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他汀类药物与慢性阻塞性肺疾病特定结局之间的关联:一项真实世界观察性研究。

Association Between Statin Medications and COPD-Specific Outcomes: A Real-World Observational Study.

作者信息

Ajmera Mayank, Shen Chan, Sambamoorthi Usha

机构信息

RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, Durham, NC, USA.

Department of Biostatistics and Health Services Research, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.

出版信息

Drugs Real World Outcomes. 2017 Mar;4(1):9-19. doi: 10.1007/s40801-016-0101-6.

Abstract

BACKGROUND

Disease-modifying drugs are not yet available for the management of chronic obstructive pulmonary disease (COPD). HMG-CoA reductase inhibitors (statins) have anti-inflammatory properties and are therefore being considered for use in the management of COPD.

OBJECTIVE

Our objective was to examine the association between statin use and COPD-specific outcomes in a real-world setting.

METHODS

This was a retrospective longitudinal dynamic cohort study that used Medicaid claims data from multiple years (2005-2008) to identify patients with newly diagnosed COPD. Statin therapy was determined from the prescription drug file using National Drug Codes (NDCs). COPD-specific outcomes such as hospitalizations and emergency room and outpatient visits were identified based on a primary diagnosis of COPD. Multivariable logistic regressions with inverse probability treatment weights (IPTWs) were used to examine the relationship between statin therapy and COPD-specific outcomes.

RESULTS

The study included 19,060 Medicaid beneficiaries with newly diagnosed COPD, 30.3% of whom received statins during the baseline period. Adults who received statins had significantly lower rates of COPD-specific hospitalizations (4.7 vs. 5.2%; p < 0.05), emergency room visits (13.4 vs. 15.4%; p < 0.001), and outpatient visits (41.4 vs. 44.7%; p < 0.001) than those who did not receive statin therapy. Even after adjusting for observed selection bias with IPTWs, adults receiving statins were less likely to have COPD-specific hospitalizations [adjusted odds ratio (AOR) 0.76; 95% confidence interval (CI) 0.66-0.87], emergency room visits (AOR 0.81; 95% CI 0.75-0.89), and outpatient visits (AOR 0.86; 95% CI 0.80-0.91) than those not receiving statins.

CONCLUSIONS

Findings from this study suggest statins have beneficial effects in patients with newly diagnosed COPD and warrant further clinical trial investigation.

摘要

背景

目前尚无改善病情的药物可用于慢性阻塞性肺疾病(COPD)的治疗。3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂(他汀类药物)具有抗炎特性,因此正被考虑用于COPD的治疗。

目的

我们的目的是在真实世界环境中研究他汀类药物使用与COPD特定结局之间的关联。

方法

这是一项回顾性纵向动态队列研究,利用多年(2005 - 2008年)的医疗补助索赔数据来识别新诊断为COPD的患者。他汀类药物治疗通过使用国家药品代码(NDCs)从处方药档案中确定。基于COPD的初步诊断确定COPD特定结局,如住院、急诊室就诊和门诊就诊。使用具有逆概率治疗权重(IPTWs)的多变量逻辑回归来研究他汀类药物治疗与COPD特定结局之间的关系。

结果

该研究纳入了19,060名新诊断为COPD的医疗补助受益人,其中30.3%在基线期接受了他汀类药物治疗。接受他汀类药物治疗的成年人COPD特定住院率(4.7%对5.2%;p < 0.05)、急诊室就诊率(13.4%对15.4%;p < 0.001)和门诊就诊率(41.4%对44.7%;p < 0.001)显著低于未接受他汀类药物治疗的成年人。即使在用IPTWs调整观察到的选择偏倚后,接受他汀类药物治疗的成年人发生COPD特定住院的可能性[调整后的优势比(AOR)0.76;95%置信区间(CI)0.66 - 0.87]、急诊室就诊(AOR 0.81;95% CI 0.75 - 0.89)和门诊就诊(AOR 0.86;95% CI 0.80 - 0.91)仍低于未接受他汀类药物治疗的成年人。

结论

本研究结果表明他汀类药物对新诊断为COPD的患者有有益作用,值得进一步进行临床试验研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd8c/5332305/68757927c75f/40801_2016_101_Fig1_HTML.jpg

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