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Medscape
4 days ago
- Health
- Medscape
Drug Combinations for CVDs Tied to Bullous Pemphigoid Risk
TOPLINE: A case-control study revealed that combinations of drugs for cardiovascular diseases and hypertension were frequently prescribed before a diagnosis of bullous pemphigoid (BP), but the risk associated with combinations did not exceed that associated with individual agents. The most common drug combinations included angiotensin-converting enzyme (ACE) inhibitors with statins and antiplatelets with statins. METHODOLOGY: Researchers conducted a nested case-control study using healthcare records from the Clinical Practice Research Datalink between 1998 and 2021 and analysed 16,844 BP cases and 79,493 age- and sex-matched control individuals having no BP diagnosis at the index date (the first date a BP diagnosis code was recorded). Association rule mining (ARM) identified the 10 most common drug class or active substance pairs prescribed to cases or control individuals on the same day and within 6 months before the index date. In the sensitivity analysis, researchers identified medication pairs prescribed within 30 days of each other and during the 6 months preceding the index date. Researchers quantified how often two drugs are co-prescribed compared with their independent prescribing by calculating a lift. They then derived the fold change (FC) as the ratio of a lift in cases vs control individuals. The analysis included multivariable conditional logistic regression to estimate the risk for BP following drug combinations and their constituent drugs. TAKEAWAY: The most frequent drug combinations associated with an increased risk for BP were ACE inhibitors-statins (FC of the lifts in the main analysis vs sensitivity analysis: 1.31 vs 1.18), antiplatelets-statins (1.23 vs 1.11), proton pump inhibitors (PPI)-antiplatelets (1.22 vs 1.14), PPI-statins (1.22 vs 1.14), and ACE inhibitors-antiplatelets (1.20 vs 1.09). For drug substances, combinations with a greater lift in BP cases were simvastatin-ramipril (FC, 1.30), simvastatin-aspirin (FC, 1.21), and ramipril-aspirin (FC, 1.19). After adjusting for BP-associated drugs, the Charlson Comorbidity Index, and relevant confounders, the increased risk remained significant for these drug class combinations: antiplatelets-statins (odds ratio [OR], 1.20), ACE inhibitors-statins (OR, 1.16), PPI-statins (OR, 1.22), ACE inhibitors-antiplatelets (OR, 1.26), and PPI-antiplatelets (OR, 1.43; P < .001 for all). The risk for BP associated with these frequently prescribed drug combinations was lower than the risk linked to each constituent drug at both class and substance levels. In both main and sensitivity analyses, patients who developed BP were more likely than control individuals to have received combinations of cardiovascular or antihypertensive drugs before diagnosis. IN PRACTICE: "The ARM algorithm exploratory analysis identified the most commonly prescribed drug combinations prior to BP. Logistic regression confirmed drug combinations for CVDs [cardiovascular diseases] or hypertension associated with increased BP risk," the authors wrote. "The increased BP risk following reported combinations was modest and was not greater than their constituent drugs. Given that the number of patients with BP is low, we do not suggest avoiding the reported drugs but instead being on the lookout for any skin reactions following treatments for CVDs or hypertension," they concluded. SOURCE: This study was led by Mikolaj Swiderski, University of Nottingham, Nottingham, England. It was published online on August 06, 2025, in Clinical and Experimental Dermatology. LIMITATIONS: The ARM algorithm considered only the frequency of prescriptions to obtain drug combinations. Additionally, the algorithm demonstrated limited clinical value, linking only half of the inferred drug class combinations with BP and failing to capture the sequence or precise timing of prescriptions. It also lacked dosage and treatment duration data, and as an exploratory tool, ARM could not establish causal relationships between drug exposures and the risk for BP. DISCLOSURES: This research was supported by the National Institute for Health and Care Research grant via the Research for Patient Benefit Programme. Swiderski reported receiving salary funding from this grant. Another author reported receiving salary funding from King's College London, University of Nottingham, and the National Institute for Health and Care Research East Midlands scholarship scheme. Additional disclosures are noted in the original article. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
10-06-2025
- Health
- Medscape
Prevalence of Autoimmune Diseases Rose in UK Pregnancies
Over the past two decades, the prevalence of autoimmune diseases among pregnant women in the UK has significantly increased, with psoriasis being the most common condition. The likelihood of diagnosis varied across sociodemographic factors, including age, ethnicity, and socioeconomic status. METHODOLOGY: Researchers conducted a UK population-based retrospective cohort study using routinely collected primary care data from Clinical Practice Research Datalink Gold and Aurum pregnancy registers. This study included 5,165,960 pregnancies in 2,831,472 women aged 15-49 years from 2000 to 2021, including 185,208 pregnancies in 100,655 women with a coded diagnosis of autoimmune disease. Researchers evaluated the prevalence trend, calculated annually for both overall and each of 17 autoimmune diseases, during pregnancy via diagnostic codes and analysed their associations with sociodemographic factors. TAKEAWAY: The overall prevalence of autoimmune diseases during pregnancy increased from 3.5% in 2000 to 4.7% in 2021; psoriasis was