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Osteoporosis International

pp 1–9

First Online: 06 July 2017Received: 08 September 2016Accepted: 14 June 2017

Abstract

SummaryDue to the suboptimal persistence to osteoporosis OP treatment, factors triggering treatment discontinuation-switching may be causing time-varying confounding. BP treatment was associated with the risk of overall infection in opposite directions in the unweighted Cox model versus the weighted MSM. The discrepancy of effect estimates for overall infection in the MSM suggested there may be time-varying confounding.

IntroductionDue to the suboptimal persistence to osteoporosis OP treatment, factors triggering treatment discontinuation-switching may be affected by prior treatment and confound the subsequent treatment effect, causing time-varying confounding.

MethodsIn a US insurance database, the association between joint treatment of bisphosphonates BP and other OP medication and the incidence of infections among postmenopausal women was assessed using a marginal structural model MSM. Stabilized weights were estimated by modeling treatment and censoring processes conditioning on past treatment, and baseline and time-varying covariates.

ResultsBP treatment was associated with the risk of overall infection in opposite directions in the unweighted Cox model {incidence rate ratio IRR 95% confidence interval CI = 1.15 1.14–1.17} versus the weighted MSM IRR 95% CI = 0.79 0.77–0.81, but was consistently associated with a lower risk of serious infection in both the unweighted Cox model IRR 95% CI = 0.79 0.78–0.81 and the weighted MSM IRR 95% CI = 0.71 0.68–0.75. Similar results were found when current and past treatments were simultaneously assessed.

ConclusionsThe discrepancy of effect estimates for overall but not serious infection comparing unweighted models and MSM suggested analyses of composite outcomes with a wide range of disease severity may be more susceptible to time-varying confounding.

KeywordsClaims Infection MSM Osteoporosis AbbreviationsBPBisphosphonates

CIConfidence interval

ICD-9-CMInternational Classification of Disease, Ninth Revision, Clinical Modification

IRRIncidence rate ratio

MSMMarginal structural model

ONJOsteonecrosis of the jaw

OPOsteoporosis

PHProportional hazards

PMOPostmenopausal osteoporosis

Electronic supplementary materialThe online version of this article doi:10.1007-s00198-017-4129-6 contains supplementary material, which is available to authorized users.

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Autor: F. Xue - V. Goli - P. Petraro - T. McMullan - J. M. Sprafka - E. J. Tchetgen Tchetgen

Fuente: https://link.springer.com/



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