Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Clin Transl Sci. 2017 Nov;10(6):426-430. doi: 10.1111/cts.12494. Epub 2017 Jul 28.
We sought to assess whether a high-profile publication that demonstrated serious clinical consequences of specific drug-drug interactions (DDIs) reduced the concomitant use of those drugs. We conducted a quasi-experimental study using 2000-2008 prescription claims from a commercial health insurer to examine trends in the dispensing of the interacting drug pairs (angiotensin-converting enzyme inhibitors[ACEI] + potassium-sparing diuretic, digoxin + clarithromycin, and glyburide + cotrimoxazole) and control drug pairs previously reported in a top-tier general medicine journal. We examined prepublication and postpublication dispensing trends using Poisson regression. ACEI + potassium-sparing diuretic use did not differ postpublication vs. prepublication (P = 0.11). Digoxin + clarithromycin use decreased minimally postpublication vs. prepublication (relative rate = 0.9996: 95% confidence interval [CI] = 0.9993-0.9998). Glyburide + cotrimoxazole use increased minimally postpublication vs. prepublication (relative rate = 1.0220; 95% CI = 1.0187-1.0254). Therefore, the high-profile DDI publication had minimal to no measurable effect in reducing the concomitant use of the interacting drugs studied. We believe that better strategies are needed to translate knowledge about DDIs into clinical practice.
我们试图评估一项备受关注的研究结果,该研究表明特定药物相互作用(DDI)会导致严重的临床后果,该研究结果是否会降低这些药物的联合使用。我们使用商业健康保险公司的 2000 年至 2008 年处方数据进行了一项准实验研究,以检验在交互药物对(血管紧张素转换酶抑制剂[ACEI]+保钾利尿剂、地高辛+克拉霉素和格列吡嗪+复方磺胺甲噁唑)和之前在顶级普通医学期刊上报道的对照药物对的配药趋势。我们使用泊松回归分析了预发表和发表后的配药趋势。ACEI+保钾利尿剂的使用在发表后与发表前没有差异(P=0.11)。地高辛+克拉霉素的使用在发表后略有减少(相对比率=0.9996:95%置信区间[CI]=0.9993-0.9998)。格列吡嗪+复方磺胺甲噁唑的使用在发表后略有增加(相对比率=1.0220;95%CI=1.0187-1.0254)。因此,备受关注的 DDI 研究结果对减少所研究的相互作用药物的联合使用几乎没有可衡量的影响。我们认为,需要更好的策略将有关 DDI 的知识转化为临床实践。