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Initial Cholinesterase Inhibitor Therapy Dose and Serious Events in Older Women and Men
Author(s) -
Rochon Paula A.,
Gruneir Andrea,
Gill Sudeep S.,
Wu Wei,
Zhu Lynn,
Herrmann Nathan,
Bell Chaim M.,
Austin Peter C.,
Stall Nathan M.,
McCarthy Lisa,
Giannakeas Vasily,
Alberga Amanda,
Seitz Dallas P.,
Normand SharonLise,
Gurwitz Jerry H.,
Bronskill Susan E.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15442
Subject(s) - medicine , hazard ratio , confidence interval , proportional hazards model , retrospective cohort study , population , cohort , cohort study , environmental health
Objectives To examine dose‐related prescribing and short‐term serious events associated with initiation of cholinesterase inhibitor (ChEI) therapy. Design Retrospective, population‐based cohort study. Setting Ontario, Canada. Participants Women (n=47,829) and men (n=32,503) aged 66 and older who initiated a ChEI between April 1, 2010, and June 30, 2016. Measurements All‐cause serious events (emergency department (ED) visits, inpatient hospitalizations, death) within 30 days of ChEI initiation. Multivariable Cox proportional hazards models were used to estimate adjusted rates of serious events. Results Overall, 4.8% of older adults were dispensed a lower‐than‐recommended ChEI starting dose, 87.9% a recommended dose, and 7.3% a higher‐than‐recommended starting dose. Eight thousand six hundred seventy‐one (10.8%) individuals experienced a serious event within 30 days of initiating therapy, primarily ED visits (8,540, 10.6%). Relative to those initiated on a recommended starting dose, those initiated on a higher dose had a significantly increased rate of serious events (women adjusted hazard ratio (aHR) 1.50, 95% confidence interval (CI) =1.38–1.63; men aHR 1.31, 95% CI=1.19–1.45). Similar patterns were found for ED visits and inpatient hospitalizations but not death. The relative effect of higher‐than‐recommended starting dose dispensed vs. recommended starting dose dispensed was greater in women than it was in men: the number needed to harm was 22 (95% confidence interval (CI)=18–29) for women and 36 (95% CI= 26–61) for men. Conclusion Serious events immediately after initiation of ChEIs were associated with starting ChEI dose. This association was stronger in women.