Segmented regression analysis of changes in antipsychotic and other psychotropic prescription in relation to the 2004 and 2009 risk communications.

a<p>p<0.05;</p>b<p>p<0.001.</p>*<p>Value is the <i>change</i> in trend not the subsequent trend, and interpretation of the model should be in conjunction with examining the time trend graphs. For example, for oral antipsychotics the trend before the 2004 intervention is a rising one, with an increase of 0.61% per quarter. There is a statistically significant downward change in trend of 0.54% per quarter, so the post-2004 risk communication estimated trend is an increase of 0.07% per quarter. There is a further statistically significant downward change in trend of 0.51% per quarter after the 2009 risk communication, so the post-2009 risk communication estimated trend is a decrease of 0.44% per quarter.</p

2004 and 2009 risk communications concerning antipsychotic use in older people with dementia.

*<p>CSM = Committee for Safety of Medicines.</p

Hypnotic, anxiolytic and antidepressant prescribing in people aged ≥65 years with dementia.

<p>Hypnotic, anxiolytic and antidepressant prescribing in people aged ≥65 years with dementia.</p

Prescribing of selected oral antipsychotics in people aged ≥65 years with dementia.

<p>Prescribing of selected oral antipsychotics in people aged ≥65 years with dementia.</p

Prescribing of all oral antipsychotics in people aged ≥65 years with dementia.

<p>Prescribing of all oral antipsychotics in people aged ≥65 years with dementia.</p

New antipsychotic prescribing and antipsychotic stopping in people aged ≥65 years with dementia.

<p>New antipsychotic prescribing and antipsychotic stopping in people aged ≥65 years with dementia.</p

Cardiovascular safety in type 2 diabetes with sulfonylureas as second-line drugs: a nation-wide population based comparative safety study

   Objective To assess the real-world cardiovascular (CV) safety for SU, in comparison with dipeptidylpeptidase-4 inhibitors (DPP4i) and thiazolidinediones (TZD) through development of robust methodology for causal inference in a whole nation study.  Research Design and Methods A cohort study was performed including people with type 2 diabetes diagnosed in Scotland before 31 December 2017, who failed to reach HbA1c 48 mmol/mol despite metformin monotherapy and initiated second-line pharmacotherapy (SU/DPP4i/TZD) on or after 1 January 2010. The primary outcome was the composite major adverse cardiovascular events (MACE), including hospitalization for myocardial infarction (MI), ischemic stroke, heart failure, and CV death. Secondary outcomes were each individual endpoint and all-cause death. Multivariable Cox proportional hazards regression and an instrumental variable (IV) approach were used to control confounding in a similar way to the randomization process in a randomized control trial.   Results Comparing SU to non-SU (DPP4i/TZD), the hazard ratio (HR) for MACE was 1.00 (95% CI: 0.91 to 1.09) from the multivariable Cox regression and 1.02 (0.91  - 1.13) and 1.03 (0.91- 1.16) using two different IVs. For all-cause death, the HR from Cox regression and the two IV analyses was 1.03 (0.94 - 1.13), 1.04 (0.93 - 1.17), and 1.03 (0.90 - 1.17).  Conclusion Our findings contribute to the understanding that second-line SU for glucose lowering are unlikely to increase CV risk or all-cause mortality. Given their potent efficacy, microvascular benefits, cost effectiveness and widespread use, this study supports that SU should remain a part of the global diabetes treatment portfolio.Article  </p