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Antibiotic use and inflammatory bowel diseases in childhood.

https://arctichealth.org/en/permalink/ahliterature139909
Source
Gut. 2011 Jan;60(1):49-54
Publication Type
Article
Date
Jan-2011
Author
Anders Hviid
Henrik Svanström
Morten Frisch
Author Affiliation
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. aii@ssi.dk
Source
Gut. 2011 Jan;60(1):49-54
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Anti-Bacterial Agents - administration & dosage - adverse effects
Child
Child, Preschool
Colitis, Ulcerative - chemically induced - epidemiology
Confounding Factors (Epidemiology)
Crohn Disease - chemically induced - epidemiology
Denmark - epidemiology
Drug Administration Schedule
Epidemiologic Methods
Female
Humans
Infant
Infant, Newborn
Inflammatory Bowel Diseases - chemically induced - epidemiology
Male
Socioeconomic Factors
Abstract
The composition of the intestinal microflora has been proposed as an important factor in the development of inflammatory bowel diseases (IBD). Antibiotics have the potential to alter the composition of the intestinal microflora. A study was undertaken to evaluate the potential association between use of antibiotics and IBD in childhood.
A nationwide cohort study was conducted of all Danish singleton children born from 1995 to 2003 (N=577,627) with individual-level information on filled antibiotic prescriptions, IBD and potential confounding variables. Using Poisson regression, rate ratios (RRs) of IBD were calculated according to antibiotic use. Antibiotic use was classified according to time since use, type, number of courses used and age at use.
IBD was diagnosed in 117 children during 3,173,117 person-years of follow-up. The RR of IBD was 1.84 (95% CI 1.08 to 3.15) for antibiotic users compared with non-users. This association appeared to be an effect on Crohn's disease (CD) alone (RR 3.41) and was strongest in the first 3 months following use (RR 4.43) and among children with =7 courses of antibiotics (RR 7.32).
Antibiotic use is common in childhood and its potential as an environmental risk factor for IBD warrants scrutiny. This is the first prospective study to show a strong association between antibiotic use and CD in childhood. However, as with any observational study, causality cannot be inferred from our results and confounding by indication--in particular, prescribing of antibiotics to children with intestinal symptoms of as yet undiagnosed CD--should also be considered as a possible explanation.
Notes
Comment In: Gastroenterology. 2011 Aug;141(2):768-7021704036
PubMed ID
20966024 View in PubMed
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Association between oral fluoroquinolone use and retinal detachment.

https://arctichealth.org/en/permalink/ahliterature105952
Source
JAMA. 2013 Nov 27;310(20):2184-90
Publication Type
Article
Date
Nov-27-2013
Author
Björn Pasternak
Henrik Svanström
Mads Melbye
Anders Hviid
Author Affiliation
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Source
JAMA. 2013 Nov 27;310(20):2184-90
Date
Nov-27-2013
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adult
Aged
Anti-Bacterial Agents - administration & dosage - adverse effects
Cohort Studies
Denmark - epidemiology
Female
Fluoroquinolones - administration & dosage - adverse effects
Humans
Incidence
Male
Middle Aged
Registries - statistics & numerical data
Retinal Detachment - epidemiology
Risk
Abstract
A recent study of ophthalmologic patients found a strong association between fluoroquinolone use and retinal detachment. Given the prevalent use of fluoroquinolones, this could, if confirmed in the general population, translate to many excess cases of retinal detachment that are potentially preventable.
To investigate if oral fluoroquinolone use is associated with an increased risk of retinal detachment.
A nationwide, register-based cohort study in Denmark from 1997 through 2011, using linked data on participant characteristics, filled prescriptions, and cases of retinal detachment with surgical treatment (scleral buckling, vitrectomy, or pneumatic retinopexy). The cohort included 748,792 episodes of fluoroquinolone use (660,572 [88%] ciprofloxacin) and 5,520,446 control episodes of nonuse.
Poisson regression was used to estimate rate ratios (RRs) for incident retinal detachment, adjusting for a propensity score that included a total of 21 variables. The risk windows were classified as current use (days 1-10 from start of treatment), recent use (days 11-30), past use (days 31-60), and distant use (days 61-180).
