Clinical Pharmacy (Meier)Head of Research Unit Prof. Dr. phil.Christoph R. MeierOverviewMembersPublicationsProjects & CollaborationsProjects & Collaborations OverviewMembersPublicationsProjects & Collaborations Projects & Collaborations 10 foundShow per page10 10 20 50 SwissPandemic&AmR-Health Ecoomy Awareness Detect (SPEARHEAD) - SP1 Research Project | 3 Project MembersFighting Antimicrobial resistance through rapid digital pandemic response Our consortium of 8 public and 4 private Swiss institutions has joined forces to address the silent pandemic of antimicrobial resistance (AMR) by launching the 'Swiss Pandemic & AMR - Health Economy Awareness Detect' (SPEARHEAD) partnership. AMR is the ability of microorganisms (like bacteria, viruses, and some parasites) to prevent antimicrobials (such as antibiotics, antivirals and antimalarials) from working against them. As a result, many treatments are becoming ineffective against infections that were previously easily treatable. SPEARHEAD will leverage lessons learnt to address the steadily worsening, silent pandemic of AMR, with potentially 10M deaths per year globally by 2050 (4 x the 2020 COVID-19 death toll) and the related economic impact on society. Analyse der Häufigkeit von medizinischen und psychologischen Problemen im Wochenbett in der Schweiz: eine epidemiologische Studie basierend auf der Datenbank des Schweizerischen Hebammenverbandes Research Project | 3 Project MembersIn einer epidemiologischen Studie werden wir eine grosse Kohorte von frisch gebackenen Müttern in der Schweiz hinsichtlich verschiedener medizinischer und psychologischer Probleme, die während dem Wochenbett auftreten können, charakterisieren. Dafür werden wir Analysen mit der 'Hebammenstatistik' durchführen, einer elektronischen Datenbank des Schweizerischen Hebammenverbandes, in welcher alle frei praktizierenden Hebammen in der Schweiz seit 2005 ihre täglichen Tätigkeiten in der Wochenbettbetreuung erfassen. Frei praktizierende Hebammen betreuen in der Schweiz 71% aller Mütter während des Wochenbetts (bis zu 8 Wochen nach Geburt), diese Dienstleistung wird von der Grundversicherung der Krankenkasse bezahlt. Während dieser Zeit konsultieren die Hebammen die Mütter, ihre Säuglinge und ihre Familie zu Hause, überwachen den Gesundheitszustand der Mutter und des Säuglings, triagieren bei auftretenden medizinischen und psychologischen Problemen (z.B. bei Zeichen postpartaler Depressionen oder Infektionen) und beraten und betreuen bei Fragen und Herausforderungen, die während dieser Zeit auftreten können, wie z.B. bei Stimmungsschwankungen, Stillproblemen oder Säuglingen, die sehr häufig schreien. The epidemiology of pre-existing chronic kidney disease in pregnant women Research Project | 6 Project MembersChanges In Serum Creatinine Values During And After Pregnancy In A Cohort Of Women With Or Without Pre-existing Chronic Kidney Disease Background: Chronic kidney disease (CKD) occurs in up to 3.3% of women of childbearing age. Impaired kidneys may not sufficiently adapt to physiological changes during pregnancy that may result in accelerated CKD progression. Objective: To describe changes in renal filtration during and after pregnancy in women with or without CKD. Methods: We performed a longitudinal descriptive study using data from the UK-based Clinical Practice Research Datalink (2000-2018). We included pregnancies ending in live birth if they had ≥ 1 serum creatinine (SCr) value during a 1-year baseline period before the estimated last menstrual period or during trimester 1. Pregnancies were categorized into 3 groups based on the mean estimated glomerular filtration rate (eGFR [ml/min/1.73m 2 ], CKD-EPI formula) during baseline/trimester 1: no CKD (eGFR ≥ 90), mild CKD (eGFR = 60-90), moderate-severe CKD (GFR < 60). We captured demographics and risk factors for CKD and calculated percentage changes of mean SCr levels (group means) as a proxy for renal filtration in 3-month intervals during and until 1 year after pregnancy. We quantified the difference between the mean baseline eGFR and the mean eGFR 6-12 months after delivery. Results: Of 169'855 included pregnancies, maternal moderate-severe CKD was present in 981 (0.6%), mild CKD in 29'433 (17.3%), and no CKD in 139'441 (82.1%) pregnancies. Pre-existing hypertension, diabetes, and/or obesity was recorded in 37% in moderate-severe CKD, and in 30% in the other 2 groups. Autoimmune diseases pre-existed in 3-4% in all groups. Mean reduction in SCr levels were larger between baseline and the end of trimester 2 in women without CKD (-22%) and with mild CKD (-24%) than in women with moderate-severe CKD (-14%). Thereafter, mean SCr levels increased, to level off around 6 months after delivery. In women without CKD, mean eGFR levels 6-12 month after delivery (118 ml/min, SD 15) were comparable to baseline