Unidad docente FarmacologíaFARMACOLhttp://hdl.handle.net/10017/2942024-03-28T13:40:51Z2024-03-28T13:40:51ZCyclosporine Use in Epidermal Necrolysis Is Associated with an Important Mortality Reduction: Evidence from Three Different ApproachesGonzález Herrada, CarlosRodríguez Martín, SaraCachafeiro, LucíaLerma Hambleton, Victoria BeatrizGonzález, OlgaLorente, José ARodríguez Miguel, AntonioGonzález Ramos, JessicaRoustán, GastónRamírez, ElenaBellón, TeresaAbajo Iglesias, Francisco José deTherapeutic Management Working Group, Pielenredhttp://hdl.handle.net/10017/602792024-02-09T15:05:28Z2017-10-01T00:00:00ZCyclosporine Use in Epidermal Necrolysis Is Associated with an Important Mortality Reduction: Evidence from Three Different Approaches
González Herrada, Carlos; Rodríguez Martín, Sara; Cachafeiro, Lucía; Lerma Hambleton, Victoria Beatriz; González, Olga; Lorente, José A; Rodríguez Miguel, Antonio; González Ramos, Jessica; Roustán, Gastón; Ramírez, Elena; Bellón, Teresa; Abajo Iglesias, Francisco José de; Therapeutic Management Working Group, Pielenred
Several immunomodulatory agents are used in the treatment of epidermal necrolysis, but evidence of their efficacy is limited. The Autonomous Community of Madrid has two reference burn units to which all patients with epidermal necrolysis are referred. One burn unit has mostly used cyclosporine (CsA), and the other has used non-CsA therapies (mainly high-dose intravenous immunoglobulin). The allocation of patients to one or the other burn unit was mainly based on proximity, resembling a random assignment. Thus, we took advantage of this ?natural experiment? to estimate the mortality risk ratio (MRR) of CsA (n . 26) compared with non-CsA (n . 16) treatment using hospital as an instrumental variable over the period from 2001 to 2015. We also computed the observed versus expected (O/E) MRR in a case series of 49 CsA-treated patients (including 23 patients from other regions treated in Madrid), and using the Score for Toxic Epidermal Necrolysis (i.e., SCORTEN) scale to estimate the expected values. The instrumental variable-based MRR of CsA versus non-CsA was 0.09 (95% confidence interval . 0.00e0.49). The O/E analysis also showed a reduction in mortality risk (MRROE . 0.42; 95% confidence interval . 0.14e0.99). We identified five other case series of CsA-treated patients providing MRROE and meta-analyzed their results. The pooled MRROE (including from this study) was 0.41 (95% confidence interval . 0.21e0.80). All three approaches consistently show that CsA reduces the mortality in epidermal necrolysis patients.
2017-10-01T00:00:00ZUse of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population studyAbajo Iglesias, Francisco José deRodríguez Martín, SaraLerma Hambleton, Victoria BeatrizMejia Abril, GinaAguilar, MónicaGarcía Luque, AmeliaLaredo, LeonorLaosa, OlgaCenteno Soto, Gustavo AGalvez, M. AngelesPuerro Vicente, Miguel FranciscoGonzalez Rojano, EsperanzaPedraza, LauraDe Pablo, ItziarAbad Santos, FranciscoRodriguez Mañas, LeocadioGil, MiguelTobias, AurelioRodríguez Miguel, AntonioRodríguez Puyol, Diego Maríahttp://hdl.handle.net/10017/602112024-02-02T01:16:51Z2020-05-14T00:00:00ZUse of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study
