe long-term oral prednisolone prescribing in UK primary care for adults with bullous pemphigoid 1998-2017. Design and setting: A prospective cohort study using routinely collected data from the Clinical Practice Research Datalink, a primary care database containing the healthcare records for over 17 million people in the UK. Method: Oral prednisolone exposure was characterised in terms of the proportion of individuals with incident bullous pemphigoid prescribed oral prednisolone following their diagnosis and the duration and dose of prednisolone. Results: 2,312 (69.6%) of 3,322 people with bullous pemphigoid were prescribed oral prednisolone in primary care. The median duration of exposure was 10.6 months (IQR 3.4 to 24.0). Of prednisolone users, 71.5% were continuously exposed for >3 months, 39.8% for >1 year, 14.7% for >3 years, 5.0% for >5 years, and 1.7% for >10 years. The median cumulative dose was 2,974mg (IQR 1,059 to 6,456). Maximum daily doses were ≥10mg/day in 74.4% of users, ≥20mg/day in 40.7%, ≥30mg/day in 18.2%, ≥40mg/day in 6.6%, ≥50mg/day in 3.8%, and ≥60mg/day in 1.9%. Conclusions: A high proportion of people with incident bullous pemphigoid are treated with oral prednisolone in UK primary care. Primary and secondary care should address steroid-sparing alternatives and, where switching is not possible, ensure prophylactic treatments and proactive monitoring of potential side-effects are in place.

scholarly journals Realising the full potential of data-enabled trials in the UK: a call for action

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e043906
Author(s):  
Matthew R Sydes ◽  
Yolanda Barbachano ◽  
Louise Bowman ◽  
Tom Denwood ◽  
Andrew Farmer ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Case Studies ◽  
Outcome Measures ◽  
Data Science ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Full Potential ◽  
National Workshop ◽  
The Uk

RationaleClinical trials are the gold standard for testing interventions. COVID-19 has further raised their public profile and emphasised the need to deliver better, faster, more efficient trials for patient benefit. Considerable overlap exists between data required for trials and data already collected routinely in electronic healthcare records (EHRs). Opportunities exist to use these in innovative ways to decrease duplication of effort and speed trial recruitment, conduct and follow-up.ApproachThe National Institute of Health Research (NIHR), Health Data Research UK and Clinical Practice Research Datalink co-organised a national workshop to accelerate the agenda for ‘data-enabled clinical trials’. Showcasing successful examples and imagining future possibilities, the plenary talks, panel discussions, group discussions and case studies covered: design/feasibility; recruitment; conduct/follow-up; collecting benefits/harms; and analysis/interpretation.ReflectionSome notable studies have successfully accessed and used EHR to identify potential recruits, support randomised trials, deliver interventions and supplement/replace trial-specific follow-up. Some outcome measures are already reliably collected; others, like safety, need detailed work to meet regulatory reporting requirements. There is a clear need for system interoperability and a ‘route map’ to identify and access the necessary datasets. Researchers running regulatory-facing trials must carefully consider how data quality and integrity would be assessed. An experience-sharing forum could stimulate wider adoption of EHR-based methods in trial design and execution.DiscussionEHR offer opportunities to better plan clinical trials, assess patients and capture data more efficiently, reducing research waste and increasing focus on each trial’s specific challenges. The short-term emphasis should be on facilitating patient recruitment and for postmarketing authorisation trials where research-relevant outcome measures are readily collectable. Sharing of case studies is encouraged. The workshop directly informed NIHR’s funding call for ambitious data-enabled trials at scale. There is the opportunity for the UK to build upon existing data science capabilities to identify, recruit and monitor patients in trials at scale.

Full Mortality risk in patients with adrenal insufficiency using Prednisolone or Hydrocortisone: A Retrospective Cohort study

2021 ◽  
Author(s):  
Kanchana Ngaosuwan ◽  
Desmond G Johnston ◽  
Ian F Godsland ◽  
Jeremy Cox ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Secondary Adrenal Insufficiency ◽  
Duration Of Action ◽  
Statistical Adjustment ◽  
Expected Mortality ◽  
Care Database

Abstract Context Prednisolone has been recommended rather than hydrocortisone for glucocorticoid replacement in adrenal insufficiency due its longer duration of action and lower cost. Objective To determine mortality rates with prednisolone versus hydrocortisone. Design Observational study. Setting A UK primary care database (Clinical Practice Research Datalink). Participants Patients with primary and secondary adrenal insufficiency, treated with either prednisolone or hydrocortisone, and controls individually matched for age, sex, period and place of follow-up. Interventions Nil Outcomes Mortality relative to individually matched controls. Results As expected, mortality in adrenal insufficiency irrespective of cause was increased, based on 5478 patients (4228 on hydrocortisone; 1250 on prednisolone) and 54314 controls (41934 and 12380, respectively). Overall, the adjusted hazard ratio (HR) was similar with the two treatments (prednisolone, 1.76 [95% CI, 1.54-2.01] vs. hydrocortisone 1.69 [1.57-1.82]; p=0.65). This was also the case for secondary adrenal insufficiency. In primary disease (1405 on hydrocortisone vs. 137 on prednisolone:13965 and 1347 controls, respectively), prednisolone-users were older, more likely to have another autoimmune disease and malignancy, and less likely to have mineralocorticoid replacement. Nevertheless, after adjustment, the HR for prednisolone-treated patients remained higher than for those taking hydrocortisone (2.92 [2.19-3.91] vs. 1.90 [1.66-2.16]; p=0.0020). Conclusions In primary but not in secondary adrenal insufficiency mortality was higher with prednisolone. The study was large, but the number of prednisolone-treated patients was small, and they had greater risk factors. Nonetheless the increased mortality associated with prednisolone persisted despite statistical adjustment. Further evidence is needed regarding the long-term safety of prednisolone as routine replacement.