SCr levels (119 ml/min, SD 13). Women with mild CKD revealed an increased eGFR (97 ml/min, SD 18) after delivery (baseline eGFR 88 ml/min, SD 9). In women with moderate-severe CKD, the post-pregnancy eGFR (55 ml/min, SD 23) was similar as in baseline (50 ml/min, SD 14), but sample size was small due to incomplete lab data. Conclusions: Our results suggest that kidneys of women with moderate-severe CKD adapted to a lesser degree to physiological changes during pregnancy, but sample size was small. Renal filtration was not decreased within 1 year after delivery in all groups. The increased post-pregnancy eGFR in women with mild CKD may reflect continued hyperfiltration or random variability. Future projects: Prevalence of Chronic Kidney Disease in Women of Childbearing Age Effect of Pregnancy on Chronic Kidney Disease Progression after Pregnancy Extracting an analytic cohort using Swiss administrative claims data to evaluate drug use and safety in pregnancy Research Project | 6 Project MembersEvidence on drug utilization and safety during pregnancy in Switzerland is sparse. The goal of this 1-year pilot study was to evaluate whether different Swiss data sources (administrative claims data of the Helsana database, inpatient hospital data captured in the Swiss Medical Hospital Statistics,and post-partum care data captured in the Swiss Statistics of Freelance Midwifes) may be used to validly evaluate drug utilization and safety during pregnancy in Switzerland. Therefore, we aimed to extract and validate an analytic cohort of pregnant women linked to their newborns in longitudinal administrative claims data of the largest Swiss health insurance company 'Helsana'. We further aimed to link mothers and children contained in this cohort to data from the Swiss Medical Hospital Statistics (MEDSTAT) as well as to data from the Swiss Statistics of Freelance Midwifes (MID). Both, MEDSTAT and MID, contain additional important information, which are not captured by administrative claims data, such as the exact gestational age at birth, weight and height of the child at birth, APGAR scores, or information on congenital malformations. This analytic cohort will then be the basis of a grant application to the Swiss National Science Foundation (SNSF) for long-term funding of a project to evaluate drug use and safety during pregnancy in Switzerland. During the past 12 months, we have achieved several of our goals: We have established a collaboration with PD Dr. Alice Panchaud, a clinical researcher at the University of Lausanne (Section sciences pharmaceutiques, Secteur Maternité) who is specialized in perinatal clinical pharmacy. Dr. Panchaud will collaborate on the project with us. We have established a collaboration with the analytic research team of the Helsana group, in collaboration with whom we are currently in the process of extracting the analytic cohort. In collaboration with Dr Panchaud and the Helsana Group, we have extracted the Helsana analytic cohort. We have published a study on the use of antiseizure medication during pregnancy in Switzerland. Two more publicatoins are in the pipline (1 is currently submitted, 1 is in review with co-authors). We have also established a collaboration with the Swiss Midwives Association (Schweizerischer Hebammenverband) and have received a dataset for analysis. We are currently undertaking a master thesis with a student with the aim to validate this dataset for research purposes. Results will be published in a peer-reviewed journal. We have developed a linkage algorithm to link the Helsana analytic cohort to the data of the Swiss midwives association and the data of the Swiss Federal Statistical Office (MEDSTAT). However, we still need to clear some legal and practical aspects, before such a linkage can take place. The main reason why it has not happened yet, are concerns over privacy protection by different stakeholders and a locak of a larger framework to guide such an undertaking. Several research groups, including us, are working on advancing this important research field. Arzneimittelreport Schweiz Research Project | 5 Project MembersAnalysis of drug use in Switzerland based on claims data from Helsana. Each year, a report is made publicly available. The risk of rosacea in patients with inflammatory bowel diseases Research Project | 2 Project MembersBACKGROUND: Cutaneous manifestations are common in patients with inflammatory bowel diseases (IBDs) (ulcerative colitis [UC] and Crohn's disease [CD]). Previous case reports described patients with IBD who developed rosacea . IBD and rosacea are inflammatory epithelial diseases, presumably associated with changes in the innate immune system. We explored the association between IBD and incident rosacea . METHODS: We conducted a population-based matched (1:1) case-control analysis on the association