Abajo Iglesias, Francisco José de; Rodríguez Martín, Sara; Lerma Hambleton, Victoria Beatriz; Mejia Abril, Gina; Aguilar, Mónica; García Luque, Amelia; Laredo, Leonor; Laosa, Olga; Centeno Soto, Gustavo A; Galvez, M. Angeles; Puerro Vicente, Miguel Francisco; Gonzalez Rojano, Esperanza; Pedraza, Laura; De Pablo, Itziar; Abad Santos, Francisco; Rodriguez Mañas, Leocadio; Gil, Miguel; Tobias, Aurelio; Rodríguez Miguel, Antonio; Rodríguez Puyol, Diego María
Background Concerns have been raised about the possibility that inhibitors of the renin?angiotensin?aldosterone system (RAAS) could predispose individuals to severe COVID-19; however, epidemiological evidence is lacking. We report the results of a case-population study done in Madrid, Spain, since the outbreak of COVID-19. Methods In this case-population study, we consecutively selected patients aged 18 years or older with a PCRconfirmed diagnosis of COVID-19 requiring admission to hospital from seven hospitals in Madrid, who had been admitted between March 1 and March 24, 2020. As a reference group, we randomly sampled ten patients per case, individually matched for age, sex, region (ie, Madrid), and date of admission to hospital (month and day; index date), from Base de datos para la Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), a Spanish primary health-care database, in its last available year (2018). We extracted information on comorbidities and prescriptions up to the month before index date (ie, current use) from electronic clinical records of both cases and controls. The outcome of interest was admission to hospital of patients with COVID-19. To minimise confounding by indication, the main analysis focused on assessing the association between COVID-19 requiring admission to hospital and use of RAAS inhibitors compared with use of other antihypertensive drugs. We calculated odds ratios (ORs) and 95% CIs, adjusted for age, sex, and cardiovascular comorbidities and risk factors, using conditional logistic regression. The protocol of the study was registered in the EU electronic Register of Post-Authorisation Studies, EUPAS34437. Findings We collected data for 1139 cases and 11 390 population controls. Among cases, 444 (39·0%) were female and the mean age was 69·1 years (SD 15·4), and despite being matched on sex and age, a significantly higher proportion of cases had pre-existing cardiovascular disease (OR 1·98, 95% CI 1·62?2·41) and risk factors (1·46, 1·23?1·73) than did controls. Compared with users of other antihypertensive drugs, users of RAAS inhibitors had an adjusted OR for COVID-19 requiring admission to hospital of 0·94 (95% CI 0·77?1·15). No increased risk was observed with either angiotensin-converting enzyme inhibitors (adjusted OR 0·80, 0·64?1·00) or angiotensin-receptor blockers (1·10, 0·88?1·37). Sex, age, and background cardiovascular risk did not modify the adjusted OR between use of RAAS inhibitors and COVID-19 requiring admission to hospital, whereas a decreased risk of COVID-19 requiring admission to hospital was found among patients with diabetes who were users of RAAS inhibitors (adjusted OR 0·53, 95% CI 0·34?0·80). The adjusted ORs were similar across severity degrees of COVID-19. Interpretation RAAS inhibitors do not increase the risk of COVID-19 requiring admission to hospital, including fatal cases and those admitted to intensive care units, and should not be discontinued to prevent a severe case of COVID-19.
