Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs

Root, Adrian A.; Wong, Angel Y. S.; Ghebremichael-Weldeselassie, Yonas; Smeeth, Liam; Bhaskaran, Krishnan; Evans, Stephen J. W.; Brauer, Ruth; Wong, Ian Chi Kei; Navaratnam, Vidya and Douglas, Ian (2016). Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs. British Journal of Pharmacology, 82(2) pp. 512–521.

DOI: https://doi.org/10.1111/bcp.12983

Abstract

Aim:

Some previous studies suggest a long term association between clarithromycin use and cardiovascular events. This study investigates this association for clarithromycin given as part of Helicobacter pylori treatment (HPT).

Methods:

Our source population was the Clinical Practice Research Datalink (CPRD), a UK primary care database. We conducted a self-controlled case series (SCCS), a case–time–control study (CTC) and a propensity score adjusted cohort study comparing the rate of cardiovascular events in the 3 years after exposure to HPT containing clarithromycin with exposure to clarithromycin free HPT.

Outcomes were first incident diagnosis of myocardial infarction (MI), arrhythmia and stroke. For the cohort analysis we included secondary outcomes all cause and cardiovascular mortality.

Results:

Twenty-eight thousand five hundred and fifty-two patients were included in the cohort. The incidence rate ratio of first MI within 1 year of exposure to HPT containing clarithromycin was 1.07 (95% CI 0.85, 1.34, P = 0.58) and within 90 days was 1.43 (95% CI 0.99, 2.09 P = 0.057) in the SCCS analysis. CTC and cohort results were consistent with these findings.

Conclusions

There was some evidence for a short term association for first MI but none for a long term association for any outcome.

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About

• Item ORO ID
• 47703
• Item Type
• Journal Item
• ISSN
• 1476-5381
• Project Funding Details

• Funded Project Name	Project ID	Funding Body
  Not Set	G0802403/1	Medical Research Council
  Not Set	MR/M014649/1	Medical Research Council

• Keywords
• adverse drug reaction; cardiovascular disease; clarithromycin; pharmacoepidemiology
• Academic Unit or School
• Faculty of Science, Technology, Engineering and Mathematics (STEM) > Mathematics and Statistics
  Faculty of Science, Technology, Engineering and Mathematics (STEM)
• Copyright Holders
• © 2016 The Authors
• Depositing User
• Yonas Ghebremichael-Weldeselassie