A total of 566 cases of retinal detachment occurred, of which 465 (82%) were rhegmatogenous detachments; 72 in fluoroquinolone users and 494 in control nonusers. The crude incidence rate was 25.3 cases per 100,000 person-years in current users, 18.9 in recent users, 26.8 in past users, and 24.8 in distant users compared with 19.0 in nonusers. Compared with nonuse, fluoroquinolone use was not associated with a significantly increased risk of retinal detachment: the adjusted RRs were 1.29 (95% CI, 0.53 to 3.13) for current use; 0.97 (95% CI, 0.46 to 2.05) for recent use; 1.37 (95% CI, 0.80 to 2.35) for past use; and 1.27 (95% CI, 0.93 to 1.75) for distant use. The absolute risk difference, estimated as the adjusted number of retinal detachment cases per 1,000,000 treatment episodes, was 1.5 (95% CI, -2.4 to 11.1) for current use.
In this cohort study based on the general Danish population, oral fluoroquinolone use was not associated with increased risk of retinal detachment. Given its limited power, this study can only rule out more than a 3-fold increase in the relative risk associated with current fluoroquinolone use; however, any differences in absolute risk are likely to be of minor, if any, clinical significance.
Notes
Comment In: JAMA. 2013 Nov 27;310(20):2151-324281459
PubMed ID
24281462 View in PubMed
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Association Between Proton Pump Inhibitor Use and Risk of Fracture in Children.

https://arctichealth.org/en/permalink/ahliterature311190
Source
JAMA Pediatr. 2020 06 01; 174(6):543-551
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
06-01-2020
Author
Yun-Han Wang
Viktor Wintzell
Jonas F Ludvigsson
Henrik Svanström
Björn Pasternak
Author Affiliation
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Source
JAMA Pediatr. 2020 06 01; 174(6):543-551
Date
06-01-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Child
Cohort Studies
Female
Fractures, Bone - chemically induced - epidemiology
Humans
Male
Propensity Score
Proton Pump Inhibitors - adverse effects
Registries
Risk factors
Sweden - epidemiology
Abstract
Proton pump inhibitor (PPI) use has been linked to increased risk of fracture in adults. Despite a trend in prescription of PPIs in children, there is scarce evidence regarding this safety concern in pediatric patients.
To evaluate the association between PPI use and risk of fracture in children.
This nationwide register-based cohort study included data from Sweden from July 2006 to December 2016. Children younger than 18 years who initiated PPI use were matched on propensity score and age with those who did not initiate PPI use.
Initiation of PPI use.
Cox regression was adopted to estimate hazard ratios (HRs) for a first fracture of any type and 5 subtypes of fracture, with follow-up for up to 5 years. To address potential residual confounding, high-dimensional propensity score matching and a direct comparison with histamine-2 receptor antagonists were performed.
There were a total of 115?933 pairs of children included. During a mean (SD) of 2.2 (1.6) years of follow-up, 5354 and 4568 cases of any fracture occurred among those who initiated PPIs vs those who did not, respectively (20.2 vs 18.3 events per 1000 person-years; hazard ratio [HR], 1.11 [95% CI, 1.06-1.15]). Use of PPIs was associated with increased risk of upper-limb fracture (HR, 1.08 [95% CI, 1.03-1.13]), lower-limb fracture (HR, 1.19 [95% CI, 1.10-1.29]), and other fractures (HR, 1.51 [95% CI, 1.16-1.97]) but not head fracture (HR, 0.93 [95% CI, 0.76-1.13]) or spine fracture (HR, 1.31 [95% CI, 0.95-1.81]). The HRs for fracture according to cumulative duration of PPI use were 1.08 (95% CI, 1.03-1.13) for 30 days or less, 1.14 (95% CI, 1.09-1.20) for 31 to 364 days, and 1.34 (95% CI, 1.13-1.58) for 365 days or more. The association was consistent in most sensitivity analyses, including high-dimensional propensity score matching (HR, 1.10 [95% CI, 1.06-1.15]), although the analysis of PPI vs histamine-2 receptor antagonist did not reach statistical significance (HR, 1.06 [95% CI, 0.97-1.15]).
In this large pediatric cohort, PPI use was associated with a small but significant increased risk of any fracture. Risk of fracture should be taken into account when weighing the benefits and risks of PPI treatment in children.
