Risk of COVID-19 Diagnosis and Hospitalisation in Patients with Osteoarthritis or Back Pain Treated with Ibuprofen Compared to Other NSAIDs or Paracetamol: A Network Cohort Study.

OBJECTIVE: We aimed to investigate whether ibuprofen use, compared with other non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs), cyclooxygenase-2 inhibitors (COX-2i) or paracetamol, increases the risk of coronavirus disease 2019 (COVID-19) diagnosis or hospitalisation. DESIGN: A prevalent user and active comparator cohort study. SETTING: Two US claims databases (Open Claims and PharMetrics Plus) mapped to the Observational Medical Outcomes Partnership Common Data Model. PARTICIPANTS: Insured patients with a history of osteoarthritis or back pain and receiving ibuprofen, other ns-NSAIDs, COX-2i or paracetamol between 1 November, 2019 and 31 January, 2020 (study enrolment window 1) or between 1 February, 2020 and 31 October, 2020 (study enrolment window 2). MAIN OUTCOME MEASURES: Large-scale propensity score matching and empirical calibration were used to minimise confounding. Incidence and hazard ratios of COVID-19 diagnosis and hospitalisation according to drug/s use were estimated and pooled in the same study period across data sources using a fixed-effects meta-analysis. Index treatment episode was the primary risk evaluation window, censored at the time of discontinuation. RESULTS: A total of 633,562 and 1,063,960 participants were included in periods 1 and 2, respectively, for the ibuprofen versus ns-NSAIDs comparison, 311,669 and 524,470 for ibuprofen versus COX-2i, and 492,002 and 878,598 for ibuprofen versus paracetamol. Meta-analyses of empirically calibrated hazard ratios revealed no significantly differential risk of COVID-19 outcomes in users of ibuprofen versus any of the other studied analgesic classes: hazard ratios were 1.13 (0.96-1.33) for the ibuprofen-ns-NSAIDs comparison, 1.03 (0.83-1.28) for the ibuprofen-COX-2i comparison and 1.13 (0.74-1.73) for ibuprofen-paracetamol comparison on COVID-19 diagnosis in the February 2020-October 2020 window. Similar hazard ratios were found on COVID-19 hospitalisation and across both study periods. CONCLUSIONS: In patients with osteoarthritis or back pain, we found no differential risks of incident COVID-19 diagnosis or COVID-19 hospitalisation for ibuprofen users compared with other ns-NSAIDs, COX-2i or paracetamol. Our findings support regulatory recommendations that NSAIDs, including ibuprofen, should be prescribed as indicated in the same way as before the COVID-19 pandemic, especially for those who rely on ibuprofen or NSAIDs to manage chronic arthritis or musculoskeletal pain symptoms.

Characterizing database granularity using SNOMED-CT hierarchy.

Multi-center observational studies require recognition and reconciliation of differences in patient representations arising from underlying populations, disparate coding practices and specifics of data capture. This leads to different granularity or detail of concepts representing the clinical facts. For researchers studying certain populations of interest, it is important to ensure that concepts at the right level are used for the definition of these populations. We studied the granularity of concepts within 22 data sources in the OHDSI network and calculated a composite granularity score for each dataset. Three alternative SNOMED-based approaches for such score showed consistency in classifying data sources into three levels of granularity (low, moderate and high), which correlated with the provenance of data and country of origin. However, they performed unsatisfactorily in ordering data sources within these groups and showed inconsistency for small data sources. Further studies on examining approaches to data source granularity are needed.

Comparative evaluation of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scoring systems in patients admitted to the cardiac intensive care unit.

PURPOSE: To assess and compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores in the cardiac intensive care unit (CICU). METHODS: A single-center, prospective cohort study in a CICU admitting patients with acute cardiovascular diseases was conducted. Both APACHE II and SOFA were calculated on admission. The area under the receiver operating characteristic curve (AUC) was used to evaluate the discriminative ability for predicting CICU survival, hospital survival, and survival 6 months after hospital discharge. Goodness of fit was assessed using the Hosmer-Lemeshow and the Brier scores. All analyses were conducted separately for the patients with acute coronary syndrome. RESULTS: Of the 300 consecutively admitted patients, 206 had acute coronary syndrome. Both scores exhibited good discriminative ability (AUC range, 0.84-0.92), and their AUCs did not differ significantly. The Hosmer-Lemeshow test P values were numerically higher (.151-.949 vs .033-.531), and the Brier score closer to zero (0.0864-0.1570 vs 0.1039-0.1264) for APACHE II compared with SOFA score models. The Acute Physiology and Chronic Health Evaluation was the best single risk factor for CICU mortality (odds ratio, 1.24; 95% confidence interval, 1.13-1.37; P < .001). CONCLUSION: Both APACHE II and SOFA scores have good and comparable discriminative ability for predicting outcome. Calibration and accuracy indices are superior for APACHE II.

Treatment of pityriasis rubra pilaris with pimecrolimus cream 1%.

Pityriasis rubra pillaris is an uncommon idiopathic dermatosis considered both a keratinization and an inflammatory disorder. Treatment is largely based on the information presented in case reports. We report the case of a young man with pityriasis rubra pillaris limited to the scalp and face, which cleared completely after application of pimecrolimus 1% cream for 2 weeks.