Biomedical subjects

Susan S Jick

Publications and source records attributed to Susan S Jick.

25 records · Page 2Linked to original sources

PubMed2004

The risk of severe depression, psychosis or panic attacks with prophylactic antimalarials.

INTRODUCTION/OBJECTIVE: Experimental and observational studies have linked mefloquine use to an increased risk of developing neuropsychiatric adverse effects such as depression or psychoses. Most of these reports relied on interview-based information from travellers. We conducted a population-based observational study using a database of medical records to quantify and compare the risk of psychiatric disorders during or after use of mefloquine with the risk during use of proguanil and/or chloroquine, or doxycycline. STUDY DESIGN/METHODS: The study population was drawn from the large UK-based General Practice Research Database (GPRD). Subjects were aged from 17-79 years and were exposed to mefloquine, proguanil, chloroquine or doxycycline (or a combination of these drugs) at some time between 1990 and 1999. We performed a person-time and a nested case-control analysis to assess the risk of developing a first-time diagnosis of depression, psychosis or panic attack during or after use of these antimalarial drugs. RESULTS: Within the study population of 35 370 subjects (45.2% males), we identified 580 subjects with a first-time diagnosis of depression (n = 505), psychosis (n = 16) or panic attack (n = 57) and two subjects committed suicide. The incidence rates of first-time diagnoses of depression during current use of mefloquine, proguanil and/or chloroquine, or doxycycline, adjusted for age, gender and calendar year, were 6.9 (95% CI 4.5-10.6), 7.6 (95% CI 5.5-10.5) and 9.5 (95% CI 3.7-24.1)/1000 person-years, respectively. The incidence rates of psychosis or panic attacks during current mefloquine exposure were 1.0/1000 person-years (95% CI 0.3-2.9) and 3.0/1000 person-years (95% CI 1.6-5.7), respectively, approximately 2-fold higher (statistically nonsignificant) than during current use of proguanil and/or chloroquine, or doxycycline. The nested case-control analysis encompassed 505 cases with depression and 3026 controls, 16 cases with psychosis and 96 controls, and 57 cases with a panic attack and 342 controls. Current use of mefloquine was not associated with an elevated risk of developing depression. In a comparison between patients currently using mefloquine with all past users of antimalarials combined, the risk estimate was elevated for current users of mefloquine for both psychosis (odds ratio [OR] 8.0, 95% CI 1.0-62.7; p < 0.05) and panic attacks (OR 2.7, 95% CI 1.1-6.5; p < 0.05). CONCLUSION: The absolute risk of developing psychosis or panic attack appears low with all the antimalarials tested. No evidence was found in this large observational study that mefloquine use increased the risk of first-time diagnosis of depression when compared with the use of other antimalarials investigated in this study.

Adolescent↗

PubMed2003

Lipid-lowering drugs and the risk of depression and suicidal behavior.

BACKGROUND: A possible association between lipid-lowering drug therapy and psychological well-being remains an issue of debate. To provide more information, we performed a nested case-control study to evaluate the effect of lipid-lowering drugs on depression and suicidal behavior. METHODS: Within the United Kingdom General Practice Research Database, we identified all cases with newly treated depression needing a referral or hospitalization and all cases with first-recorded diagnosis of suicidal behavior between January 1, 1991, and December 31, 1999, from a study base that comprised all patients who were aged between 40 and 79 years and who had various exposures of interest. Each case was matched with up to 4 controls, randomly selected from the study base, on age, sex, medical practice, calendar time, and years since enrollment in the General Practice Research Database. RESULTS: A nested case-control analysis comprised 458 newly diagnosed cases of depression with 1830 controls, and 105 cases of suicidal behavior with 420 controls. The adjusted odds ratio of depression was 0.4 (95% confidence interval, 0.2-0.9) for current statin use, compared with hyperlipidemic nonuse. The adjusted odds ratios for other exposures were all around 1.0. None of the adjusted odds ratios for suicidal behavior were significantly different from unity. CONCLUSIONS: The use of statins and other lipid-lowering drugs is not associated with an increased risk of depression or suicide. On the contrary, individuals with current statin use may have a lower risk of developing depression, an effect that could be explained by improved quality of life due to decreased risk of cardiovascular events or more health consciousness in patients receiving long-term treatment.

Adult↗

PubMed2003

Who receives lipid-lowering drugs: the effects of comorbidities and patient characteristics on treatment initiation.

AIMS: Little is known about the effects of comorbidities and patient characteristics on treatment initiation of lipid-lowering drugs (LLDs), which can be helpful in the evaluation of the risks and benefits of LLDs. METHODS: Baseline characteristics among subjects who received their first ever-recorded LLD prescription in general practice between 1 January 1990 and 31 December 1997, and hyperlipidaemic patients without LLD therapy during the same period were obtained from the UK General Practice Research Database. Differences between patients who received and patients who did not receive LLDs, as well as patients who received different classes of LLDs were compared by fitting multivariate logistic regression models that adjusted for age, sex, body mass index, smoking status, and year of treatment initiation or hyperlipidaemia diagnosis. RESULTS: We found that there were many differences in the baseline characteristics, such as number of general practitioner visits, diagnosis and severity of cardiovascular diseases, and concurrent medications, between the 25 331 patients who received and the 16 287 patients who did not receive LLDs. We also noted that patients with statin therapy had more prior hospitalization, more recent myocardial infarction/stroke, and more concurrent cardiovascular medications, than those patients who received other LLDs. CONCLUSIONS: Patients who received LLDs in primary care, especially patients with statin therapy, were more likely to be elderly and to have more concomitant severe cardiovascular comorbidities than those hyperlipidaemic patients who did not receive LLDs. Examining the medical records of individuals eligible for LLD therapy is an important first step in selectively targeting who will experience the greatest benefit to risk ratio for the treatment of hyperlipidaemia, and is an important step in avoiding confounding by indication when designing epidemiological studies comparing the risks and benefits of treatments for hyperlipidaemia.

