Patterns of use of tamoxifen and aromatase inhibitors: A population-based observational study

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 556-556
Author(s):  
L. Huiart ◽  
S. Dell'Aniello ◽  
S. Suissa
Keyword(s):  
Aromatase Inhibitors ◽  
Large Population ◽  
General Practice Research Database ◽  
Real Life ◽  
Population Based ◽  
Practice Research ◽  
First Year ◽  
Research Database ◽  
Patterns Of Use ◽  
Few Data

556 Background: Few data are available outside clinical trials on the use of aromatase inhibitors (AI) as adjuvant treatment for early breast cancer (BC). We therefore used a large population-based database to describe patterns of use of AI over time, in comparison with tamoxifen, as well as switches between these regimens. Methods: We identified 13,479 women treated for BC with tamoxifen, anastrazole, letrozole, or exemestane between 1998 and June 2008 in the UK General Practice Research Database (GPRD). Patients were followed from their first prescription for 5 years or until recurrence, death, switch to another treatment or occurrence of a major thromboembolic or uterine event. Results: Mean age at cohort entry was 62 years (SD=14.0) in the tamoxifen group (n=10,806) and 70.8 (SD = 12.4) in the AI group (n=2,673). Overall, in the first year of treatment 88.8% of patients had prescriptions covering more than 80% of the year (88.3% and 90.8% in tamoxifen and in AI group respectively). Table 1 describes prescriptions covering less than 80% of the days for each year of treatment in 3 subgroups. Among women started on AI therapy diagnosed with BC after 2006, 9.6% switched treatment. Half of them switched from one AI to another AI, the other half switched from AI to tamoxifen. Switches occurred within the first year of treatment in 76% of cases. Among women over 50 years of age who started a tamoxifen therapy after 2000, 31% of women switched to AI in the course of the study, of which 12% within the first year of treatment (11.1% and 13.7% for women diagnosed in 2000–2004 and after 2005 respectively). Conclusions: The real-life patterns of use of tamoxifen and AI therapy demonstrate high rates of adherence. However, the relatively high percentage of switchers among AI users is suggestive of an association with side-effects. [Table: see text] No significant financial relationships to disclose.

Antibiotic prescribing in primary care for end-of-life cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9627-9627 ◽  
Author(s):  
Wei Gao ◽  
James F. Spicer ◽  
Irene Higginson
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
General Practice Research Database ◽  
Population Based ◽  
Practice Research ◽  
Antibiotic Prescribing ◽  
Research Database ◽  
Clinical Practices ◽  
Morbidity Score ◽  
Co Morbidity

9627 Background: There is ongoing debate on whether it is appropriate to administer anti-infection medications to patients approaching end of life. Population-based epidemiologic data on current antibiotic prescribing status is needed to shed lights on this issue. Methods: A population-based retrospective cohort study, based on data extracted from the General Practice Research Database (GPRD). Patients (N=29,810) with one of five major cancers (lung, colorectal, breast, prostate, head and neck), and who died in 2000-2008 were included for this analysis. Prescriptions of antibiotics(BNF codes: 5.1.1-5.1.13) for individual patients in the last 3 months of life were reviewed and analysed. The outcome was with (1) or without (0) antibiotic prescriptions. A Generalized Estimating Equation (GEE) logistic regression model was used to assess for the associations between outcome and explanatory variables. Results: Overall, 26.8% of patients(95%CI: 26.3-27.3%) had been prescribed antibiotics. There was an increasing trend in antibiotic prescribing for end-of-life cancer patients, rising from 23.2%(21.5-24.9%) in 2000 to 29.5%(28.0-31.0%) in 2008 (p<0.001). Patients with the following characteristics were more likely to be prescribed antibiotics(p<0.001): being younger(<70:ORs 1.14-1.27) vs 80+, male gender(OR: 1.10; 1.03-1.18), lung & head & neck cancer(ORs:1.50-2.00) vs colorectal cancer, higher co-morbidity score(ORs vs 0-3:1.02-1.19), smoking(OR vs non-smoking 1.17;1.07-1.27), living in Northern Ireland(OR:1.43; 1.17-1.75) and Scotland(ORs: 1.23; 1.03 to 1.47) vs London. No difference by whether they drank alcohol or social economic status. Conclusions: Antibiotic prescribing at the end of life was common and increasing over the years. Further studies need to investigate clinical conditions associated with antibiotic prescribing to inform clinical practices and end of life care policy.

