Department of Clinical Epidemiology, BIPS-Institute for Epidemiology and Prevention Research, Achterstr. 30, 28359 Bremen, Germany.
Eur J Clin Pharmacol. 2013 Mar;69(3):549-57. doi: 10.1007/s00228-012-1334-2. Epub 2012 Jul 5.
High-dimensional propensity score (hd-PS) adjustment has been proposed as a tool to improve control for confounding in pharmacoepidemiological studies using longitudinal claims databases. We investigated whether hd-PS matching improved confounding by indication in a study of Cox-2 inhibitors (coxibs) and traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) and their association with the risk of upper gastrointestinal complications (UGIC).
In a cohort study of new users of coxibs and tNSAIDs we compared the effectiveness of these drugs to reduce UGIC using hd-PS matching and conventional propensity score (PS) matching in the German Pharmacoepidemiological Research Database.
The unadjusted rate ratio (RR) of UGIC for coxib users versus tNSAID users was 1.21 [95 % confidence interval (CI) 0.91-1.61]. The conventional PS matched cohort based on 79 investigator-identified covariates resulted in a RR of 0.84 (0.56-1.26). The use of the hd-PS algorithm based on 900 empirical covariates further decreased the RR to 0.62 (0.43-0.91).
A comparison of hd-PS matching versus conventional PS matching resulted in improved point estimates for studying an intended treatment effect of coxibs versus tNSAIDs when benchmarked against results from randomized controlled trials.
高维倾向评分（hd-PS）调整被提议作为一种工具，以改善使用纵向索赔数据库进行药物流行病学研究的混杂控制。我们研究了在 COX-2 抑制剂（coxibs）和传统非甾体抗炎药（tNSAIDs）及其与上胃肠道并发症（UGIC）风险相关性的研究中，hd-PS 匹配是否改善了指示性混杂。
在一项新使用 coxibs 和 tNSAIDs 的患者队列研究中，我们在德国药物流行病学研究数据库中比较了使用 hd-PS 匹配和传统倾向评分（PS）匹配来评估这些药物对降低 UGIC 的有效性。
coxib 使用者与 tNSAID 使用者发生 UGIC 的未调整率比（RR）为 1.21[95%置信区间（CI）0.91-1.61]。基于 79 个研究者确定的协变量的传统 PS 匹配队列得出的 RR 为 0.84（0.56-1.26）。基于 900 个经验协变量的 hd-PS 算法的使用进一步将 RR 降低至 0.62（0.43-0.91）。
与随机对照试验的结果相比，hd-PS 匹配与传统 PS 匹配的比较导致了 coxibs 与 tNSAIDs 治疗效果的研究中，点估计值的改善。
