Response to: 'Association between use of non-steroidal anti-inflammatory drugs and risk of myocardial infarction in patients with spondyloarthritis and osteoarthritis'.
Response to: 'Association between use of non-steroidal anti-inflammatory drugs and risk of myocardial infarction in patients with spondyloarthritis and osteoarthritis'.
复制标题
回应：“脊柱关节炎和骨关节炎患者使用非甾体抗炎药与心肌梗死风险之间的关联”。
DOI：
10.1136/annrheumdis-2018-213771
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发表时间：
2019
影响因子：
27.4
通讯作者：
Neogi,Tuhina
中科院分区：
文献类型：
--
作者：
Dubreuil,Maureen;Louie-Gao,Qiong;Peloquin,Christine;Choi,HyonK;Zhang,Yuqing;Neogi,Tuhina
我们要感谢周和同事的来信。1如已发表论文2所述，心肌梗死（MI）病例定义基于在健康改善网络（THIN）中记录为MI读取代码的诊断，这是一种在药物流行病学研究中识别MI的有效方法。3因为THIN是基于全科医生的编码记录，所以Zhou等人建议的额外信息1并不系统地可用。这在讨论章节中已经被认为是一种局限性，我们在讨论章节中还描述了我们的内部MI验证研究，其中89%的MI病例具有支持MI发生的管理代码;这些代码包括住院、进行ECG或血管造影以及转诊至心脏病专家。同样，骨关节炎的定义也在方法章节中概述。我们认识到考虑年龄作为与非甾体抗炎药（NSAID）使用相关的效应修饰因子的重要性，并试图通过仅限于55-70岁受试者的敏感性分析部分解决这一问题。最常见的NSAID处方在我们论文的在线补充表1中进行了描述。2. NSAID的剂量和频率问题值得进一步研究。最后，我们不知道有数据表明软骨素与MI风险的关系。根据最新的美国风湿病学会和欧洲抗风湿联盟指南，不建议全身性糖皮质激素用于治疗膝关节或髋关节骨关节炎或脊柱关节炎;因此，我们预计本研究受试者中的使用率较低。此外，这些药物将被视为因果途径中的中间体，因此对任何此类药物的调整都会引起偏倚。
We wish to thank Zhou and colleagues for their letter. 1 As outlined in the published paper, 2 the myocardial infarction (MI) case definition was based on the diagnosis being recorded as a MI Read code in The Health Improvement Network (THIN), a validated means of identifying MI in pharmacoepidemiological studies. 3 Because THIN is based on general practitioner’s coded records, the additional information Zhou et al suggested 1 is not systematically available. This was already acknowledged in the discussion section as a limitation, and we additionally described our internal MI validation study in the discussion section, in which 89% of MI cases had an administrative code supporting the occurrence of an MI; these codes included a hospitalisation, having had an ECG or angiogram performed and a referral to a cardiologist. Similarly, the definition of osteoarthritis is also outlined in the Methods section. We recognise the importance of considering age as an effect modifier related to non-steroidal anti-inflammatory drug (NSAID) use and attempted to partly address this through the sensitivity analysis restricted to subjects aged 55–70. The most frequent NSAID prescriptions are described in online supplementary table 1 from our paper. 2 The topic of NSAID dosage and frequency certainly deserves further study. Finally, we are not aware of data demonstrating a relation of chondroitin to risk of MI. Systemic glucocorticoids are not recommended for the treatment of knee or hip osteoarthritis nor for spondyloarthritis according to the most recent American College of Rheumatology and European League Against Rheumatism guidelines; therefore, we expect low prevalence of use among subjects in this study. Further, these medications would be considered to be intermediates in the causal pathway, and therefore adjustment for any of those types of medications would induce bias.