scholarly journals Propranolol Reduces Risk of Knee or Hip Replacement Due to Osteoarthritis: a Propensity Score Matched Cohort Study-using Data From the Clinical Practice Research Datalink.

2021 ◽  
Author(s):  
Georgina Nakafero ◽  
Matthew J Grainge ◽  
Ana M Valdes ◽  
Nick Townsend ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Propensity Score ◽  
Total Joint Replacement ◽  
Controlled Trial ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Number Needed To Treat ◽  
Using Data

Abstract Objectives To examine the association between β-blocker prescription and knee or hip total joint replacement (TJR) in a UK primary-care population with incident knee or hip osteoarthritis (OA).Methods Cohort study using data from the Clinical Practice Research Datalink. Participants aged ≥40 years with incident knee or hip OA, exposed to β-blockers after OA diagnosis (new-user design), were matched to one control for age, sex, OA location and propensity score (PS) for β-blocker prescription. Cox-proportional hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. The analyses were adjusted for factors that influence health-seeking behaviour, progression of OA, and stratified according to β-blocker classification. Data analysis was conducted using Stata.Results Data for 6,970 PS-matched β-blocker exposed and unexposed participants were included. Any β-blocker prescription was not associated with knee or hip TJR (aHR 1.11; 95% CI 0.98 – 1.25). However, prescription of lipophilic non-selective β-blockers having membrane stabilising effects associated with reduced risk of knee or hip TJR (aHR 0.69; 95% CI 0.52 – 0.93). Of these, there was a protective effect for propranolol (aHR 0.71; 95% CI 0.53 – 0.95), the commonest prescribed drug in this class. The number needed to treat (95% CI) with propranolol for two years in order to prevent one TJR was 32 (23-52).Conclusion Propranolol, a non-selective β-blocker, reduces the risk of knee and hip TJR. This is consistent with its analgesic effects in other conditions and a randomised controlled trial is required to further evaluate its analgesic potential and safety in OA.

scholarly journals Estimating the risk of acute kidney injury associated with use of diuretics and renin angiotensin aldosterone system inhibitors: A population based cohort study using the clinical practice research datalink

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jemima Scott ◽  
Tim Jones ◽  
Maria Theresa Redaniel ◽  
Margaret T. May ◽  
Yoav Ben-Shlomo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Clinical Practice ◽  
Propensity Score ◽  
Cox Regression ◽  
Kidney Injury ◽  
Exposed Group ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Raas Inhibitors

Abstract Background The risk of acute kidney injury (AKI) attributable to renin angiotensin aldosterone (RAAS) inhibitors and diuretics remains unclear. Methods We conducted a prospective cohort study using the Clinical Practice Research Datalink (2008–2015) linked to Hospital Episode Statistics – Admitted Patient Care and Office for National Statistics mortality data. Patients were included if they had one or more chronic diagnoses requiring medication. Exposed patients had a first ever prescription for RAAS inhibitors/diuretics during the study period. AKI risk associated with exposure was determined by multivariable Cox regression, propensity score-adjusted Cox regression and a prior event rate ratio (PERR) analysis. Results One hundred forty thousand nine hundred fifty-two individuals were included. Increased AKI risk in the exposed group was demonstrated in both the multivariable and propensity score-adjusted cox regressions (HR 1.23 (95% CI 1.04–1.45) and HR 1.24 (1.05–1.47) respectively). The PERR analysis provided a similar overall hazard ratio with a wider confidence interval (HR 1.29 (0.94–1.63)). The increased AKI risk in the exposed group was present only in those receiving two or more antihypertensives. Absolute AKI risk was small. Conclusions RAAS inhibitors/diuretics result in an increased risk of AKI. The absolute increase in AKI risk is small, however, and needs to be considered in the context of any potential benefits.

scholarly journals Pharmacoepidemiology in pregnancy: analysis protocol for an observational cohort study in the UK Clinical Practice Research Datalink

2022 ◽  
Vol 7 ◽  
pp. 12
Author(s):  
Ciarrah-Jane Barry ◽  
Christy Burden ◽  
Neil Davies ◽  
Venexia Walker
Keyword(s):  
Cohort Study ◽  
Clinical Practice ◽  
Drug Exposure ◽  
Negative Control ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Control Analysis ◽  
Definitive Evidence ◽  
Using Data ◽  
The Uk

Large numbers of women take prescription and over-the-counter medications during pregnancy. However, there is very little definitive evidence about the potential effects of these drugs on the mothers and offspring. We will investigate the risks and benefits of continuing prescriptive drug use for chronic pre-existing maternal conditions such as diabetes, hypertension and thyroid related conditions throughout pregnancy. If left untreated, these conditions are established risk factors for adverse neonatal and maternal outcomes. However, some treatments for these conditions are associated with adverse neonatal outcomes. Our primary aims are twofold. Firstly, we aim to estimate the beneficial effect on the mother of continuing treatment during pregnancy. Second, we aim to determine whether there is an associated detrimental impact on the neonate of continuation of maternal treatment during pregnancy. To establish this evidence, we will investigate the relationship between maternal drug prescriptions and adverse and beneficial offspring outcomes to provide evidence to guide clinical decisions. We will conduct a hypothesis testing observational intergenerational cohort study using data from the UK Clinical Practice Research Datalink (CPRD). We will apply four statistical methods: multivariable adjusted regression, propensity score regression, instrumental variables analysis and negative control analysis. These methods should account for potential confounding when estimating the association between the drug exposure and maternal or neonatal outcome. In this protocol we describe the aims, motivation, study design, cohort and statistical analyses of our study to aid reproducibility and transparency within research.

scholarly journals Do β-adrenoreceptor blocking drugs associate with reduced risk of symptomatic osteoarthritis and total joint replacement in the general population? A primary care-based, prospective cohort study using the Clinical Practice Research Datalink

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e032050
Author(s):  
Georgina Nakafero ◽  
Matthew Grainge ◽  
Ana Valdes ◽  
Nick Townsend ◽  
Christian Mallen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Joint Replacement ◽  
Index Date ◽  
Primary Outcome ◽  
Total Joint Replacement ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Exclusion Criteria ◽  
Β Blocker

IntroductionTo investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription.SettingPrimary care.Methods and analysisThis is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription.Statistical analysisKaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription.Ethics and disseminationThis study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18_227R). The results of this study will be published in peer-reviewed journals and presented at conferences.SummaryThis prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.

scholarly journals Rheumatoid arthritis and excess mortality: down but not out. A primary care cohort study using data from Clinical Practice Research Datalink

Rheumatology ◽  
2018 ◽  
Vol 57 (6) ◽  
pp. 977-981 ◽  
Author(s):  
Abhishek Abhishek ◽  
Georgina Nakafero ◽  
Chang-Fu Kuo ◽  
Christian Mallen ◽  
Weiya Zhang ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
Cohort Study ◽  
Clinical Practice ◽  
Excess Mortality ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Using Data

scholarly journals Validation of hip osteoarthritis diagnosis recording in the UK Clinical Practice Research Datalink

2018 ◽  
Vol 28 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Rory J. Ferguson ◽  
Daniel Prieto‐Alhambra ◽  
Christine Walker ◽  
Dahai Yu ◽  
Jose M. Valderas ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Hip Osteoarthritis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk
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