the most prevalent condition, followed by inflammatory bowel disease and rheumatoid arthritis between 2000 and 2010 and type 1 diabetes and inflammatory bowel disease in 2010-2021. The prevalence of most of the autoimmune diseases significantly increased between 2000 and 2021, with the steepest rise observed in Hashimoto's thyroiditis (+6.22%), coeliac disease (+6.20%), and alopecia areata (+4.75%). Women living in less deprived areas had higher odds of autoimmune diseases during pregnancy than those living in more deprived areas (adjusted odds ratio [aOR], 1.10; 95% CI, 1.07-1.14), and Black women had significantly lower odds than White women (aOR, 0.48; 95% CI, 0.45-0.51). Compared with women aged 15-20 years, those aged 21-30 years (aOR, 1.17; 95% CI, 1.14-1.20), 31-40 years (aOR, 1.50; 95% CI, 1.45-1.55), and 41-50 years (aOR, 1.75; 95% CI, 1.68-1.82) had increased odds of being diagnosed with autoimmune disease before pregnancy. IN PRACTICE: "This study gives a clear estimate of the burden of autoimmune diseases in pregnancy in the UK and the possible association with various demographic factors, and will help the process of improving maternity care for women with these health conditions," the authors wrote. SOURCE: This study was led by Megha Singh, PhD, Department of Applied Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, England. It was published online on June 02, 2025, in The Lancet Rheumatology . LIMITATIONS: This study did not include some rare autoimmune diseases like dermatomyositis. Although the use of primary care data reduced entry-level coding biases, improvements in recording practices over time might affect data quality and completeness, potentially affecting observed trends. Additionally, this study may have underestimated the prevalence of autoimmune diseases since most cases are diagnosed and managed in secondary care. DISCLOSURES: This study was supported by the Strategic Priority Fund "Tackling multimorbidity at scale" programme. One author initially worked at the University of Birmingham and later joined AstraZeneca and currently holds an honorary contract with the University of Birmingham.
Medscape
15-05-2025
- Health
- Medscape
High A1c Fluctuations Linked to Mortality Risk in Diabetes
Higher A1c variability, assessed over a 4-year period, was associated with a substantially increased risk for subsequent mortality outcomes in patients with type 1 diabetes (T1D) and those with type 2 diabetes (T2D), regardless of average A1c levels. METHODOLOGY: The importance of glycaemic control, as reflected by average A1c levels, is well-established in diabetes management guidelines; however, growing evidence suggests that A1c variability may also be important for various microvascular and macrovascular outcomes. Researchers in England carried out a population-based cohort study to examine predictors of high A1c variability and evaluate the relationship between high A1c variability and all-cause mortality in patients with diabetes. They included 20,347 patients with T1D (mean age, 52.9 years; 57.4% men) and 409,821 patients with T2D (mean age, 67.5 years; 55.8% men), all aged 31 years or older, from the Clinical Practice Research Datalink database. All participants had at least four A1c measurements taken at least 30 days apart during 2011-2014 and were followed from 2015 to 2017 for subsequent mortality outcomes. The A1c variability score was calculated by measuring the frequency of A1c fluctuations of at least 0.5% (or 5.5 mmol/mol) between successive measurements over time, expressed as a percentage; A1c variability score estimates were categorised into four levels: 0 to < 20, 20 to < 50, 50 to < 80, and 80-100. TAKEAWAY: Variability measures were generally higher in T2D, with 38% of patients with T2D vs 33% of those with T1D having an A1c variability score ≥ 50. Predictors of high A1c variability were younger age, obesity, comorbidities, and residence in deprived areas for both T1D and T2D, whereas non-White ethnicity was a predictor of high variability only in T1D. A higher vs lower A1c variability score (≥ 80 vs < 20) was associated with nearly a threefold increase in mortality risk for patients with T1D and a twofold increased risk for those with T2D (hazard ratio [HR] for T1D, 2.78; 95% CI, 2.15-3.60; HR for T2D, 1.91; 95% CI, 1.83-1.99). The impact of average A1c levels on mortality was less pronounced than that of A1c variability, as evidenced by higher population attributable fractions for variability (A1c variability score ≥ 20) than for average A1c levels in both T1D and T2D. IN PRACTICE: "Regardless of whether variability can be reduced, given its strong effects on mortality risk, it could be incorporated into A1c targets or trigger enhanced monitoring and support," the authors wrote. SOURCE: The study was led by Liza Bowen and Iain Carey, School of Health & Medical Sciences, City St George's, University of London, London, England. It was published online on May 6, 2025, in Diabetes Research and Clinical Practice . LIMITATIONS: The study included only patients with diabetes who had at least four A1c measurements in primary care between 2011 and 2014. Patients with T1D likely had additional A1c measurements recorded in hospital records that were not included in the primary care dataset. DISCLOSURES: The study was funded by the National Institute for Health and Care Research (NIHR) - Research for Patient Benefit Programme and supported by the NIHR Applied Research Collaboration South London at King's College Hospital National Health Service Foundation Trust. One author was supported by an NIHR Clinical Lectureship in General Practice. Another author reported consulting for and/or receiving speaker honoraria and grant support from various healthcare and pharmaceutical companies.