between IBD and rosacea , stratified by IBD disease duration and severity. We used data from the UK-based Clinical Practice Research Datalink. Cases had an incident diagnosis of rosacea recorded between 1995 and 2013. RESULTS: Among 80,957 rosacea cases and the same number of controls, a history of UC was associated with an increased risk of rosacea (odds ratio [OR] 1.65, 95% confidence interval [CI], 1.43-1.90), with the highest OR in those with short UC duration (OR 2.85, 95% confidence interval, 1.80-4.50 for patients with <2 years of disease history). A history of CD yielded an overall OR of 1.49 (95% CI, 1.25-1.77), which did not correlate with disease duration. Additional analyses on IBD disease severity yielded evidence for a higher risk of rosacea in those with higher UC and CD activity. CONCLUSIONS: Our findings provide evidence that patients with IBD may be at increased risk of rosacea (higher in UC), particularly during phases of increased IBD-associated gastrointestinal tract inflammation. A study on the epidemiology of stevens-johnson syndrome and toxic epidermal necrolysis Research Project | 6 Project MembersStevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions. Due to the rare nature of SJS/TEN, available evidence on the frequency of these diseases and on the role of a potential causal involvement of drugs is scarce. Some hospital based studies provide evidence on a possible role of certain drugs, but further evidence is needed, as SJS/TEN treatment is mainly based on discontinuation of suspected drugs. Previously published incidence rates (IRs) are scarce and vary greatly due to the low numbers of patients studied and due to difficulties in defining the population at risk. In addition, follow-up data on mortality and especially on long-term complications in survivors of SJS/TEN are sparse. The planned epidemiological study will include a case-control part identifying drugs which have been taken at the time of the onset of SJS/TEN, as well as two different cohort studies. In the first cohort study we will assess IRs of SJS/TEN overall as well as in new users of different drugs. In the second cohort analysis we will quantify mortality rates and identify long-term complications of SJS/TEN applying a Cox proportional hazard analysis. The suggested project will involve one of the largest SJS/TEN study populations available, and will be among the first SJS/TEN studies using a large longitudinal database (first one on the Clinical Practice Research Datalink - CPRD). Arzneimittelreport Schweiz Research Project | 2 Project MembersAssessment of and reporting on use of pharmaceuticals in Switzerland based on claims data. The epidemiology of and risk factors for tinnitus: a large epidemiological study in the UK Research Project | 2 Project MembersA large epidemiolgical study will be done to explore the frequency of tinnitus in the general population using the UK-based CPRD. We will idenify exposure parameters which are associated with an alatered risk of developing tinnitus. Treatment outcome and side effects in patients with acute exacerbation of COPD treated in primary care in the UK before and after the introduction of guidelines endorsing 5 rather than 14 days of oral corticosteroids: a hypothesis-testing study Research Project | 5 Project MembersThis study seeks to investigate if the introduction of guidelines introduced in 2015 supporting a shortened OCS course during acute exacerbation of COPD (AECOPD) altered the treatment efficacy and safety. The study population of interest will consist of patients with AECOPD treated with OCS in general practices in the United Kingdom that form part of the CPRD (Clinical Practice Research Datalink). The primary exposure is treatment with OCS before and after the introduction of the guidelines recommending only five days of treatment. The primary outcome is the time to next exacerbation during the 12 months after the index exacerbation. Secondary outcomes will be the number of exacerbations during the 12 months after the index exacerbation; duration of OCS therapy (if available), treatment safety, notably, the number of patients with new onset diabetes during twelve months after AECOPD. 1 1 OverviewMembersPublicationsProjects & Collaborations