2020-05-14T00:00:00ZSelective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control StudyAlqdwah-Fattouh, RashaRodríguez Martín, SaraBarreira Hernández, DianaIzquierdo Esteban, LauraGil, MiguelGonzález Bermejo, DianaFernández Antón, EncarnaciónRodríguez Miguel, AntonioGarcía Lledó, José AlbertoBolumar Montrull, FranciscoAbajo Iglesias, Francisco José dehttp://hdl.handle.net/10017/602092024-02-05T17:11:26Z2022-02-03T00:00:00ZSelective Serotonin Reuptake Inhibitors and Risk of Noncardioembolic Ischemic Stroke: A Nested Case-Control Study
Alqdwah-Fattouh, Rasha; Rodríguez Martín, Sara; Barreira Hernández, Diana; Izquierdo Esteban, Laura; Gil, Miguel; González Bermejo, Diana; Fernández Antón, Encarnación; Rodríguez Miguel, Antonio; García Lledó, José Alberto; Bolumar Montrull, Francisco; Abajo Iglesias, Francisco José de
BACKGROUND: Multiple studies have reported that the use of selective serotonin reuptake inhibitors (SSRIs) is associated with an increased risk of ischemic stroke; however, this finding may be the result of a confounding by indication. We examined the association using different approaches to minimize such potential bias. METHODS: A nested case-control study was carried out in a Spanish primary health-care database over the study period 2001 to 2015. Cases were patients sustaining an ischemic stroke with no sign of cardioembolic or unusual cause. For each case, up to 5 matched controls (for exact age, sex, and index date) were randomly selected. Antidepressants were divided in 6 pharmacological subgroups according to their mechanism of action. The current use of SSRIs (use within a 30-day window before index date) was compared with nonuse, past use (beyond 365 days) and current use of other antidepressants through a conditional logistic regression model to obtain adjusted odds ratios and 95% CI. Only initiators of SSRIs and other antidepressants were considered. RESULTS: A total of 8296 cases and 37 272 matched controls were included. Of them, 255 (3.07%) were current users of SSRIs among cases and 834 (2.24%) among controls, yielding an adjusted odds ratio of 1.14 (95% CI, 0.97?1.34) as compared with nonusers, 0.94 (95% CI, 0.77?1.13) as compared with past-users and 0.74 (95% CI, 0.58?0.93) as compared with current users of other antidepressants. No relevant differences were found by duration (?1, >1 year), sex, age (<70, ?70 years old) and background vascular risk. CONCLUSIONS: The use of SSRIs was not associated with an increased risk of noncardioembolic ischemic stroke. On the contrary, as compared with other antidepressants, SSRIs appeared to be protective.
2022-02-03T00:00:00ZInfluenza Vaccination and Risk of Ischemic Stroke: A Population-Based Case-Control StudyRodríguez Martín, Sarahttp://hdl.handle.net/10017/602082024-02-09T10:54:21Z2022-11-08T00:00:00ZInfluenza Vaccination and Risk of Ischemic Stroke: A Population-Based Case-Control Study
Rodríguez Martín, Sara
Background and Objectives: To assess the relationship between influenza vaccination in the general population and risk of a first ischemic stroke (IS) during pre-epidemic, epidemic, and postepidemic periods. Methods: A nested case-control study was conducted in a Spanish primary care database over 2001?2015. Individuals aged 40?99 years with at least 1 year registry and no history of stroke or cancer were selected to conform the source cohort, from which incident IS cases were identified and classified as cardioembolic or noncardioembolic. Five controls per case were randomly selected, individually matched with cases for exact age, sex, and date of stroke diagnosis (index date). A patient was considered vaccinated when he/she had a recorded influenza vaccination at least 14 days before the index date within the same season. Adjusted odds ratios (aORs) and their respective 95% CIs were computed through a conditional logistic regression. Pneumococcal vaccination was used as a negative control. Results: From a cohort of 3,757,621 patients, we selected 14,322 incident IS cases (9,542 noncardioembolic and 4,780 cardioembolic) and 71,610 matched controls. Of them, 41.4% and 40.5%, respectively, were vaccinated yielding a crudeOR of 1.05 (95% CI 1.01?1.10). Vaccinated patients presented a higher prevalence of vascular risk factors, diseases, and comedication than those nonvaccinated, and after full adjustment, the association of influenza vaccination with IS yielded an aOR of 0.88 (95% CI 0.84?0.92), appearing early (aOR15?30 days 0.79; 95% CI 0.69?0.92) and slightly declining over time (aOR>150 days 0.92; 95%CI 0.87?0.98). A reduced risk of similar magnitude was observed with both types of IS, in the 3 epidemic periods, and in all subgroups analyzed (men, women, individuals younger and older than 65 years of age, and those with intermediate and high vascular risk). By contrast, pneumococcal vaccination was not associated with a reduced risk of IS (aOR 1.08; 95% CI 1.04?1.13). Discussion: Results are compatible with amoderate protective effect of influenza vaccine on IS appearing early after vaccination. The finding that a reduced risk was also observed in pre-epidemic periods suggests that either the ?protection? is not totally linked to prevention of influenza infection or it may be partly explained by unmeasured confounding factors.
2022-11-08T00:00:00Z