scholarly journals Drug-dependent risk of self-harm in patients with bipolar disorder: a comparative effectiveness study using machine learning imputed outcomes (Preprint)

10.2196/24522 ◽  
2020 ◽  
Author(s):  
Anastasiya Nestsiarovich ◽  
Praveen Kumar ◽  
Nicolas Raymond Lauve ◽  
Nathaniel G Hurwitz ◽  
Aurélien J Mazurie ◽  
...  
Keyword(s):  
Machine Learning ◽  
Bipolar Disorder ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Comparative Effectiveness Study ◽  
Self Harm ◽  
Drug Dependent

Association of exercise with quality of life and mood symptoms in a comparative effectiveness study of bipolar disorder

2013 ◽  
Vol 151 (2) ◽  
pp. 722-727 ◽  
Author(s):  
Louisa G. Sylvia ◽  
Edward S. Friedman ◽  
James H. Kocsis ◽  
Emily E. Bernstein ◽  
Benjamin D. Brody ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bipolar Disorder ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Mood Symptoms ◽  
Comparative Effectiveness Study

scholarly journals Using Machine Learning Imputed Outcomes to Assess Drug-Dependent Risk of Self-Harm in Patients with Bipolar Disorder: A Comparative Effectiveness Study (Preprint)

2020 ◽  
Author(s):  
Anastasiya Nestsiarovich ◽  
Praveen Kumar ◽  
Nicolas Raymond Lauve ◽  
Nathaniel G Hurwitz ◽  
Aurélien J Mazurie ◽  
...  
Keyword(s):  
Machine Learning ◽  
Bipolar Disorder ◽  
Sensitivity Analysis ◽  
Reuptake Inhibitor ◽  
Individual Treatment ◽  
Administrative Claims ◽  
Tetracyclic Antidepressants ◽  
Self Harm ◽  
Drug Dependent ◽  
Time Varying Covariates

BACKGROUND Incomplete suicidality coding in administrative claims data is a known obstacle for observational studies. With most of the negative outcomes missing from the data, it is challenging to assess the evidence on treatment strategies for the prevention of self-harm in bipolar disorder (BD), including pharmacotherapy and psychotherapy. There are conflicting data from studies on the drug-dependent risk of self-harm, and there is major uncertainty regarding the preventive effect of monotherapy and drug combinations. OBJECTIVE The aim of this study was to compare all commonly used BD pharmacotherapies, as well as psychotherapy for the risk of self-harm, in a large population of commercially insured individuals, using self-harm imputation to overcome the known limitations of this outcome being underrecorded within US electronic health care records. METHODS The IBM MarketScan administrative claims database was used to compare self-harm risk in patients with BD following 65 drug regimens and drug-free periods. Probable but uncoded self-harm events were imputed via machine learning, with different probability thresholds examined in a sensitivity analysis. Comparators included lithium, mood-stabilizing anticonvulsants (MSAs), second-generation antipsychotics (SGAs), first-generation antipsychotics (FGAs), and five classes of antidepressants. Cox regression models with time-varying covariates were built for individual treatment regimens and for any pharmacotherapy with or without psychosocial interventions (“psychotherapy”). RESULTS Among 529,359 patients, 1.66% (n=8813 events) had imputed and/or coded self-harm following the exposure of interest. A higher self-harm risk was observed during adolescence. After multiple testing adjustment (<i>P</i>≤.012), the following six regimens had higher risk of self-harm than lithium: tri/tetracyclic antidepressants + SGA, FGA + MSA, FGA, serotonin-norepinephrine reuptake inhibitor (SNRI) + SGA, lithium + MSA, and lithium + SGA (hazard ratios [HRs] 1.44-2.29), and the following nine had lower risk: lamotrigine, valproate, risperidone, aripiprazole, SNRI, selective serotonin reuptake inhibitor (SSRI), “no drug,” bupropion, and bupropion + SSRI (HRs 0.28-0.74). Psychotherapy alone (without medication) had a lower self-harm risk than no treatment (HR 0.56, 95% CI 0.52-0.60; <i>P</i>=8.76×10<sup>-58</sup>). The sensitivity analysis showed that the direction of drug-outcome associations did not change as a function of the self-harm probability threshold. CONCLUSIONS Our data support evidence on the effectiveness of antidepressants, MSAs, and psychotherapy for self-harm prevention in BD. CLINICALTRIAL ClinicalTrials.gov NCT02893371; https://clinicaltrials.gov/ct2/show/NCT02893371

Use of Treatment Services in a Comparative Effectiveness Study of Bipolar Disorder

2013 ◽  
Vol 64 (11) ◽  
pp. 1119-1126 ◽  
Author(s):  
Louisa G. Sylvia ◽  
Dan Iosifescu ◽  
Edward S. Friedman ◽  
Emily E. Bernstein ◽  
Charles L. Bowden ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Treatment Services ◽  
Comparative Effectiveness Study

scholarly journals Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Helgo Magnussen ◽  
◽  
Sarah Lucas ◽  
Therese Lapperre ◽  
Jennifer K. Quint ◽  
...  
Keyword(s):  
Primary Care ◽  
Triple Therapy ◽  
Comparative Effectiveness ◽  
Inhaled Corticosteroids ◽  
Blood Eosinophil ◽  
Research Database ◽  
Effectiveness Study ◽  
Increased Risk ◽  
Comparative Effectiveness Study ◽  
Oral Corticosteroids

Abstract Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. Results A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94–1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10–1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03–2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. Conclusions In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851).

scholarly journals 4CPS-146 Ustekinumab and adalimumab for psoriasis patients who are no-responders to etanercept: a comparative effectiveness study

2018 ◽  
Author(s):  
S García Gil ◽  
F Gutiérrez Nicolás ◽  
GJ Nazco Casariego ◽  
M García Bustinduy ◽  
FJ Guimerá Martín-Neda ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Effectiveness Study ◽  
Comparative Effectiveness Study
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