Blumenthal Kimberly G, Lai Kenneth H, Huang Mingshu, Wallace Zachary S, Wickner Paige G, Zhou Li
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass.
Partners HealthCare System, Boston, Mass.
J Allergy Clin Immunol Pract. 2017 May-Jun;5(3):737-743.e3. doi: 10.1016/j.jaip.2016.12.006. Epub 2017 Jan 18.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used medications in the United States. NSAID use can be limited by adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs).
We aimed to use electronic health record data to determine the incidence and predictors of HSRs to prescription NSAIDs.
We performed a retrospective cohort study of all adult outpatients in a large health care system prescribed diclofenac, indomethacin, nabumetone, or piroxicam between January 1, 2004, and September 30, 2012. The primary outcome was an ADR or HSR attributed to the prescribed NSAID within 1 year of prescription, determined from a longitudinal allergy database. We used natural language processing to classify known ADRs as either HSRs or side effects. Multivariable logistic regression models were used to identify independent risk factors for NSAID HSRs.
Of 62,719 patients prescribed NSAIDs, 1,035 (1.7%) had an ADR, of which 189 (18.3%) were HSRs. Multivariable regression analysis identified that patients with prior drug HSR history (odds ratio [OR] 1.8 [95% CI 1.3, 2.5]), female sex (OR 1.8 [95% CI 1.3, 2.4]), autoimmune disease (OR 1.7 [95% CI 1.1, 2.7]), and those prescribed the maximum standing NSAID dose (OR 1.5 [95% CI 1.1, 2.0]) had increased odds of NSAID HSR.
NSAID therapeutic use can be limited by ADRs; about 1 in 5 NSAID ADRs is an HSR. Both patient and drug factors contribute to HSR risk and are important to guide patient counseling.
非甾体抗炎药（NSAIDs）是美国使用最频繁的药物之一。NSAIDs的使用可能会受到药物不良反应（ADRs）的限制，包括过敏反应（HSRs）。
我们旨在利用电子健康记录数据来确定处方NSAIDs发生HSRs的发生率及预测因素。
我们对2004年1月1日至2012年9月30日期间在一个大型医疗保健系统中开具双氯芬酸、吲哚美辛、萘丁美酮或吡罗昔康处方的所有成年门诊患者进行了一项回顾性队列研究。主要结局是处方后1年内归因于所开具NSAID的ADR或HSR，通过纵向过敏数据库确定。我们使用自然语言处理将已知的ADR分类为HSR或副作用。多变量逻辑回归模型用于识别NSAID HSR的独立危险因素。
在62719例开具NSAIDs的患者中，1035例（1.7%）出现了ADR，其中189例（18.3%）为HSR。多变量回归分析确定，既往有药物HSR病史的患者（比值比[OR]1.8[95%CI 1.3,2.5]）、女性（OR 1.8[95%CI 1.3,2.4]）、自身免疫性疾病（OR 1.7[95%CI 1.1,2.7]）以及开具NSAID最大常规剂量的患者（OR 1.5[95%CI 1.1,2.0]）发生NSAID HSR的几率增加。
NSAIDs的治疗应用可能会受到ADR的限制；约五分之一的NSAID ADR是HSR。患者因素和药物因素均会导致HSR风险增加，对指导患者咨询很重要。