Projects & Collaborations 10 foundShow per page10 10 20 50 SwissPandemic&AmR-Health Ecoomy Awareness Detect (SPEARHEAD) - SP1 Research Project | 3 Project MembersFighting Antimicrobial resistance through rapid digital pandemic response Our consortium of 8 public and 4 private Swiss institutions has joined forces to address the silent pandemic of antimicrobial resistance (AMR) by launching the 'Swiss Pandemic & AMR - Health Economy Awareness Detect' (SPEARHEAD) partnership. AMR is the ability of microorganisms (like bacteria, viruses, and some parasites) to prevent antimicrobials (such as antibiotics, antivirals and antimalarials) from working against them. As a result, many treatments are becoming ineffective against infections that were previously easily treatable. SPEARHEAD will leverage lessons learnt to address the steadily worsening, silent pandemic of AMR, with potentially 10M deaths per year globally by 2050 (4 x the 2020 COVID-19 death toll) and the related economic impact on society. Analyse der Häufigkeit von medizinischen und psychologischen Problemen im Wochenbett in der Schweiz: eine epidemiologische Studie basierend auf der Datenbank des Schweizerischen Hebammenverbandes Research Project | 3 Project MembersIn einer epidemiologischen Studie werden wir eine grosse Kohorte von frisch gebackenen Müttern in der Schweiz hinsichtlich verschiedener medizinischer und psychologischer Probleme, die während dem Wochenbett auftreten können, charakterisieren. Dafür werden wir Analysen mit der 'Hebammenstatistik' durchführen, einer elektronischen Datenbank des Schweizerischen Hebammenverbandes, in welcher alle frei praktizierenden Hebammen in der Schweiz seit 2005 ihre täglichen Tätigkeiten in der Wochenbettbetreuung erfassen. Frei praktizierende Hebammen betreuen in der Schweiz 71% aller Mütter während des Wochenbetts (bis zu 8 Wochen nach Geburt), diese Dienstleistung wird von der Grundversicherung der Krankenkasse bezahlt. Während dieser Zeit konsultieren die Hebammen die Mütter, ihre Säuglinge und ihre Familie zu Hause, überwachen den Gesundheitszustand der Mutter und des Säuglings, triagieren bei auftretenden medizinischen und psychologischen Problemen (z.B. bei Zeichen postpartaler Depressionen oder Infektionen) und beraten und betreuen bei Fragen und Herausforderungen, die während dieser Zeit auftreten können, wie z.B. bei Stimmungsschwankungen, Stillproblemen oder Säuglingen, die sehr häufig schreien. The epidemiology of pre-existing chronic kidney disease in pregnant women Research Project | 6 Project MembersChanges In Serum Creatinine Values During And After Pregnancy In A Cohort Of Women With Or Without Pre-existing Chronic Kidney Disease Background: Chronic kidney disease (CKD) occurs in up to 3.3% of women of childbearing age. Impaired kidneys may not sufficiently adapt to physiological changes during pregnancy that may result in accelerated CKD progression. Objective: To describe changes in renal filtration during and after pregnancy in women with or without CKD. Methods: We performed a longitudinal descriptive study using data from the UK-based Clinical Practice Research Datalink (2000-2018). We included pregnancies ending in live birth if they had ≥ 1 serum creatinine (SCr) value during a 1-year baseline period before the estimated last menstrual period or during trimester 1. Pregnancies were categorized into 3 groups based on the mean estimated glomerular filtration rate (eGFR [ml/min/1.73m 2 ], CKD-EPI formula) during baseline/trimester 1: no CKD (eGFR ≥ 90), mild CKD (eGFR = 60-90), moderate-severe CKD (GFR < 60). We captured demographics and risk factors for CKD and calculated percentage changes of mean SCr levels (group means) as a proxy for renal filtration in 3-month intervals during and until 1 year after pregnancy. We quantified the difference between the mean baseline eGFR and the mean eGFR 6-12 months after delivery. Results: Of 169'855 included pregnancies, maternal moderate-severe CKD was present in 981 (0.6%), mild CKD in 29'433 (17.3%), and no CKD in 139'441 (82.1%) pregnancies. Pre-existing hypertension, diabetes, and/or obesity was recorded in 37% in moderate-severe CKD, and in 30% in the other 2 groups. Autoimmune diseases pre-existed in 3-4% in all groups. Mean reduction in SCr levels were larger between baseline and the end of trimester 2 in women without CKD (-22%) and with mild CKD (-24%) than in women with moderate-severe CKD (-14%). Thereafter, mean SCr levels increased, to level off around 6 months after delivery. In women without CKD, mean eGFR levels 6-12 month after delivery (118 ml/min, SD 15) were comparable to baseline SCr levels (119 ml/min, SD 13). Women with mild CKD revealed an increased eGFR (97 ml/min, SD 18) after delivery (baseline eGFR 88 ml/min, SD 9). In women with moderate-severe CKD, the post-pregnancy eGFR (55 ml/min, SD 23) was similar as in baseline (50 ml/min, SD 14), but sample size was small due to incomplete lab data. Conclusions: Our results suggest that kidneys of women with moderate-severe CKD adapted to a lesser degree to physiological changes during pregnancy, but sample size was small. Renal filtration was not decreased within 1 year after delivery in all groups. The increased post-pregnancy eGFR in women with mild CKD may reflect continued hyperfiltration or random variability. Future projects: Prevalence of Chronic Kidney Disease in Women of Childbearing Age Effect of