Evaluating Drug Prescription Patterns in Undiagnosed Common Variable Immunodeficiency Patients

Objective To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was ass...

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Bibliographic Details
Published in:Journal of clinical immunology Vol. 43; no. 8; pp. 2181 - 2191
Main Authors: Ilkjær, Frederik V., Johansen, Isik S., Martin-Iguacel, Raquel, Westh, Lena, Katzenstein, Terese L., Hansen, Ann-Brit E., Nielsen, Thyge L., Larsen, Carsten S., Rasmussen, Line D.
Format: Journal Article
Language:English
Published: New York Springer US 01.11.2023
Springer Nature B.V
Subjects:
Antibiotics
Biomedical and Life Sciences
Biomedicine
Bronchodilator Agents
Bronchodilators
Case-Control Studies
Common variable immunodeficiency
Common Variable Immunodeficiency - diagnosis
Common Variable Immunodeficiency - drug therapy
Common Variable Immunodeficiency - epidemiology
Denmark
Diagnosis
Drug Prescriptions
Glucocorticoids
health services
Humans
Immune system
Immunology
immunosuppression
Infectious Diseases
Internal Medicine
Medical Microbiology
Original Article
Public health
regression analysis
risk
Statistical analysis
Steroid hormones
Steroids
Denmark
CVID
drug prescription
primary care
PID
diagnostic delay
indicators
ISSN:0271-9142, 1573-2592, 1573-2592
Online Access:Get full text
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Summary:Objective To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis. Methods We conducted a nested case-control study, identifying all individuals ( n =130 cases) diagnosed with CVID in Denmark (1994–2014) and 45 age- and sex-matched population controls per case ( n =5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals. Results In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) ( p <0.001). Conclusion CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies.
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ISSN:0271-9142
1573-2592
1573-2592
DOI:10.1007/s10875-023-01598-1