Comparison of diagnostic evaluations for cough among initiators of angiotensin converting enzyme inhibitors and angiotensin receptor blockers.
Comparison of diagnostic evaluations for cough among initiators of angiotensin converting enzyme inhibitors and angiotensin receptor blockers.
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DOI：
10.1002/pds.3977
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发表时间：
2016-05
影响因子：
2.6
通讯作者：
Stürmer T
中科院分区：
文献类型：
--
作者：
Gokhale M;Girman C;Chen Y;Pate V;Funk MJ;Stürmer T
与药物相关的鉴别诊断评价可能会由于临床前结局检测的增加而使效应估计产生偏倚。持续性咳嗽是血管紧张素转换酶抑制剂（ACEI）的常见副作用，我们假设ACEI启动者将接受更多的诊断评估，可能导致临床前肺癌的诊断。我们比较了ACEI与血管紧张素受体阻滞剂（ARB）启动者之间咳嗽相关诊断评估和肺癌的发生率。使用2007-2012年医疗保险索赔的20%样本，我们确定了年龄在66-99岁之间的ACEI或ARB的启动者。使用调整的考克斯模型比较诊断评估和肺癌的发生率。使用比例差异比较每月检查概率。分别有342，611和108，116例ACEI和ARB启动者。在启动前和启动后6个月内，胸部X线检查的每月概率范围为最小4.7%至最大21.2%。在启动后6个月内诊断程序的发生率差异很小（胸部X线风险比（HR）= 1.12; 95% CI：1.10-1.14），胸部MRI（0.86，95% CI：0.74-0.99）、CT扫描（1.09，95% CI：0.99-1.18）或支气管镜检查（1.03，95% CI：0.83-1.29））。胸部X线检查的比例差异在开始前一个月达到峰值（8.4%，95% CI：8.1-8.6），但此后可忽略不计。ACEI组与ARB组肺癌发生率无差异（HR=0.99，95%CI：0.84-1.16）。结果表明，ACEI与ARB启动后的最小差异胸部检查和肺癌发病率没有差异，但建议在首次记录处方前一个月进行差异检查。后者可能反映了首次观察到的药房索赔前的药物使用或开始ACEI治疗前的检查增加。
Differential diagnostic evaluation associated with a drug may bias effect estimates due to an increased detection of preclinical outcomes. Persistent cough is a common side effect with angiotensin-converting enzyme inhibitors (ACEI) and we hypothesized that ACEI initiators would undergo more diagnostic evaluations, potentially leading to diagnosis of preclinical lung cancer. We compared the incidence of cough-related diagnostic evaluations and lung cancer among ACEI versus angiotensin receptor blockers (ARB) initiators. Using a 20% sample of Medicare claims 2007–2012, we identified initiators of ACEI or ARB, age 66–99 years. Incidence of diagnostic evaluation and lung cancer were compared using adjusted Cox models. Monthly probabilities of workup were compared using proportion differences. There were 342,611 and 108,116 ACEI and ARB initiators, respectively. Monthly probability of chest X-rays ranged from minimum 4.7% to maximum 21.2% in the 6 months pre and post-initiation. Differences in incidence of diagnostic procedures in the 6 months after initiation were only minimal (chest X-rays hazard ratio (HR) = 1.12; 95% CI: 1.10–1.14), chest-MRI (0.86, 95% CI: 0.74–0.99), CT-scans (1.09, 95% CI: 0.99–1.18) or bronchoscopies (1.03, 95% CI: 0.83–1.29)). Proportion differences for chest X-rays peaked in the month pre-initiation (8.4%, 95% CI: 8.1–8.6) but negligible thereafter. There was no difference in the incidence of lung cancer among ACEI versus ARB initiators (HR=0.99, 95% CI: 0.84–1.16). Results indicate minimal differential chest workup after ACEI vs ARB initiation and no difference in lung cancer incidence, but suggest differential workup in the month before the first recorded prescription. The latter may reflect drug use before the first observed pharmacy claim or increased workup before initiation of ACEI therapy.