| アブストラクト | PURPOSE: To evaluate the potential of a Cox marginal structural model (MSM) to estimate the time-varying causal inference of a known clinical trial association where the effectiveness of inhaled corticosteroid- (ICS-) versus non-ICS-containing treatments has been compared in patients with chronic obstructive pulmonary disease (COPD). METHODS: This retrospective study from 2006-2016 used linked data from Clinical Practice Research Datalink-GOLD, Hospital Episode Statistics, and Office for National Statistics mortality. A Cox MSM, incorporating a new-user design, was deemed capable of replicating a clinical trial-like pathway. Repeated outcomes for exacerbation events and stabilized weights were used to include time-varying and fixed covariate exposures. RESULTS: Of 45,958 patients, 55% were male; 52% had moderate COPD. ICS-treated patients had a higher incidence of comorbid asthma than non-ICS-treated patients. Adjusted hazard risk ratios for any exacerbation event: ICS and/or long-acting beta2-agonist (LABA) versus long-acting muscarinic antagonist (LAMA), 1.07 (95% confidence interval 1.04-1.10); ICS/LABA versus LABA and/or LAMA, 1.05 (1.00-1.10); ICS and/or LABA and/or LAMA versus LAMA, 1.04 (1.01-1.06); ICS and/or LABA and/or LAMA versus LABA and/or LAMA 1.02 (0.97-1.07). CONCLUSIONS: The Cox MSM was not able to fully demonstrate results consistent with the previously established benefits of ICS-containing treatments seen in clinical trials. Future studies should continue to investigate causal inference methods and their capability to estimate the long-term outcomes of treatment in COPD. |
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| ジャーナル名 | Annals of epidemiology |
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| Pubmed追加日 | 2021/11/20 |
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| 投稿者 | Cabrera, Claudia; Quelen, Celine; Ouwens, Mario; Hedman, Katarina; Rigney, Una; Quint, Jennifer K |
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| 組織名 | Real World Science and Digital, BioPharmaceuticals Medical, AstraZeneca,;Gothenburg, Sweden. Electronic address: claudia.s.cabrera@astrazeneca.com.;Creativ-Ceutical, London, UK.;Gothenburg, Sweden.;BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden.;UKMC, AstraZeneca, Luton, UK.;National Heart & Lung Institute, Imperial College London, London, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34798296/ |
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