Adult↗

PubMed2003

Discontinuation and switching of therapy after initiation of lipid-lowering drugs: the effects of comorbidities and patient characteristics.

AIMS: To evaluate the effects of comorbidities and patient characteristics on treatment continuation among patients starting their first course of lipid-lowering drug (LLD) therapy. METHODS: Within the UK General Practice Research Database (GPRD), we identified 22 408 patients who started LLD therapy due to coronary heart disease, hyperlipidaemia, or other atherosclerotic diseases, and who received > or = two prescriptions for LLD between January 1 1990 and December 31 1997. Differences in potential predictors of treatment continuation between patients who continued, and patients who discontinued/switched lipid-lowering therapy within 1 year after treatment initiation were compared by fitting multivariate logistic regression models. The effects of baseline characteristics on treatment continuation after switching of LLDs were also analysed. RESULTS: Discontinuation/switching of lipid-lowering therapy was common during the study period, especially among patients who received nonstatin, nonfibrate LLDs (log-rank test P = 0.0001). Statin use, more frequent physician visits, more concurrent cardiovascular medications, diabetes, and fewer noncardiovascular medications were associated with treatment continuation of LLDs. Among patients who switched therapy, prescribing of a statin as the substituted LLD, more concurrent cardiovascular medications, and later treatment switching were related to a higher probability of treatment continuation after switching LLDs. CONCLUSIONS: Treatment continuation after initiation or switching of lipid-lowering therapy largely increased with concomitant cardiovascular comorbidities, and more health care utilization, and is more common for statins than for other LLDs. Practice guidelines, patient education, and quality of care assessment for lipid-lowering therapy should emphasize factors that predispose patients to discontinuation/switching, in an effort to optimize the choice of therapeutic regimens and to improve patient adherence.

Adult↗

PubMed2003

Validity of the general practice research database.

The United Kingdom General Practice Research Database (GPRD) is an office-based, computer-generated, medical resource designed from its inception to be used for epidemiologic research. A distinct version of the GPRD is maintained by the Boston Collaborative Drug Surveillance Program and has been the source of more than 130 scientific articles primarily addressing drug safety issues. We reviewed evidence related to the validity of the GPRD. Specifically, with our extensive experience with this automated database, we evaluated the quality and completeness of the data that it contains.

Databases, Factual↗

PubMed2002

Statins and the risk of idiopathic venous thromboembolism.

AIMS: To evaluate the association between current statin use and the risk of idiopathic venous thromboembolism (VTE). METHODS: A population-based retrospective follow-up with a nested case-control analysis using the General Practice Research Database. RESULTS: There were 72 cases of idiopathic VTE. Using normolipidaemic nonuse as the reference group, the adjusted relative risks for idiopathic VTE for current/recent statin use, past statin use, past other lipid-lowering drug use, and hyperlipidaemic nonuse were 0.8 (0.3, 2.7), 2.4 (0.6, 10.0), 1.8 (0.4, 7.4), and 0.9 (0.4, 2.0) in the follow-up analysis, and were 1.1 (0.3, 4.3), 3.7 (0.6, 24.1), 2.0 (0.3, 11.6), and 0.4 (0.2, 1.2) in the case-control analysis. CONCLUSIONS: Current statin use was not associated with a reduced risk of idiopathic VTE.

Adult↗

PubMed2002

Itraconazole and fluconazole and certain rare, serious adverse events.

STUDY OBJECTIVE: To determine rates of drug-induced, rare, serious adverse events affecting the liver, kidneys, skin, or blood, occurring within 45 days of completing a prescription or refill for itraconazole or fluconazole. DESIGN: Population-based follow-up study SETTING: United Kingdom-based General Practice Research Database. PATIENTS: Total of 54,803 users of either fluconazole or itraconazole. MAIN RESULTS: Four patients were identified with illnesses for which a drug-induced etiology could not be ruled out; one with an elevated liver function test while taking itraconazole, one with thrombocytopenia, one with neutropenia, and one with an abnormal liver function test just after receiving fluconazole. For itraconazole the rate was 3.2/100,000 prescriptions (95% confidence interval [CI] 0.6-17.9) for serious, adverse liver events; for fluconazole 2.8/100,000 prescriptions (95% CI 0.8-10.3) for serious, adverse blood events and 1.4/100,000 prescriptions (95% CI 0.25-8.2) for serious, adverse liver events. CONCLUSION: Itraconazole and fluconazole do not commonly cause rare, serious adverse events affecting the liver, kidneys, skin, or blood.

Adolescent↗