PubMed ID
32176276 View in PubMed
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Association between tumor necrosis factor-a antagonists and risk of cancer in patients with inflammatory bowel disease.

https://arctichealth.org/en/permalink/ahliterature104168
Source
JAMA. 2014 Jun 18;311(23):2406-13
Publication Type
Article
Date
Jun-18-2014
Author
Nynne Nyboe Andersen
Björn Pasternak
Saima Basit
Mikael Andersson
Henrik Svanström
Sarah Caspersen
Pia Munkholm
Anders Hviid
Tine Jess
Author Affiliation
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.
Source
JAMA. 2014 Jun 18;311(23):2406-13
Date
Jun-18-2014
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Denmark
Female
Humans
Inflammatory Bowel Diseases - drug therapy
Male
Middle Aged
Neoplasms - epidemiology
Registries
Risk
Risk factors
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Young Adult
Abstract
A Cochrane review and network meta-analysis concluded that there is need for more research on adverse effects, including cancer, after treatment with tumor necrosis factor a (TNF-a) antagonists and that national registries and large databases would provide relevant sources of data to evaluate these effects.
To investigate whether patients with inflammatory bowel disease (IBD) exposed to TNF-a antagonists were at increased risk of developing cancer.
Nationwide register-based cohort study in Denmark, 1999-2012. Participants were 56,146 patients 15 years or older with IBD identified in the National Patient Registry, of whom 4553 (8.1%) were exposed to TNF-a antagonists. Cancer cases were identified in the Danish Cancer Registry.
Rate ratios (RRs) for incident cancer (overall and site-specific) comparing TNF-a antagonist users and nonusers, estimated using Poisson regression adjusted for age, calendar year, disease duration, propensity scores, and use of other IBD medications.
During 489,433 person-years of follow-up (median, 9.3 years [interquartile range, 4.2-14.0]), 81 of 4553 patients exposed to TNF-a antagonists (1.8%) (median follow-up, 3.7 years [interquartile range, 1.8-6.0]) and 3465 of 51,593 unexposed patients (6.7%) developed cancer, yielding a fully adjusted RR of 1.07 (95% CI, 0.85-1.36). There was no significantly increased risk of cancer in analyses according to time since first TNF-a antagonist exposure (less than 1 year: RR, 1.10 [95% CI, 0.67-1.81]; 1 to less than 2 years: RR, 1.22 [95% CI, 0.77-1.93]; 2 to less than 5 years: RR, 0.82 [95% CI, 0.54-1.24]; 5 or more years: RR, 1.33 [95% CI, 0.88-2.03]) and in analyses according to the number of TNF-a antagonist doses received (1 to 3 doses: RR, 1.02 [95% CI, 0.71-1.47]; 4 to 7 doses: RR, 0.89 [95% CI, 0.55-1.42]; 8 or more doses: RR, 1.29 [95% CI, 0.90-1.85]). No site-specific cancers were in significant excess in fully adjusted models.
In this Danish nationwide study, exposure to TNF-a antagonists among patients with IBD was not associated with an increased risk of cancer over a median follow-up of 3.7 years among those exposed. An increased risk associated with longer-term accumulated doses and follow-up cannot be excluded.
PubMed ID
24938563 View in PubMed
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Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth.

https://arctichealth.org/en/permalink/ahliterature269718
Source
JAMA. 2016 Jan 5;315(1):58-67
Publication Type
Article
Date
Jan-5-2016
Author
Ditte Mølgaard-Nielsen
Henrik Svanström
Mads Melbye
Anders Hviid
Björn Pasternak
Source
JAMA. 2016 Jan 5;315(1):58-67
Date
Jan-5-2016
Language
English
Publication Type
Article
Keywords
Abortion, Spontaneous - chemically induced - epidemiology
Administration, Oral
Adult
Antifungal Agents - administration & dosage - adverse effects
Candidiasis, Vulvovaginal - drug therapy
Case-Control Studies
Cohort Studies
Denmark - epidemiology
Female
Fluconazole - administration & dosage - adverse effects
Gestational Age
Humans
Maternal Age
Pregnancy
Pregnancy Complications, Infectious - drug therapy
Propensity Score
Registries
Stillbirth
Young Adult
Abstract
Vaginal candidiasis is common during pregnancy. Although intravaginal formulations of topical azole antifungals are first-line treatment for pregnant women, oral fluconazole is often used despite limited safety information.
