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Propensity-score (PS) matching was used to adjust for baseline characteristics. The probability of being prescribed desmopressin versus oxybutynin or tamsulosin was calculated through a multivariable logistic regression model that contained all baseline covariates with the exception of laboratory values.

There were no other missing data. Covariate balance before and after PS matching was assessed using standardized differences. A standardized difference less than of 0. The estimated PS was used to match 1:1 new users of desmopressin with new users of oxybutynin or tamsulosin with a caliper size of 0. In a sensitivity analysis, we performed a stratified analysis using deciles of the PS. All analyses were performed using Aetion platform version 3.

We identified 232,749 adults who satisfied study inclusion and exclusion criteria (S1A Appendix). Of those, 229,612 were newly prescribed oxybutynin and 3,137 were newly prescribed desmopressin. Adults prescribed desmopressin genderqueer more likely to be men, to be younger, to have a slightly higher creatinine, to have benign prostatic hyperplasia, and to have filled a prescription for steroids in the preceding 180 days.

Adults prescribed oxybutynin were more likely to have a diagnosis of hypertension or obesity and to have filled a prescription for a diuretic, angiotensin-converting enzyme (ACE) inhibitor, or an older generation antihypertensive in the preceding 180 days (S1B Appendix). The majority of the remaining baseline characteristics (including baseline serum sodium) were balanced before PS matching.

The median duration of follow-up was 51 days (interquartile range: 42,121) (S1C Appendix). The major risk factors for hyponatremia were relatively rare in both groups (for example, diuretic use) (Table 1) and were well-balanced. In the PS-matched population, there were 114 patients who were diagnosed with hyponatremia after being prescribed desmopressin (146 events per 1,000 person-years) compared to nine Vibativ (Telavancin for Injection)- Multum who were prescribed oxybutynin (11 events per 1,000 person-years).

Specifically, 77 patients prescribed desmopressin experienced the outcome (314 per 1,000 person-years) compared to 278 patients prescribed with oxybutynin (15 per 1,000 person-years). Adults prescribed desmopressin were less likely to be male and to have benign prostatic hyperplasia or cardiovascular disease.

After PS matching, these characteristics and all other measured characteristics were well balanced. Vibativ (Telavancin for Injection)- Multum the unmatched population, there were 134 patients who were diagnosed with hyponatremia after being prescribed desmopressin (177 events per 1,000 person-years) compared to 1,466 patients after being prescribed tamsulosin (8. The findings were robust regardless of the comparator medication used and were also observed Vibativ (Telavancin for Injection)- Multum a shorter follow-up period of 30 days.

These findings raise concerns about the safety of this formulation of desmopressin, particularly if Vibativ (Telavancin for Injection)- Multum medication is being used off-label for the treatment of nocturia. However, we found that the absolute rate of hyponatremia was approximately 146 per 1,000 person-years, which is many-fold higher than rates reported in the clinical trial literature. One reason for the lower rate observed in clinical trials may be that trial participants have closely monitored serum sodium levels.

Frequent laboratory monitoring allows for treatment discontinuation if the sodium level begins to drop and approaches, but does not yet reach, the cutoff for hyponatremia. An alternate bayer vulkollan for the higher rate of hyponatremia we observed might be reverse causation because some patients with severe hyponatremia are treated with desmopressin.

We think this is unlikely because we excluded patients with a recent diagnosis of hyponatremia and because the baseline serum sodium values for the patients who had laboratory measures were normal. Vibativ (Telavancin for Injection)- Multum is possible we may have missed some patients who were hospitalized for another diagnosis but also had hyponatremia during the hospitalization.

However, we think this is also unlikely because Vibativ (Telavancin for Injection)- Multum excluded all patients with a recent hospitalization within the preceding 180 days. Another potential limitation Vibativ (Telavancin for Injection)- Multum our study is unmeasured confounding.

For example, we did not have access to some over-the-counter medications that are associated with hyponatremia (for example, nonsteroidal anti-inflammatory drugs) or other risk factors for hyponatremia (for example, low-solute diet coupled with high water intake, alcohol use).

Furthermore, we identified hyponatremia using insurance claims diagnoses, which have acceptable specificity Vibativ (Telavancin for Injection)- Multum poor sensitivity. Another limitation is that we assumed censoring was noninformative. While we included a grace period of up to 14 days after treatment discontinuation to identify potential study outcomes during this time period, we may have missed outcomes if, for example, the patient was censored because they died.

Finally, an important limitation is that we lacked the Vibativ (Telavancin for Injection)- Multum size to calculate the rate of hyponatremia with various doses of desmopressin.

The new formulation contains an excipient designed to enhance absorption across johnson 2001 nasal mucosa. Since the new formulation of intranasal desmopressin was only marketed in 2018, data for its use in routine care are not yet available.

However, it will be important to investigate outcomes from its clinical use using similar methods described in this study to monitor how the risk of hyponatremia observed in the pivotal clinical trials will compare to the risk in routine practice.

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Comments:

09.05.2019 in 04:07 Любовь:
Какая фраза... супер

13.05.2019 in 04:14 Ефрем:
Объясните почему исключительно так? Сомневаюсь, почему не уточнить этот обзор.

15.05.2019 in 07:13 isverneitrad:
Это просто отличная мысль

15.05.2019 in 14:13 tracamar:
Извините, я удалил это сообщение