Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan.
Graduate Institute of DataScience, College of Management, Taipei Medical University, Taipei, Taiwan.
J Clin Pharmacol. 2022 Nov;62(11):1412-1418. doi: 10.1002/jcph.2090. Epub 2022 Jun 13.
Bisphosphonates are considered an effective inhibitor of glutamine synthetase and thus can be used for treating tuberculosis (TB). However, its clinical benefit in TB remains unknown. We conducted a population-based cohort study by using the Taiwan National Health Insurance Research Database and TB databases of the Taiwan Centers for Disease Control. Patients with osteoporosis and a history of bone fracture from 2007 to 2014 were identified. Among them, bisphosphonate users and propensity score-matched nonusers were selected. A stratified multivariable Cox proportional hazard regression model was employed to investigate the independent predictors of TB. Among 218 908 patients with osteoporosis and bone fracture, 46 842 bisphosphonate users and 46 842 propensity score-matched nonusers were selected. Within the 2-year follow-up, 723 patients-348 in the user group and 375 in the nonuser group-developed TB. Bisphosphonate use was not an independent predictor of TB in the multivariable Cox proportional hazard model (adjusted hazard ratio, 0.86; 95%CI, 0.71-1.04); however, male sex, older age, being bedridden, and steroid use were independent risk factors. The real-world data revealed that bisphosphonate use did not protect patients with osteoporosis against TB.
双膦酸盐被认为是谷氨酰胺合成酶的有效抑制剂，因此可用于治疗肺结核（TB）。然而，其在 TB 中的临床获益尚不清楚。我们通过使用台湾全民健康保险研究数据库和台湾疾病控制中心的 TB 数据库进行了一项基于人群的队列研究。确定了 2007 年至 2014 年患有骨质疏松症和骨折史的患者。在这些患者中，选择了双膦酸盐使用者和倾向评分匹配的非使用者。采用分层多变量 Cox 比例风险回归模型来探讨 TB 的独立预测因素。在 218908 例患有骨质疏松症和骨折的患者中，选择了 46842 例双膦酸盐使用者和 46842 例倾向评分匹配的非使用者。在 2 年的随访中，723 例患者（使用者组 348 例，非使用者组 375 例）发生了 TB。多变量 Cox 比例风险模型显示，双膦酸盐的使用并不是 TB 的独立预测因素（调整后的危险比，0.86；95%CI，0.71-1.04）；然而，男性、年龄较大、卧床不起和使用类固醇是独立的危险因素。真实世界的数据显示，双膦酸盐的使用并不能保护骨质疏松症患者免受 TB 侵害。