To study the association between oral fluconazole exposure during pregnancy and the risk of spontaneous abortion and stillbirth.
Nationwide register-based cohort study in Denmark, 1997-2013. From a cohort of 1,405,663 pregnancies, oral fluconazole-exposed pregnancies were compared with up to 4 unexposed pregnancies matched on propensity score, maternal age, calendar year, and gestational age (based on gestational age at first day of treatment with eligible controls surviving through this date). To test for confounding by indication, pregnancies exposed to intravaginal formulations of topical azoles were used as an additional comparator group.
Filled prescriptions for oral fluconazole were obtained from the National Prescription Register.
Hazard ratios (HRs) for spontaneous abortion and stillbirth, estimated using proportional hazards regression.
Among 3315 women exposed to oral fluconazole from 7 through 22 weeks' gestation, 147 experienced a spontaneous abortion, compared with 563 among 13,246 unexposed matched women. There was a significantly increased risk of spontaneous abortion associated with fluconazole exposure (HR, 1.48; 95% CI, 1.23-1.77). Among 5382 women exposed to fluconazole from gestational week 7 to birth, 21 experienced a stillbirth, compared with 77 among 21,506 unexposed matched women. There was no significant association between fluconazole exposure and stillbirth (HR, 1.32 [95% CI, 0.82-2.14]). Using topical azole exposure as the comparison, 130 of 2823 women exposed to fluconazole vs 118 of 2823 exposed to topical azoles had a spontaneous abortion (HR, 1.62 [95% CI, 1.26-2.07]); 20 of 4301 women exposed to fluconazole vs 22 of 4301 exposed to topical azoles had a stillbirth (HR, 1.18 [95% CI, 0.64-2.16]).
In this nationwide cohort study in Denmark, use of oral fluconazole in pregnancy was associated with a statistically significant increased risk of spontaneous abortion compared with risk among unexposed women and women with topical azole exposure in pregnancy. Until more data on the association are available, cautious prescribing of fluconazole in pregnancy may be advisable. Although the risk of stillbirth was not significantly increased, this outcome should be investigated further.
PubMed ID
26746458 View in PubMed
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Association of treatment with carvedilol vs metoprolol succinate and mortality in patients with heart failure.

https://arctichealth.org/en/permalink/ahliterature260228
Source
JAMA Intern Med. 2014 Oct;174(10):1597-604
Publication Type
Article
Date
Oct-2014
Author
Björn Pasternak
Henrik Svanström
Mads Melbye
Anders Hviid
Source
JAMA Intern Med. 2014 Oct;174(10):1597-604
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Adult
Aged
Carbazoles - therapeutic use
Denmark - epidemiology
Female
Follow-Up Studies
Heart Failure - drug therapy - mortality - physiopathology
Humans
Male
Metoprolol - analogs & derivatives - therapeutic use
Middle Aged
Odds Ratio
Propanolamines - therapeutic use
Propensity Score
Proportional Hazards Models
Stroke Volume - drug effects
Treatment Outcome
Ventricular Function, Left - drug effects
Abstract
The ß-blockers carvedilol and metoprolol succinate both reduce mortality in patients with heart failure (HF), but the comparative clinical effectiveness of these drugs is unknown.
To investigate whether carvedilol is associated with improved survival compared with metoprolol succinate.
Cohort study of patients with incident HF with reduced left ventricular ejection fraction (LVEF) (=40%) who received carvedilol (n?=?6026) or metoprolol succinate (n?=?5638) using data from a Danish national HF registry linked with health care and administrative databases.
All-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were analyzed using Cox regression with adjustment for a propensity score, derived from a range of clinical, socioeconomic, and demographic characteristics.
