| アブストラクト | OBJECTIVE: To investigate the association of concurrent use of oral anticoagulants (OACs) and sulfonylureas and the risk of hypoglycemia in individuals with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS: A retrospective cohort study was conducted between 2001 and 2017 using electronic primary healthcare data from the IQVIA Medical Research Data (IMRD) that incorporates data supplied by The Health Improvement Network (THIN), a propriety database of Cegedim SA. Individuals with T2DM who received OAC prescription and sulfonylureas were included. We compared the risk of hypoglycemia with sulfonylureas and OACs using propensity score matching and Cox regression. RESULTS: 109,040 individuals using warfarin and sulfonylureas and 77,296 using direct oral anticoagulants (DOACs) and sulfonylureas were identified and included. There were 285 hypoglycemia events in the warfarin with sulfonylureas group (incidence rate = 17.8 per 1,000 person-years), while in the sulfonylureas only, 304 hypoglycemia events were observed (incidence rate = 14.4 per 1,000 person-years). There were 14 hypoglycemic events in the DOACs with sulfonylureas group (incidence rates = 14.8 per 1,000 person-years), while in the sulfonylureas alone group, 60 hypoglycemia events were observed (incidence rate =23.7 per 1,000 person-years). Concurrent use of warfarin and sulfonylureas was associated with increased risk of hypoglycemia compared with sulfonylureas alone (HR 1.38; 95% CI 1.10-1.75). However, we found no evidence of an association between concurrent use of DOACs and sulfonylureas and risk of hypoglycemia (HR 0.54; 95% CI, 0.27-1.10) when compared with sulfonylureas only. CONCLUSIONS: We provide real-world evidence of possible drug-drug interactions between warfarin and sulfonylureas. The decision to prescribe warfarin with coexistent sulfonylureas to individuals with T2DM should be carefully evaluated in the context of other risk factors of hypoglycemia, and availability of alternative medications. |
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| 投稿者 | Alwafi, Hassan; Wong, Ian C K; Naser, Abdallah Y; Banerjee, Amitava; Mongkhon, Pajaree; Whittlesea, Cate; Alsharif, Alaa; Wei, Li |
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| 組織名 | Research Department of Practice and Policy, School of Pharmacy, University;College London, London, United Kingdom.;Faculty of Medicine, Umm Al Qura University, Mecca, Saudi Arabia.;Centre for Safe Medication Practice and Research, Department of Pharmacology and;Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam,;Hong Kong SAR, China.;Department of Pharmacy, The University of Hong Kong - Shenzhen Hospital,;Shenzhen, China.;Laboratory of Data Discovery for Health, Hong Kong Science Park, Pak Shek Kok,;Centre for Medicines Optimisation Research and Education, University College;London Hospitals National Health Service (NHS) Foundation Trust, London, United;Kingdom.;Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of;Pharmacy, Isra University, Amman, Jordan.;Institute of Health Informatics, University College London, London, United;Department of Cardiology, University College London Hospitals NHS Trust, London,;United Kingdom.;Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.;Department of Pharmacy Practice, School of Pharmaceutical Sciences, University of;Phayao, Phayao, Thailand.;Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy,;Chiang Mai University, Chiang Mai, Thailand.;Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint;Abdulrahman University, Riyadh, Saudi Arabia. |
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