| アブストラクト | BACKGROUND: There is conflicting evidence about nephrotoxicity risk associated with 5-aminosalicylates for treatment of IBD. AIMS: To determine population-based temporal trends for 5-aminosalicylates and estimated risk of nephrotoxicity associated with 5-aminosalicylate use for ulcerative colitis (UC) and Crohn's disease (CD). METHODS: Retrospective cohort and nested case-control study, using the Health Improvement Network primary care database linked to hospital discharge coding for patients in England, 1996-2017. Nephrotoxicity risk analysis was a first recorded renal impairment diagnosis adjusted for key variables and was assessed between 2008 and 2017. RESULTS: A total of 35 601 patients with prevalent UC or CD were included. The proportion of patients prescribed 5-aminosalicylates fell from 83% in 1996-1999 to 71% in 2012-2015 for UC patients and 64% to 45% for CD patients. Thirty per cent of patients had prolonged 5-aminosalicylate use. Between 2008 and 2017, the incident rate of nephrotoxicity was similar and stable for UC (12.6/1000 person-years) and CD (10.9/1000 person-years) patients. Multivariate analysis showed no evidence for association between current prescription of 5-aminosalicylate and nephrotoxicity in UC or CD patients, comparing </= 30 days prescription prior to index vs 31-</=180 days. However, active disease, disease duration, concomitant cardiovascular disease or diabetes and nephrotoxic drug use were independently associated with development of nephrotoxicity in UC and CD. CONCLUSIONS: Despite the paucity of evidence for their benefit, 5-aminosalicylates were prescribed to approximately half of CD patients (30% prolonged therapy). Nephrotoxicity was rare in this patient cohort, and was not associated with 5-aminosalicylate use, but rather with disease status, comorbidity and use of nephrotoxic drugs. |
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| ジャーナル名 | Alimentary pharmacology & therapeutics |
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| 投稿日 | 2019/7/13 |
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| 投稿者 | Jairath, Vipul; Hokkanen, Suvi R K; Guizzetti, Leonardo; Boxall, Naomi; Campbell-Hill, Sarah; Patel, Haridarshan |
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| 組織名 | Division of Gastroenterology, Department of Medicine, Western University, London,;Ontario, Canada.;Department of Epidemiology and Biostatistics, Western University, London,;IQVIA, London, UK.;Robarts Clinical Trials Inc., London, Ontario, Canada.;Evidence and Value Generation, Global Medical Affairs, Takeda Pharmaceuticals;International Inc., London, UK.;International Inc., Deerfield, Illinois. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31298421/ |
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