The mean (SD) age of the patients was 69.3 (9.1) years, 71% were men, and 51% were hospitalized at index HF diagnosis. During a median (interquartile range) 2.4 (1.0-3.0) years of follow-up, 875 carvedilol users and 754 metoprolol users died; the cumulative incidence of mortality was 18.3% and 18.8%, respectively. The adjusted hazard ratio for carvedilol users vs metoprolol users was 0.99 (95% CI, 0.88 to 1.11), corresponding to an absolute risk difference of -0.07 (95% CI, -0.84 to 0.77) deaths per 100 person-years. Estimates were consistent across subgroup analyses by sex, age, levels of LVEF, New York Heart Association classification, and history of ischemic heart disease. A higher proportion of carvedilol users achieved the recommended daily target dose (50 mg; 3124 [52%]) than did metoprolol users (200 mg; 689 [12%]); among patients who reached the target dose, the adjusted hazard ratio was 0.97 (95% CI, 0.72-1.30). A robustness analysis with 1:1 propensity score matching confirmed the primary findings (hazard ratio, 0.97 [95% CI, 0.84-1.13]). The adjusted hazard ratio for cardiovascular mortality was 1.05 (95% CI, 0.88-1.26).
These findings from real-world clinical practice indicate that the effectiveness of carvedilol and metoprolol succinate in patients with HF is similar.
Notes
Erratum In: JAMA Intern Med. 2014 Nov;174(11):1875
PubMed ID
25173681 View in PubMed
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Association of treatment with losartan vs candesartan and mortality among patients with heart failure.

https://arctichealth.org/en/permalink/ahliterature125286
Source
JAMA. 2012 Apr 11;307(14):1506-12
Publication Type
Article
Date
Apr-11-2012
Author
Henrik Svanström
Björn Pasternak
Anders Hviid
Author Affiliation
Department of Epidemiology Research, Statens Serum Institut, Ørestads Boulevard 5, 206/305, 2300 København S Denmark. htr@ssi.dk
Source
JAMA. 2012 Apr 11;307(14):1506-12
Date
Apr-11-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers - administration & dosage
Benzimidazoles - administration & dosage
Cohort Studies
Denmark - epidemiology
Dose-Response Relationship, Drug
Female
Heart Failure - drug therapy - mortality
Humans
Losartan - administration & dosage
Male
Registries - statistics & numerical data
Risk
Tetrazoles - administration & dosage
Abstract
The benefit of angiotensin II-receptor blockers (ARBs) in heart failure is thought to be a class effect, but no head-to-head randomized trials have compared individual ARBs. Results from observational studies suggest that losartan may be associated with increased mortality in patients with heart failure compared with other ARBs.
To assess the hypothesis that losartan use is associated with increased all-cause mortality in heart failure patients as compared with candesartan.
We conducted a nationwide Danish registry-based cohort study, linking individual-level information on hospital contacts, filled prescriptions, and potential confounders. Patients aged 45 years and older with first-time hospitalization for heart failure in 1998-2008 were identified from the Danish National Patient Registry. New users of losartan and candesartan were selected for inclusion in the study cohort.
We used Cox proportional hazards regression to compare the risk of all-cause mortality in users of losartan and candesartan.
Among 4397 users of losartan, 1212 deaths occurred during 11,347 person-years of follow-up (unadjusted incidence rate [IR]/100 person-years, 10.7; 95% CI, 10.1-11.3) compared with 330 deaths during 3675 person-years among 2082 users of candesartan (unadjusted IR/100 person-years, 9.0; 95% CI, 8.1-10.0). Compared with candesartan, losartan was not associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.10; 95% CI, 0.96-1.25) or cardiovascular mortality (adjusted HR, 1.14; 95% CI, 0.96-1.36). Compared with high doses of candesartan (16-32 mg), low-dose (12.5 mg) and medium-dose losartan (50 mg) were associated with increased mortality (HR, 2.79; 95% CI, 2.19-3.55 and HR, 1.39; 95% CI, 1.11-1.73, respectively); use of high-dose losartan (100 mg) was similar in risk (HR, 0.71; 95% CI, 0.50-1.00).
Among patients with heart failure, overall use of losartan compared with candesartan was not associated with an increased mortality risk. Although low doses of losartan were associated with increased mortality, there was no increased mortality comparing high-dose losartan against the highest doses of candesartan.
