Cholinesterase Inhibitors and Adverse Pulmonary Events in Older People with Chronic Obstructive Pulmonary Disease and Concomitant Dementia

详细信息    查看全文

• 作者：Dr Anne Stephenson (1) (2)
  Dallas P. Seitz (3)
  Hadas D. Fischer (4)
  Andrea Gruneir (1) (4) (5)
  Chaim M. Bell (2) (4) (5) (6)
  Andrea S. Gershon (4) (5)
  Longdi Fu (4)
  Geoff M. Anderson (1) (4) (5)
  Peter C. Austin (4)
  Paula A. Rochon (1) (4) (5) (6)
  Sudeep S. Gill (7)
  
• 刊名：Drugs & Aging
• 出版年：2012
• 出版时间：March 2012
• 年：2012
• 卷：29
• 期：3
• 页码：213-223
• 全文大小：166KB
• 参考文献：1. Ballard C, Gauthier S, Corbett A, et al. Alzheimer鈥檚 disease. Lancet 2011; 377(9770): 1019鈥?1 CrossRef
  2. Hogan D, Bailey P, Black S, et al. Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia. CMAJ 2008; 179(10): 1019鈥?6 CrossRef
  3. Gill SS, Bronskill SE, Mamdani M, et al. Representation of patients with dementia in clinical trials of donepezil. Can J Clin Pharmacol 2004; 11(2): e274鈥?5
  4. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J Med 2009 Oct 15; 361(16): 1529鈥?8 CrossRef
  5. Rochon PA, Berger PB, Gordon M. The evolution of clinical trials: inclusion and representation. CMAJ 1998 Dec 1; 159(11): 1373鈥?
  6. Birks J. Cholinesterase inhibitors for Alzheimer鈥檚 disease. Cochrane Database Syst Rev 2006; (1): CD005593
  7. Thacker EL, Schneeweiss S. Initiation of acetylcholinesterase inhibitors and complications of chronic airways disorders in elderly patients. Drug Saf 2006; 29(11): 1077鈥?5 CrossRef
  8. Gershon AS, Wang C, Guan J, et al. Identifying individuals with physician diagnosed COPD in health administrative databases. COPD 2009 Oct; 6(5): 388鈥?4 CrossRef
  9. Levy AR, O鈥橞rien BJ, Sellors C, et al. Coding accuracy of administrative drug claims in the Ontario Drug Benefit database. Can J Clin Pharmacol 2003; 10(2): 67鈥?1
  10. Gill SS, Bronskill SE, Normand SL, et al. Antipsychotic drug use and mortality in older adults with dementia. Ann Intern Med 2007 Jun 5; 146(11): 775鈥?6 CrossRef
  11. Gill SS, Anderson GM, Fischer HD, et al. Syncope and its consequences in patients with dementia receiving Cholinesterase inhibitors: a population-based cohort study. Arch Intern Med 2009 May 11; 169(9): 867鈥?3 CrossRef
  12. Rochon PA, Normand SL, Gomes T, et al. Antipsychotic therapy and short-term serious events in older adults with dementia. Arch Intern Med 2008; 168(10): 1090鈥? CrossRef
  13. Austin P. Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol 2010; 172(9): 1092鈥? CrossRef
  14. Rosenbaum P, Rubin D. Constructing a control group using multivariate matched sampling methods that incorporate the propensity score. Am Stat 1985; 39(1): 33鈥?
  15. D鈥橝gostino R. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998; 17(19): 2265鈥?1 CrossRef
  16. Stukel T, Fisher E, Wennberg D, et al. Analysis of observation studies in the presence of treatment selection bias: effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods. JAMA 2007; 297(3): 278鈥?5 CrossRef
  17. Austin P, Grootendorst P, Anderson G. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med 2007; 26(4): 734鈥?3 CrossRef
  18. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45(6): 613鈥? CrossRef
  19. Austin P. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28(25): 3083鈥?07 CrossRef
  20. Mamdani M, Sykora K, Li P, et al. Reader鈥檚 guide to critical appraisal of cohort studies: 2. Assessing potential for confounding. BMJ 2005 Apr 23; 330(7497): 960鈥? CrossRef
  21. Austin P. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011; 10(2): 150鈥?1 CrossRef
  22. Akazawa M, Stearns SC, Biddle AK. Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims. Health Serv Res 2008; 43(6): 2164鈥?2 CrossRef
  23. Burge S, Wedzicha J. COPD exacerbations: definitions and classifications. Eur Respir J 2003; 41 Suppl.: 46s鈥?3s CrossRef
  24. Donaldson GC, Hurst JR, Smith CJ, et al. Increased risk of myocardial infarction and stroke following exacerbation of COPD. Chest 2010; 137(5): 1091鈥? CrossRef
  25. Gruneir A, Anderson GM, Rochon PA, et al. Transitions in long-term care and potential implications for quality reporting in Ontario, Canada. J Am Med Dir Assoc 2010 Nov; 11(9): 629鈥?5 CrossRef
  26. Gruneir A, Bell CM, Bronskill SE, et al. Frequency and pattern of emergency department visits by long-term care residents: a population-based study. J Am Geriatr Soc 2010 Mar; 58(3): 510鈥? CrossRef
  27. Austin P. Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Stat Med 2011; 30(11): 1292
  28. Austin P, Laupacis A. A tutorial on methods to estimating clinically and policy-meaningful measures of treatment effects in prospective observational studies: a review. Int J Biostat 2011; 7(1): Article 6
  29. Shepherd G, Klein-Schwartz W, Edwards R. Donepezil overdose: a tenfold dosing error. Ann Pharmacother 1999; 33(7): 812鈥? CrossRef
  30. Greene Y, Noviasky J, Tariot P. Donepezil overdose. J Clin Psych 1999; 60(1): 56鈥? CrossRef
  31. Liggett SB, Daughaday CC, Senior RM. Ipratropium in patients with COPD receiving Cholinesterase inhibitors. Chest 1988 Jul; 94(1): 210鈥? CrossRef
  
