Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

Wang, Yuanyuan; Bos, Jens; Boezen, H. Marike; Alffenaar, Jan‐Willem C.; Boven, Job F M van; Schuiling-Veninga, Catharina C M; Wilffert, Bob

doi:10.1136/bmjresp-2019-000535

Cited by 3 publications

(4 citation statements)

References 39 publications

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“…Therefore, no clear conclusion could be drawn about the effects of these specific antibiotics used for AECOPD. Regarding specific antibiotics in our study, doxycycline had significant beneficial treatment effects on AECOPD, which is consistent with 2 guidelines and a recent study [30]. The resistance of common pathogens for AECOPD like H. influenzae and S. pneumoniae to doxycycline is reported to be rare in the Netherlands [31], and this may contribute to its successful short-term treatment effects.…”

Section: Primary Findingssupporting

confidence: 90%

“…Hence, our findings reflect the real-world effects of antibiotic treatment for AECOPD. Second, properly diagnosed COPD patients and their complete background information (e.g., lung function, smoking status, and re-lated comorbidities) that were lacking in previous observational studies were included in this study [30]. Moreover, the outcomes were adjusted for possible confounders using both logistic regression and PS analyses.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

et al. 2022

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Background: Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. Objectives: This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. Methods: A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. Results: Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. Conclusion: Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.

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Section: Primary Findingssupporting

confidence: 90%

Section: Strengths and Limitationsmentioning

confidence: 99%

Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

et al. 2022

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“…An HR of less than one indicates that the probability of hospital discharge was reduced and thus the LOS was longer. The following covariables were considered as potential confounders: age [ 21 ], sex, BMI, FEV 1 , GOLD stage, sputum purulence, pH, smoking status, respiratory failure, recent hospitalization, maintenance theophylline and in-hospital systemic corticosteroid (SCS) use [ 22 ]. Model 1 was adjusted for age, model 2 was adjusted for covariates which changed the point estimate by more than 5%, and model 3 was additionally adjusted for FEV 1 .…”

Section: Methodsmentioning

confidence: 99%

In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study

et al. 2023

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Background The use of antibiotics in mild to severe acute exacerbations of chronic obstructive pulmonary disease (COPD) remains controversial. Aim To explore in-hospital antibiotic use in severe acute exacerbations of COPD (AECOPD), to analyze determinants of in-hospital antibiotic use, and to investigate its association with hospital length of stay (LOS) and in-hospital mortality. Methods A retrospective, observational study was conducted in Ghent University Hospital. Severe AECOPD were defined as hospitalizations for AECOPD (ICD-10 J44.0 and J44.1) discharged between 2016 and 2021. Patients with a concomitant diagnosis of pneumonia or ‘pure’ asthma were excluded. An alluvial plot was used to describe antibiotic treatment patterns. Logistic regression analyses identified determinants of in-hospital antibiotic use. Cox proportional hazards regression analyses were used to compare time to discharge alive and time to in-hospital death between antibiotic-treated and non-antibiotic-treated AECOPD patients. Results In total, 431 AECOPD patients (mean age 70 years, 63% males) were included. More than two-thirds (68%) of patients were treated with antibiotics, mainly amoxicillin-clavulanic acid. In multivariable analysis, several patient-related variables (age, body mass index (BMI), cancer), treatment-related variables (maintenance azithromycin, theophylline), clinical variables (sputum volume and body temperature) and laboratory results (C-reactive protein (CRP) levels) were associated with in-hospital antibiotic use independent of sputum purulence, neutrophil counts, inhaled corticosteroids and intensive care unit of which CRP level was the strongest determinant. The median hospital LOS was significantly longer in antibiotic-treated patients (6 days [4–10]) compared to non-antibiotic-treated patients (4 days [2–7]) (p < 0.001, Log rank test). This was indicated by a reduced probability of hospital discharge even after adjustment for age, sputum purulence, BMI, in-hospital systemic corticosteroid use and forced expiratory volume in one second (FEV1) (adjusted hazard ratio 0.60; 95% CI 0.43; 0.84). In-hospital antibiotic use was not significantly associated with in-hospital mortality. Conclusions In this observational study in a Belgian tertiary hospital, in-hospital antibiotic use among patients with severe AECOPD was determined by the symptom severity of the exacerbation and the underlying COPD severity as recommended by the guidelines, but also by patient-related variables. Moreover, in-hospital antibiotic use was associated with a longer hospital stay, which may be linked to their disease severity, slower response to treatment or 'harm' due to antibiotics. Trial registration Number: B670201939030; date of registration: March 5, 2019.

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“…Each patient has a unique anonymous identifier; date of birth and gender are known. Due to the high patient-pharmacy commitment in the Netherlands, the medication records for each patient are virtually complete, except for over the counter (OTC) drugs and medication dispensed during hospitalization.” [ 17 , 19 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

Role of Traditional Cardiovascular Risk Factors after Initiation of Statin Therapy: A PharmLines Inception Cohort Study

Steenhuis

Vos

Bos

2022

Cardiovascular Therapeutics

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Background. Multiple studies and meta-analyses examined the role of traditional risk factors for cardiovascular events in statin treatment-naive patients. Nowadays, millions receive such therapy for the primary prevention of cardiovascular events (CVE). Objective. CVEs still occur in patients on primary preventive statin therapy. Therefore, further risk stratification within these patients is urgently needed. Methods. Using the unique linkage between biomedical data and prescription data from the PharmLines Initiative, we assessed the role of several risk factors used in cardiovascular risk models, using a time-dependent Cox PH model, in the occurrence of drug treatment of CVEs after initiation of statin therapy. Results. Among 602 statin therapy starters, 11% received drug treatment for CVE within an average follow-up period of 832 days. After multivariable modelling, cholesterol levels and blood pressure at baseline were no longer associated, whereas self-reported diabetes and increasing age were highly associated with the outcome when on statin therapy (hazard ratio (HR): 3.01, 95% confidence interval (95% CI): 1.48-6.12 and 1.04; 95% CI: 1.01-1.07, respectively). Males, smokers, and nonadherent patients had increased risks (HR 1.6, 1.12, and 1.18, resp.), though not statistically significant. Conclusion. Drug treatment for CVEs after statin initiation is increased in patients with diabetes type 2, in aged patients, males, smokers, and those with poor adherence, while there was no association with baseline cholesterol levels and blood pressure. These factors should be taken into account during the monitoring of statin therapy and may lead to changes in statin treatment or risk-related lifestyle factors.

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Influence of age on real-life effects of doxycycline for acute exacerbations among COPD outpatients: a population-based cohort study

Cited by 3 publications

References 39 publications

Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

In-hospital antibiotic use for severe chronic obstructive pulmonary disease exacerbations: a retrospective observational study

Role of Traditional Cardiovascular Risk Factors after Initiation of Statin Therapy: A PharmLines Inception Cohort Study

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