Notes
Comment In: JAMA. 2012 Jul 25;308(4):336; author reply 336-722820775
PubMed ID
22496265 View in PubMed
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Atypical antipsychotics olanzapine, quetiapine, and risperidone and risk of acute major cardiovascular events in young and middle-aged adults: a nationwide register-based cohort study in Denmark.

https://arctichealth.org/en/permalink/ahliterature263447
Source
CNS Drugs. 2014 Oct;28(10):963-73
Publication Type
Article
Date
Oct-2014
Author
Björn Pasternak
Henrik Svanström
Mattis F Ranthe
Mads Melbye
Anders Hviid
Source
CNS Drugs. 2014 Oct;28(10):963-73
Date
Oct-2014
Language
English
Publication Type
Article
Keywords
Administration, Oral
Adolescent
Adult
Antipsychotic Agents - adverse effects
Benzodiazepines - adverse effects
Cardiovascular Diseases - chemically induced - epidemiology
Cohort Studies
Denmark - epidemiology
Dibenzothiazepines - adverse effects
Female
Follow-Up Studies
Humans
Injections, Intramuscular
Male
Middle Aged
Proportional Hazards Models
Registries
Risk
Risperidone - adverse effects
Sensitivity and specificity
Young Adult
Abstract
A number of serious cardiovascular safety concerns related to the use of atypical antipsychotics, compared with no use, have emerged, but nearly all reports are from studies of older patients. We aimed to compare the risk of cardiovascular events between the three most commonly used atypical antipsychotics in young and middle-aged adults.
We conducted a nationwide register-based cohort study in Denmark, 1997-2011, including adults aged 18-64 years, who started treatment with oral or intramuscular olanzapine (n = 15,774), oral quetiapine (n = 18,717), and oral or intramuscular risperidone (n = 14,134). The primary outcome was any major cardiovascular event (composite of cardiovascular mortality, acute coronary syndrome, or ischemic stroke) within 1 year following treatment initiation. Cox regression was used to estimate hazard ratios (HRs) while on current antipsychotic monotherapy in the outpatient setting, adjusting for an outcome-specific disease risk score.
The crude rate of any major cardiovascular event was 5.3 per 1,000 person-years among olanzapine users, 3.4 in quetiapine users, and 5.2 in risperidone users. Compared with risperidone, the risk of any major cardiovascular event was not significantly different in olanzapine users (HR 0.90, 95 % confidence interval [CI] 0.53-1.52) and quetiapine users (HR 0.79, 95 % CI 0.45-1.39). The absolute risk difference per 1,000 person-years on treatment was -0.5 (95 % CI -2.4 to 2.7) events for olanzapine and -1.1 (95 % CI -2.9 to 2.0) events for quetiapine.
Among young and middle-aged outpatients, the risk of acute major cardiovascular events was similar with use of olanzapine, quetiapine, and risperidone. Although moderate relative differences cannot be ruled out, any differences are small in absolute terms.
PubMed ID
24895158 View in PubMed
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Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study.

https://arctichealth.org/en/permalink/ahliterature106787
Source
BMJ. 2013;347:f5906
Publication Type
Article
Date
2013
Author
Lisen Arnheim-Dahlström
Björn Pasternak
Henrik Svanström
Pär Sparén
Anders Hviid
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden.
Source
BMJ. 2013;347:f5906
Date
2013
Language
English
Publication Type
Article
Keywords
Adolescent
Autoimmune Diseases - epidemiology - immunology
Child
Cohort Studies
Denmark - epidemiology
Female
Humans
Incidence
Nervous System Diseases - epidemiology - immunology
Papillomavirus Infections - prevention & control
Papillomavirus Vaccines - adverse effects
Risk factors
Sweden - epidemiology
Venous Thromboembolism - epidemiology - immunology
Abstract
To assess the risk of serious adverse events after vaccination of adolescent girls with quadrivalent human papillomavirus (qHPV) vaccine.
Register based cohort study.
Denmark and Sweden, October 2006 to December 2010.
997,585 girls aged 10-17, among whom 296,826 received a total of 696,420 qHPV vaccine doses.