scholarly journals Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink

BMJ Open ◽  
2018 ◽  
Vol 8 (5) ◽  
pp. e020371
Author(s):  
Uwe Koppe ◽  
Dorothea Nitsch ◽  
Kathryn E Mansfield ◽  
Rohini Mathur ◽  
Krishnan Bhaskaran ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Kidney Injury ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Matched Cohort ◽  
Long Term Effects ◽  
The Uk

scholarly journals Risk of adverse events in patients prescribed long‐term opioids: A cohort study in the UK Clinical Practice Research Datalink

2019 ◽  
Vol 23 (5) ◽  
pp. 908-922 ◽  
Author(s):  
John Bedson ◽  
Ying Chen ◽  
Julie Ashworth ◽  
Richard A. Hayward ◽  
Kate M. Dunn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Adverse Events ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

scholarly journals Risk of dementia in adults with cerebral palsy: a matched cohort study using general practice data

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042652
Author(s):  
Kimberley J Smith ◽  
Mark D Peterson ◽  
Christina Victor ◽  
Jennifer M Ryan
Keyword(s):  
General Practice ◽  
Cerebral Palsy ◽  
Cohort Study ◽  
Direct Result ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Diagnosis Of Dementia ◽  
New Diagnosis ◽  
Incident Cases

ObjectivesDetermine the risk of incident dementia in adults with cerebral palsy (CP) compared with age, sex and general practice (GP) matched controls.DesignRetrospective cohort study.SettingUK GPs linked into the Clinical Practice Research Datalink (CPRD).ParticipantsCPRD data were used to identify adults aged 18 or older with a diagnosis of CP. Each adult with CP was matched to three controls who were matched for age, sex and GP. In total, 1703 adults with CP and 5109 matched controls were included in the analysis. The mean baseline age of participants was 33.30 years (SD: 15.48 years) and 46.8% of the sample were female.Primary outcomeNew diagnosis of dementia during the follow-up period (earliest date of 1987 to latest date of 2015).ResultsDuring the follow-up, 72 people were identified with a new diagnosis of dementia. The overall proportion of people with and without CP who developed dementia was similar (CP: n=19, 1.1%; matched controls n=54, 10.0%). The unadjusted HR suggested that people with CP had an increased hazard of being diagnosed with dementia when compared with matched controls (HR 2.69, 95% CI 1.44 to 5.00). This association was attenuated when CP comorbidities (sensory impairment, intellectual disability and epilepsy) were accounted for (HR 1.92, 95% CI 0.92 to 4.02).ConclusionsThere was no difference in the proportion of people with CP and matched controls who were diagnosed with dementia during the follow-up. Furthermore, while there was evidence for an increased hazard of dementia among people with CP, the fact that this association was attenuated after controlling for comorbidities indicates that this association may be explained by comorbidities rather than being a direct result of CP. Findings should be interpreted with caution due to the low number of incident cases of dementia.

scholarly journals Predicting prostate cancer progression: protocol for a retrospective cohort study to identify prognostic factors for prostate cancer outcomes using routine primary care data

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019409 ◽  
Author(s):  
Samuel W D Merriel ◽  
Margaret T May ◽  
Richard M Martin
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Cancer Progression ◽  
Practice Research ◽  
Cancer Registration ◽  
Clinical Practice Research Datalink ◽  
Gleason Grade ◽  
Prostate Cancer Progression ◽  
The Uk

IntroductionProstate cancer is the most common cancer in men in the UK, with nearly 40 000 diagnosed in 2014; and it is the second most common cause of male cancer-related mortality. The clinical conundrum is that most men live with prostate cancer rather than die from it, while existing treatments have significant associated morbidity. Recent studies have shown very low mortality rates (1% after a median of 10-year follow-up) and no treatment-related reductions in mortality, in men with localised prostate cancer. This study will identify prognostic factors associated with prostate cancer progression to help differentiate aggressive from more indolent tumours in men with localised disease at diagnosis, and so inform the decision to adopt conservative (active surveillance) or radical (surgery or radiotherapy) management strategies.Methods and analysisThe Clinical Practice Research Datalink (CPRD) contains 57 318 men who were diagnosed with prostate cancer between 1 January 1987 and 31 December 2016. These men will be linked to the Office for National Statistics (ONS) and the National Cancer Registration and Analysis Service registry databases for mortality, TNM stage, Gleason grade and treatment data. Men with a diagnosis date prior to 1 January 1987 and men with lymph node or distant metastases at diagnosis will be excluded. A priori determined prognostic factors potentially associated with prostate cancer mortality, the end point of cancer progression, will be measured at baseline, and the participants followed through to development of cancer progression, death or the end of the follow-up period (31 December 2016). Cox proportional hazards regression will be used to estimate crude and mutually adjusted HRs. Mortality risk will be predicted using flexible parametric survival models that can accurately fit the shape of the hazard function.Ethics and disseminationThis study protocol has approval from the Independent Scientific Advisory Committee for the UK Medicines and Healthcare products Regulatory Agency Database Research (protocol 17_041). The findings will be presented in peer-reviewed journals and local CPRD researcher meetings.

Sign in / Sign up

Export Citation Format

Share Document