Comparative Safety of Gout Treatment Strategies on Cardiovascular Outcomes Using Observational Data: Clone-censor-weight Target Trial Emulation Approach.
Comparative Safety of Gout Treatment Strategies on Cardiovascular Outcomes Using Observational Data: Clone-censor-weight Target Trial Emulation Approach.
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使用观察数据比较痛风治疗策略对心血管结果的安全性：克隆审查权重目标试验模拟方法。
DOI：
10.1097/ede.0000000000001608
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kim,SeoyoungC
中科院分区：
文献类型：
--
作者：
Yoshida,Kazuki;Liu,Jun;Desai,RishiJ;Glynn,RobertJ;Solomon,DanielH;Kim,SeoyoungC
背景：我们试图使用与电子健康记录实验室数据相关联的联邦医疗保险索赔数据来检查痛风强化治疗目标血尿酸盐策略的心血管安全性。方法：我们选择了开始降尿酸治疗的痛风患者。我们模拟了一项假设性试验，比较了24个月内七种不同治疗方法的主要心血管不良事件(非致命性心肌梗死、非致命性中风和心血管死亡)的发生率。在制定日益强化的策略时，考虑了三个方面：(1)继续降尿酸治疗，(2)血尿酸监测，(3)当血尿酸和GT；6 mg/dl时，修改降尿酸治疗。结果：我们确定了4402名痛风患者开始进行降尿酸治疗(平均年龄77岁；男性60%)。在常规护理下总计6611人年的随访中，主要心血管事件(首次和复发)的发生率为4.5/100PY(95%CI=4.0，5.1)。与常规护理相比，比率比率(RR)建议减少(RR点估计为0.88-0.84)。所有95%的CI都是不精确的，但他们的上限排除了RRS的大幅增加。对于集中在随访期间的第一个主要心血管不良事件以及与需要继续进行降尿酸治疗(但不一定是滴定)的策略进行比较的分析，RR更接近1.0。结论：我们的治疗策略试验仿真没有发现强化降尿酸策略增加了重大心血管不良事件的风险。结果可能会为风湿病学会推荐的强化治疗靶点血尿酸盐策略的心血管安全性提供保证。
Background:We sought to examine the cardiovascular safety of intensive treat-to-target serum urate strategies for gout using Medicare claims data linked to electronic health record laboratory data.Methods:We selected patients with gout who initiated urate-lowering therapy. We emulated a hypothetical trial comparing the rate of major adverse cardiovascular events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) among seven different strategies over 24 months. Three aspects were considered in defining increasingly intensive strategies:(1) continuation of urate-lowering therapy,(2) serum urate monitoring, and (3) modification of urate-lowering therapy when serum urate> 6 mg/dl. We applied the “clone-censor-weight” method to account for baseline and time-varying confounding.Results:We identified 4402 patients with gout who initiated urate-lowering therapy (mean age 77; male 60%). During a total of 6611 person–years (PY) of follow-up under usual care, the rate of major cardiovascular events (first and recurrent) was 4.5/100 PY (95% CI= 4.0, 5.1). The rate ratios (RRs) suggested reductions (RR point estimates 0.88–0.84) compared with usual care. All 95% CIs were imprecise, but their upper bounds excluded substantial increase in RRs. RRs were closer to 1.0 for the analysis focusing on the first major adverse cardiovascular event during follow-up and on comparison to the strategy requiring continuation of urate-lowering therapy (but not necessarily titration).Conclusions:Our treatment strategy trial emulation did not find increased risk of major adverse cardiovascular events with intensive urate-lowering strategies. Results may provide reassurance of the cardiovascular safety of intensive treat-to-target serum urate strategies recommended by rheumatology societies.
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农药林丹扩散并分配到磷脂酰胆碱双层中。
DOI：
10.1016/0005-2736(77)90045-1
发表时间：
1977
期刊：
Biochimica et biophysica acta
影响因子：
--
作者：
J. Lakowicz;D. Hogen;G. Omann
通讯作者：
G. Omann
林丹在合成膜和天然膜中的分配。
DOI：
10.1016/0005-2736(85)90109-9
发表时间：
1985
期刊：
Biochimica et biophysica acta
影响因子：
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作者：
M. C. Antunes;V. Madeira
通讯作者：
V. Madeira
影响因子：
2.9
作者：
HACKENBERG, H;KLINGENBERG, M
通讯作者：
KLINGENBERG, M
线粒体膜中的 ADP-ATP 载体
影响因子：
2.3
作者：
M. Klingenberg
通讯作者：
M. Klingenberg
影响因子：
2.9
作者：
DEVENDITTIS, E;PALUMBO, G;BOCCHINI, V
通讯作者：
BOCCHINI, V