scholarly journals Comorbidities of Idiopathic Thrombocytopenic Purpura: A Population-Based Study

2009 ◽  
Vol 2009 ◽  
pp. 1-12 ◽  
Author(s):  
M. A. Feudjo-Tepie ◽  
G. Le Roux ◽  
K. J. Beach ◽  
D. Bennett ◽  
N. J. Robinson
Keyword(s):  
Medical Information ◽  
Medical Condition ◽  
General Practice Research Database ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Population Based ◽  
Practice Research ◽  
Research Database ◽  
Medical Conditions ◽  
Before And After

A person experiencing more than one medical condition may have ambiguous clinical presentation. ITP is a serious autoimmune disease with little epidemiological evidence on its burden, risk factors, and comorbidities. Using the United Kingdom general practice research database, we conducted a 14 years population-based case control-type study to explore medical conditions more likely to cooccur with ITP and their temporal relationship in association with ITP. ITP patients were matched to non-ITP on practice, age, gender, and follow-up period. Potential comorbidities were represented by patients’ medical information at the preferred term level of the MedDRA international classification. As well as death (; 95% CI [4.47–806.0]) and known clinical signs and symptoms of ITP, ITP is associated with considerable number of medical conditions. The association between ITP and some of these conditions is apparent both before and after ITP diagnosis. Specific targeted studies can now be setup to reexamine observed associations.

The concurrent use of antithrombotic therapies and the risk of bleeding in patients with atrial fibrillation

2013 ◽  
Vol 109 (03) ◽  
pp. 431-439 ◽  
Author(s):  
Laurent Azoulay ◽  
Sophie Dell’Aniello ◽  
Teresa Simon ◽  
Christel Renoux ◽  
Samy Suissa
Keyword(s):  
Atrial Fibrillation ◽  
Triple Therapy ◽  
Large Population ◽  
Population Based ◽  
Practice Research ◽  
Control Analysis ◽  
Research Database ◽  
Risk Of Bleeding ◽  
Concurrent Use ◽  
Increased Risk

SummaryPatients with atrial fibrillation (AF) often receive, in addition to warfarin, antithrombotic drugs to manage other comorbid conditions. To date, few population-based studies have quantified the bleeding risk associated with the concurrent use of these therapies. The United Kingdom General Practice Research Database was used to identify a cohort of 70,760 patients newly-diagnosed with AF between 1993 and 2008. A nested case-control analysis was conducted within that cohort, and conditional logistic regression was used to estimate adjusted rate ratios (RRs) of bleeding associated with current use of warfarin, aspirin, and clopidogrel in single therapy, as well as in dual and triple therapy, as compared with non-use of any therapy. A total of 10,850 patients experienced a bleeding event during follow-up. In single therapy, warfarin was associated with the highest increased risk (RR: 2.08, 95% confidence interval [CI]: 1.95–2.23), followed by clopidogrel (RR: 1.57, 95% CI: 1.37–1.81) and aspirin (RR: 1.25, 95% CI: 1.17–1.34). In dual therapy, combinations containing warfarin were associated with a higher increased risk (warfarin-aspirin: RR: 2.87, 95% CI: 2.58–3.19, and warfarin-clopidogrel: RR: 2.74, 95% CI: 2.14–3.51), than those not containing warfarin (aspirin-clopidogrel: RR: 1.68, 95% CI: 1.44–1.97). Triple therapy of warfarin-aspirin-clopidogrel was associated with the highest increased risk (RR: 3.75, 95% CI: 2.71–5.19). This large population-based study suggests that while all antithrombotic therapies are associated with an elevated risk of bleeding, the risks increase in an additive fashion with dual and triple therapy, particularly in combinations containing warfarin.