• 作者单位：Dr Anne Stephenson (1) (2)
  Dallas P. Seitz (3)
  Hadas D. Fischer (4)
  Andrea Gruneir (1) (4) (5)
  Chaim M. Bell (2) (4) (5) (6)
  Andrea S. Gershon (4) (5)
  Longdi Fu (4)
  Geoff M. Anderson (1) (4) (5)
  Peter C. Austin (4)
  Paula A. Rochon (1) (4) (5) (6)
  Sudeep S. Gill (7)
  
  1. Women鈥檚 College Research Institute, Women鈥檚 College Hospital, Toronto, ON, Canada
  2. St Michael鈥檚 Hospital, 30 Bond Street, 6th Floor, Toronto, Ontario, Canada, M5B 1W8
  3. Department of Psychiatry, Queen鈥檚 University, Kingston, ON, Canada
  4. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  5. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
  6. Department of Medicine, University of Toronto, Toronto, ON, Canada
  7. St Mary鈥檚 of the Lake Hospital, Queen鈥檚 University, Kingston, ON, Canada
  

文摘

Background: Cholinesterase inhibitors (ChEIs) are a mainstay treatment for individuals with dementia. ChEIs may worsen airflow obstruction because of their pro-cholinergic properties. Objective: The objective of this study was to evaluate the risk of serious pulmonary complications in the elderly with concomitant chronic obstructive pulmonary disease (COPD) and dementia who were receiving ChEIs. Methods: This was a population-based, cohort study conducted between 2003 and 2010 in residents of Ontario, Canada. Subjects were over the age of 66 years and had concomitant dementia and COPD, identified using linked administrative databases. Exposure to ChEIs was determined using a drug benefits database. The primary outcome was an emergency room (ER) visit or hospitalization for COPD. The risk difference at 60 days and the relative risk (RR) for study outcomes were estimated in the propensity score-matched sample. Results: Of 266 840 individuals with COPD, 45 503 had a concomitant diagnosis of dementia. A total of 7166 unexposed subjects were matched to subjects newly exposed to ChEIs. New users of ChEIs were not at significantly higher risk of ER visits or hospitalizations for COPD (RR 0.90; 95% CI 0.76, 1.07) or COPD exacerbations (RR 1.02; 95% CI 0.91,1.15). Furthermore, ER visits for any respiratory diagnoses were not increased among new users of ChEIs (RR 1.02; 95% CI 0.87, 1.19) when compared with non-users. Subgroup analyses were consistent with the main analysis. Conclusions: In a large cohort of elderly individuals with COPD and dementia, new users of ChEIs had a similar risk for adverse pulmonary outcomes as those who were not receiving ChEIs.