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心血管疾病老年人服用卡格列净增加截肢风险
作者:小柯机器人 发布时间:2020/8/27 14:46:01

美国布列根和妇女医院和哈佛医学院Michael Fralick团队比较了不同年龄和心血管疾病风险的成年人服用卡格列净所致的截肢风险。2020年8月25日,《英国医学杂志》发表了该成果。

为了根据年龄和心血管疾病来估计新开处方药卡格列净所致的成人下肢截肢风险,研究组基于两个商业和一个医保索赔数据库2013-2017年的数据,进行了一项基于人群、新用户的队列研究。接受新开处方药卡格列净的患者按倾向评分,与新开处方药胰高血糖素样肽-1(GLP-1)受体激动剂的患者按1:1匹配。

根据年龄和心血管疾病将患者分为四组:第1组,年龄在65岁以下且无基线心血管疾病的患者;第2组,年龄小于65岁的基线心血管疾病患者;第3组,年龄在65岁及以上且无基线心血管疾病的患者;第4组,年龄65岁及以上的基线心血管疾病患者。通过荟萃分析计算出每组中每1000人年的总风险比和比率差异。主要结局为需手术的下肢截肢。

在三个数据库中,研究组共确定了310840对倾向评分匹配的成人,分别使用卡格列净或GLP-1激动剂治疗。各组间接受卡格列净与接受GLP-1激动剂的成人相比,第1组,每1000人年截肢的风险比为1.09,比率差异为0.12;第2组分别为1.18和1.06;第3组分别为1.30和0.47;第4组分别为1.73和3.66。

总之,使用卡格列净增加的截肢风险很小,且65岁及以上有基线心血管疾病的成人风险增加最为明显。

附:英文原文

Title: Risk of amputation with canagliflozin across categories of age and cardiovascular risk in three US nationwide databases: cohort study

Author: Michael Fralick, Seoyoung C Kim, Sebastian Schneeweiss, Brendan M Everett, Robert J Glynn, Elisabetta Patorno

Issue&Volume: 2020/08/25

Abstract: Objective To estimate the rate of lower limb amputation among adults newly prescribed canagliflozin according to age and cardiovascular disease.

Design Population based, new user, cohort study.

Data sources Two commercial and Medicare claims databases, 2013-17.

Participants Patients newly prescribed canagliflozin were propensity score matched 1:1 with patients newly prescribed a glucagon-like peptide-1 (GLP-1) receptor agonist. Hazard ratios and rate differences per 1000 person years were computed for the rate of lower limb amputation in the following four groups: group 1, patients aged less than 65 years without baseline cardiovascular disease; group 2, patients aged less than 65 with baseline cardiovascular disease; group 3, patients aged 65 or older without baseline cardiovascular disease; group 4, patients aged 65 or older with baseline cardiovascular disease. Within each group, pooled hazard ratio and rate difference per 1000 person years were calculated by meta-analysis.

Intervention Canagliflozin versus a GLP-1 agonist.

Main outcome measures Lower limb amputation requiring surgery.

Results Across the three databases, 310840 propensity score matched adults who started canagliflozin or a GLP-1 agonist were identified. The hazard ratio and rate difference per 1000 person years for amputation in adults receiving canagliflozin compared with a GLP-1 agonist for each group was: group 1, hazard ratio 1.09 (95% confidence interval 0.83 to 1.43), rate difference 0.12 (0.31 to 0.55); group 2, hazard ratio 1.18 (0.86 to 1.62), rate difference 1.06 (1.77 to 3.89); group 3, hazard ratio 1.30 (0.52 to 3.26), rate difference 0.47 (0.73 to 1.67); and group 4, hazard ratio 1.73 (1.30 to 2.29), rate difference 3.66 (1.74 to 5.59).

Conclusions The increase in rate of amputation with canagliflozin was small and most apparent on an absolute scale for adults aged 65 or older with baseline cardiovascular disease, resulting in a number needed to treat for an additional harmful outcome of 556 patients at six months (that is, 18 more amputations per 10000 people who received canagliflozin). These results help to contextualize the risk of amputation with canagliflozin in routine care.

DOI: 10.1136/bmj.m2812

Source: https://www.bmj.com/content/370/bmj.m2812

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj