Effectiveness and safety of medicines used in COPD patients: pharmacoepidemiological studies

Wang, Y., 2020, [Groningen]: University of Groningen. 211 p.

Research output: ThesisThesis fully internal (DIV)

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  • Title and contents

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  • Chapter 1

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  • Chapter 2

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  • Chapter 9

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In the first part of the thesis, we evaluated the effects of antibiotics in both prevention and treatment of exacerbations of chronic obstructive pulmonary disease (AECOPD). In a meta-analysis, we demonstrated that prophylactic use of antibiotics in COPD, especially macrolides, are effective in preventing AECOPD, irrespective of the duration or dosing schedule. In a cohort study using the prescription database we showed that doxycycline is effective for treating AECOPD in addition to treatment with systemic corticosteroids. In further research combining data with more detailed clinical data from Lifelines to reduce confounding, we confirmed this finding. The beneficial effects from other antibiotics remained unclear in this study. In patients with COPD, polypharmacy is also common. Therefore, we conducted a systematic review and found many potential drug-drug-interactions (DDIs) that have been associated with antibiotic therapy. Hence, clinicians and pharmacists should pay more attention to these potential DDIs to avoid related drug adverse events and treatment failure. In the second part, we evaluated the safety of varenicline, an effective medicine used for smoking cessation in COPD. Since evidence on possible neuropsychiatric adverse events is conflicting, we evaluated its neuropsychiatric safety based on real-life data by using both a cohort and prescription sequence symmetry analysis (PSSA) design. The two studies showed consistent evidence that varenicline is not associated with the risk of neuropsychiatric adverse events in both the COPD and general population. PSSA can be used as an effective tool for post-market surveillance of medicines.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Award date8-May-2020
Place of Publication[Groningen]
Print ISBNs978-94-034-2555-9
Electronic ISBNs978-94-034-2554-2
Publication statusPublished - 2020

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