Incident hospital diagnosed autoimmune, neurological, and venous thromboembolic events (53 different outcomes) up to 180 days after each qHPV vaccine dose. Only events with at least five vaccine exposed cases were considered for further assessment. Rate ratios adjusted for age, country, calendar year, and parental country of birth, education, and socioeconomic status were estimated, comparing vaccinated and unvaccinated person time. For outcomes where the rate ratio was significantly increased, we regarded three criteria as signal strengthening: analysis based on 20 or more vaccine exposed cases (reliability), rate ratio 3.0 or more (strength), and significantly increased rate ratio in country specific analyses (consistency). We additionally assessed clustering of events in time and estimated rate ratios for a risk period that started on day 181.
Among the 53 outcomes, at least five vaccine exposed cases occurred in 29 and these were analysed further. Whereas the rate ratios for 20 of 23 autoimmune events were not significantly increased, exposure to qHPV vaccine was significantly associated with Behcet's syndrome, Raynaud's disease, and type 1 diabetes. Each of these three outcomes fulfilled only one of three predefined signal strengthening criteria. Furthermore, the pattern of distribution in time after vaccination was random for all three and the rate ratios for these outcomes in the period from day 181 after vaccination were similar to the rate ratios in the primary risk period. The rate ratios for five neurological events were not significantly increased and there were inverse associations with epilepsy (rate ratio 0.66, 95% confidence interval 0.54 to 0.80) and paralysis (0.56, 0.35 to 0.90). There was no association between exposure to qHPV vaccine and venous thromboembolism (0.86, 0.55 to 1.36).
This large cohort study found no evidence supporting associations between exposure to qHPV vaccine and autoimmune, neurological, and venous thromboembolic adverse events. Although associations for three autoimmune events were initially observed, on further assessment these were weak and not temporally related to vaccine exposure. Furthermore, the findings need to be interpreted considering the multiple outcomes assessed.
Notes
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Comment In: J Pediatr. 2014 May;164(5):124024742654
Comment In: BMJ. 2013;347:f563124108153
PubMed ID
24108159 View in PubMed
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A collaborative approach to investigating the risk of thrombocytopenic purpura after measles-mumps-rubella vaccination in England and Denmark.

https://arctichealth.org/en/permalink/ahliterature133482
Source
Vaccine. 2012 Apr 19;30(19):3042-6
Publication Type
Article
Date
Apr-19-2012
Author
Nick Andrews
Julia Stowe
Elizabeth Miller
Henrik Svanström
Kari Johansen
Jan Bonhoeffer
Anders Hviid
Author Affiliation
Statistics Modelling and Economics Department, Health Protection Services, Health Protection Agency, Colindale, London NW9 5EQ, United Kingdom. nick.andrews@hpa.org.uk
Source
Vaccine. 2012 Apr 19;30(19):3042-6
Date
Apr-19-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cohort Studies
Denmark
Drug-Related Side Effects and Adverse Reactions - epidemiology
England
Female
Humans
Infant
Infant, Newborn
International Cooperation
Male
Measles-Mumps-Rubella Vaccine - administration & dosage - adverse effects
Purpura, Thrombocytopenic - chemically induced - epidemiology
Risk assessment
Vaccination - adverse effects
Young Adult
Abstract
The assessment of rare adverse events following vaccination may not be possible within a single country due to an insufficiently large denominator population. In 2008 a European consortium (VAESCO) was funded to perform collaborative vaccine safety studies. To help assess the feasibility of multi-country collaboration England and Denmark, who have established vaccine safety research infrastructures, undertook to work to a common protocol and share results and data to estimate the risk of a known true adverse event, thrombocytopenic purpura (TP) following measles-mumps-rubella (MMR) vaccination. TP is a known rare reaction to MMR and therefore provided an opportunity to assess whether two countries would produce similar results when working collaboratively. Despite some initial problems with ensuring data were comparable, the two countries gave very similar estimates of the relative incidence in the 6 weeks after vaccination and a pooled relative incidence estimate of 2.13 (95% confidence interval 1.55-2.94) and attributable risk of 1 in 50,000 doses. Both countries used hospital admissions for TP and the analysis was performed using the self controlled case series method which is particularly suited to collaborative studies because of its implicit control for individual level confounding. The study therefore shows the potential for vaccine safety collaborations across Europe to detect true associations through use of common protocols and sharing of results or data.
PubMed ID
21699947 View in PubMed
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