Department of Infectious Diseases, Odense University Hospital, J.B. Winsløws Vej 4, Odense, Denmark.
Department of Internal Medicine, Aalborg University Hospital, Højtoftevej 2, Thisted, Denmark.
J Clin Immunol. 2023 Nov;43(8):2181-2191. doi: 10.1007/s10875-023-01598-1. Epub 2023 Oct 14.
To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis.
We conducted a nested case-control study, identifying all individuals (n=130 cases) diagnosed with CVID in Denmark (1994-2014) and 45 age- and sex-matched population controls per case (n=5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals.
In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) (p<0.001).
CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies.
比较在诊断为普通变异型免疫缺陷症（CVID）之前的 3 年内，CVID 患者与匹配对照者的抗生素（AB）、全身皮质类固醇和吸入性支气管扩张剂/皮质激素的使用情况，并评估使用量是否与 CVID 后续诊断的风险相关。
我们开展了一项巢式病例对照研究，在丹麦全国登记处中，确定了所有在 1994 年至 2014 年期间被诊断为 CVID 的个体（n=130 例病例），并为每个病例匹配 45 名年龄和性别相匹配的人群对照（n=5850 名对照）。药物使用量估计为每人每年的定义日剂量。我们使用条件逻辑回归计算比值比和 95%置信区间。
在 CVID 诊断前的 3 年内，我们观察到所有三种药物类别使用的频率更高，且用量更大。药物使用与随后发生 CVID 诊断的风险之间存在统计学显著关联，且关联与药物使用量更高和到 CVID 诊断的时间更短有关。在研究期间，病例组中比对照组更多的患者（≥1 份）开具了纳入药物的处方，AB（97% vs 52%）、全身皮质类固醇（35% vs 7.4%）和吸入性支气管扩张剂/皮质激素（46% vs 11.7%）（p<0.001）。
在诊断为 CVID 之前的 3 年内，CVID 患者使用 AB、全身皮质类固醇和吸入性支气管扩张剂/皮质激素的频率和用量明显高于对照者。在初级保健中开具这些药物可能是考虑（主动）筛查 CVID 的机会。需要进一步研究以确定最佳处方截止值，以支持将其纳入公共卫生政策。