Risk of cataract and glaucoma in patients with multiple sclerosis

2011 ◽  
Vol 18 (5) ◽  
pp. 628-638 ◽  
Author(s):  
Marloes T Bazelier ◽  
Sigrid Mueller-Schotte ◽  
Hubert GM Leufkens ◽  
Bernard MJ Uitdehaag ◽  
Tjeerd van Staa ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
General Practice Research Database ◽  
Population Based ◽  
Practice Research ◽  
Research Database ◽  
Hazard Ratios ◽  
Increased Risk ◽  
History Of ◽  
The Uk ◽  
Hospital Registry

Background: The aim of the study was to evaluate whether multiple sclerosis (MS) is associated with risk of cataract or glaucoma. Methods: We conducted a population-based cohort study utilizing the UK General Practice Research Database (1987–2009) linked to the national hospital registry of England (1997–2008). Incident MS patients (5576 cases) were identified and each was matched to six patients without MS (controls) by age, gender, and practice. Cox proportional hazard models were used to estimate hazard ratios (HRs) of incident cataract and glaucoma in MS. Time-dependent adjustments were made for age, history of diseases and drug use. Results: MS patients had no overall increased risk of cataract, adjusted (adj.) HR 1.15 (95% CI 0.94–1.41) or glaucoma, adj. HR 1.02 (95% CI 0.78–1.33). Risk of cataract (adj. HR 2.45 (95% CI 1.56–3.86)) and glaucoma (adj. HR 1.70 (95% CI 1.01–2.86)) was significantly greater in patients < 50 years, particularly in men < 50 years: cataract, adj. HR 4.23 (95% CI 2.22–8.05) and glaucoma, adj. HR 2.76 (95% CI 1.28–5.93). Conclusion: This is the first study which showed that the risk of cataract and glaucoma is elevated in MS patients younger than 50 years, particularly men.

scholarly journals Real-world effect of antidepressants for depressive disorder in primary care: protocol of a population-based cohort study

2020 ◽  
Vol 23 (3) ◽  
pp. 122-126
Author(s):  
Franco De Crescenzo ◽  
Cesar Garriga ◽  
Anneka Tomlinson ◽  
Carol Coupland ◽  
Orestis Efthimiou ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Depressive Disorder ◽  
General Practice Research Database ◽  
Severe Depression ◽  
Population Based ◽  
Practice Research ◽  
Research Database ◽  
Care Protocol ◽  
The Uk

IntroductionClinical guidelines recommend antidepressants as the first line of treatment for adults with moderate-to-severe depression. Randomised trials provide the best evidence on the comparative effectiveness of antidepressants for depression, but are limited by a short follow-up and a highly selected population. We aim to conduct a cohort study on a large database to assess acceptability, efficacy, safety and tolerability of antidepressant monotherapy in people with depressive disorder in primary care.Methods and analysisThis is a protocol for a cohort study using data from the QResearch primary care research database, which is the largest general practice research database in the UK. We will include patients registered for at least 1 year from 1 January 1998, diagnosed with a new episode of depression and on antidepressant and a comparison group not on antidepressant. The exposure of interest will be treatment with antidepressant medications. Our outcomes will be acceptability (treatment discontinuation due to any cause), efficacy (clinical response and remission); safety (adverse events (AEs) and all-cause mortality); and tolerability (dropouts due to any AE) measured at 2 months, 6 months and 1 year. For each outcome, we will estimate the absolute risks for all antidepressants, and relative effects between antidepressants using Cox’s proportion hazards models. We will calculate HRs and 99.9% CIs for each outcome of interest.DiscussionThe main limitation is the observational nature of our study, while the major strengths include the large representative population contained in QResearch and the possibly high generalisability.

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