LATE-BREAKING ABSTRACT: Stability of blood eosinophil count in COPD patients in the UK clinical practice research datalink

Blood eosinophils are a potentially useful biomarker for guiding inhaled corticosteroid (ICS) treatment decisions in COPD. We investigated whether existing blood eosinophil counts predict benefit from initiation of ICS compared to bronchodilator therapy.We used routinely collected data from UK primary care in the Clinical Practice Research Datalink. Participants were ≥40 years with COPD, ICS-naïve and starting a new inhaled maintenance medication (intervention group: ICS; comparator group: long-acting bronchodilator, non-ICS). Primary outcome was time-to-first exacerbation, compared between ICS and non-ICS groups, stratified by blood eosinophils (“high” (≥150/µL) and “low” (<150/µL) groups).Of 9475 eligible patients, 53.9% initiated ICS and 46.1% non-ICS treatment with no difference in eosinophils between treatment groups (p=0.71). Exacerbation risk was higher in patients prescribed ICS than non-ICS, but with a lower risk in those with “high” eosinophils (hazard ratio 1.04, 95% CI 0.98 to 1.10) than “low” eosinophils (1.19, 95% CI 1.09 to 1.31) (p value for interaction=0.01). Risk of pneumonia hospitalisation with ICS was greatest in those with “low” eosinophils (hazard ratio 1.26, 95% CI 1.05 to 1.50; p value for interaction=0.04). Results were similar whether the most recent blood eosinophil count or the mean of blood eosinophil counts was used.In a primary care population, the most recent blood eosinophil count could be used to guide initiation of ICS in COPD patients. We suggest that ICS should be considered in those with higher eosinophils and avoided in those with lower eosinophils (<150/µL).

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Calcium channel blockers and cancer: a risk analysis using the UK Clinical Practice Research Datalink (CPRD)

BMJ Open ◽

10.1136/bmjopen-2015-009147 ◽

2016 ◽

Vol 6 (1) ◽

pp. e009147 ◽

Cited By ~ 25

Author(s):

Lamiae Grimaldi-Bensouda ◽

Olaf Klungel ◽

Xavier Kurz ◽

Mark C H de Groot ◽

Ana S Maciel Afonso ◽

...

Keyword(s):

Clinical Practice ◽

Risk Analysis ◽

Calcium Channel ◽

Calcium Channel Blockers ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Channel Blockers ◽

The Uk

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Development and validation of prediction models to estimate risk of primary total hip and knee replacements using data from the UK: two prospective open cohorts using the UK Clinical Practice Research Datalink

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-213894 ◽

2018 ◽

Vol 78 (1) ◽

pp. 91-99 ◽

Cited By ~ 7

Author(s):

Dahai Yu ◽

Kelvin P Jordan ◽

Kym I E Snell ◽

Richard D Riley ◽

John Bedson ◽

...

Keyword(s):

Clinical Practice ◽

Large Scale ◽

Prediction Models ◽

Cox Proportional Hazards ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Total Hip ◽

Risk Of Death ◽

Geographical Regions ◽

The Uk

ObjectivesThe ability to efficiently and accurately predict future risk of primary total hip and knee replacement (THR/TKR) in earlier stages of osteoarthritis (OA) has potentially important applications. We aimed to develop and validate two models to estimate an individual’s risk of primary THR and TKR in patients newly presenting to primary care.MethodsWe identified two cohorts of patients aged ≥40 years newly consulting hip pain/OA and knee pain/OA in the Clinical Practice Research Datalink. Candidate predictors were identified by systematic review, novel hypothesis-free ‘Record-Wide Association Study’ with replication, and panel consensus. Cox proportional hazards models accounting for competing risk of death were applied to derive risk algorithms for THR and TKR. Internal–external cross-validation (IECV) was then applied over geographical regions to validate two models.Results45 predictors for THR and 53 for TKR were identified, reviewed and selected by the panel. 301 052 and 416 030 patients newly consulting between 1992 and 2015 were identified in the hip and knee cohorts, respectively (median follow-up 6 years). The resultant model C-statistics is 0.73 (0.72, 0.73) and 0.79 (0.78, 0.79) for THR (with 20 predictors) and TKR model (with 24 predictors), respectively. The IECV C-statistics ranged between 0.70–0.74 (THR model) and 0.76–0.82 (TKR model); the IECV calibration slope ranged between 0.93–1.07 (THR model) and 0.92–1.12 (TKR model).ConclusionsTwo prediction models with good discrimination and calibration that estimate individuals’ risk of THR and TKR have been developed and validated in large-scale, nationally representative data, and are readily automated in electronic patient records.

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Statin use and reduced risk of biliary tract cancers in the UK Clinical Practice Research Datalink

Gut ◽

10.1136/gutjnl-2018-317504 ◽

2018 ◽

Vol 68 (8) ◽

pp. 1458-1464 ◽

Cited By ~ 3

Author(s):

Zhiwei Liu ◽

Rotana Alsaggaf ◽

Katherine A McGlynn ◽

Lesley A Anderson ◽

Huei-Ting Tsai ◽

...

Keyword(s):

Clinical Practice ◽

Biliary Tract ◽

Conditional Logistic Regression ◽

Incidence Density ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Biliary Tract Cancers ◽

The Uk ◽

Reduced Risk ◽

Statin Use

ObjectiveTo evaluate the association between statin use and risk of biliary tract cancers (BTC).DesignThis is a nested case–control study conducted in the UK Clinical Practice Research Datalink. We included cases diagnosed with incident primary BTCs, including cancers of the gall bladder, bile duct (ie, both intrahepatic and extrahepatic cholangiocarcinoma), ampulla of Vater and mixed type, between 1990 and 2017. For each case, we selected five controls who did not develop BTCs at the time of case diagnosis, matched by sex, year of birth, calendar time and years of enrolment in the general practice using incidence density sampling. Exposures were defined as two or more prescription records of statins 1 year prior to BTC diagnosis or control selection. ORs and 95% CIs for associations between statins and BTC overall and by subtypes were estimated using conditional logistic regression, adjusted for relevant confounders.ResultsWe included 3118 BTC cases and 15 519 cancer-free controls. Current statin use versus non-use was associated with a reduced risk of all BTCs combined (adjusted OR=0.88, 95% CI 0.79 to 0.98). The reduced risks were most pronounced among long-term users, as indicated by increasing number of prescriptions (ptrend=0.016) and cumulative dose of statins (ptrend=0.008). The magnitude of association was similar for statin use and risk of individual types of BTCs. The reduced risk of BTCs associated with a record of current statin use versus non-use was more pronounced among persons with diabetes (adjusted OR=0.72, 95% CI 0.57 to 0.91). Among non-diabetics, the adjusted OR for current statin use versus non-use was 0.91 (95% CI 0.81 to 1.03, pheterogeneity=0.007).ConclusionCompared with non-use of statins, current statin use is associated with 12% lower risk of BTCs; no association found with former statin use. If replicated, particularly in countries with a high incidence of BTCs, our findings could pave the way for evaluating the value of statins for BTC chemoprevention.

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