Pregnancy on Chronic Kidney Disease Progression after Pregnancy Extracting an analytic cohort using Swiss administrative claims data to evaluate drug use and safety in pregnancy Research Project | 6 Project MembersEvidence on drug utilization and safety during pregnancy in Switzerland is sparse. The goal of this 1-year pilot study was to evaluate whether different Swiss data sources (administrative claims data of the Helsana database, inpatient hospital data captured in the Swiss Medical Hospital Statistics,and post-partum care data captured in the Swiss Statistics of Freelance Midwifes) may be used to validly evaluate drug utilization and safety during pregnancy in Switzerland. Therefore, we aimed to extract and validate an analytic cohort of pregnant women linked to their newborns in longitudinal administrative claims data of the largest Swiss health insurance company 'Helsana'. We further aimed to link mothers and children contained in this cohort to data from the Swiss Medical Hospital Statistics (MEDSTAT) as well as to data from the Swiss Statistics of Freelance Midwifes (MID). Both, MEDSTAT and MID, contain additional important information, which are not captured by administrative claims data, such as the exact gestational age at birth, weight and height of the child at birth, APGAR scores, or information on congenital malformations. This analytic cohort will then be the basis of a grant application to the Swiss National Science Foundation (SNSF) for long-term funding of a project to evaluate drug use and safety during pregnancy in Switzerland. During the past 12 months, we have achieved several of our goals: We have established a collaboration with PD Dr. Alice Panchaud, a clinical researcher at the University of Lausanne (Section sciences pharmaceutiques, Secteur Maternité) who is specialized in perinatal clinical pharmacy. Dr. Panchaud will collaborate on the project with us. We have established a collaboration with the analytic research team of the Helsana group, in collaboration with whom we are currently in the process of extracting the analytic cohort. In collaboration with Dr Panchaud and the Helsana Group, we have extracted the Helsana analytic cohort. We have published a study on the use of antiseizure medication during pregnancy in Switzerland. Two more publicatoins are in the pipline (1 is currently submitted, 1 is in review with co-authors). We have also established a collaboration with the Swiss Midwives Association (Schweizerischer Hebammenverband) and have received a dataset for analysis. We are currently undertaking a master thesis with a student with the aim to validate this dataset for research purposes. Results will be published in a peer-reviewed journal. We have developed a linkage algorithm to link the Helsana analytic cohort to the data of the Swiss midwives association and the data of the Swiss Federal Statistical Office (MEDSTAT). However, we still need to clear some legal and practical aspects, before such a linkage can take place. The main reason why it has not happened yet, are concerns over privacy protection by different stakeholders and a locak of a larger framework to guide such an undertaking. Several research groups, including us, are working on advancing this important research field. Arzneimittelreport Schweiz Research Project | 5 Project MembersAnalysis of drug use in Switzerland based on claims data from Helsana. Each year, a report is made publicly available. The risk of rosacea in patients with inflammatory bowel diseases Research Project | 2 Project MembersBACKGROUND: Cutaneous manifestations are common in patients with inflammatory bowel diseases (IBDs) (ulcerative colitis [UC] and Crohn's disease [CD]). Previous case reports described patients with IBD who developed rosacea . IBD and rosacea are inflammatory epithelial diseases, presumably associated with changes in the innate immune system. We explored the association between IBD and incident rosacea . METHODS: We conducted a population-based matched (1:1) case-control analysis on the association between IBD and rosacea , stratified by IBD disease duration and severity. We used data from the UK-based Clinical Practice Research Datalink. Cases had an incident diagnosis of rosacea recorded between 1995 and 2013. RESULTS: Among 80,957 rosacea cases and the same number of controls, a history of UC was associated with an increased risk of rosacea (odds ratio [OR] 1.65, 95% confidence interval [CI], 1.43-1.90), with the highest OR in those with short UC duration (OR 2.85, 95% confidence interval, 1.80-4.50 for patients with <2 years of disease history). A history of CD yielded an overall OR of 1.49 (95% CI, 1.25-1.77), which did not correlate with disease duration. Additional analyses on IBD disease severity yielded evidence for a higher risk of rosacea in those with higher UC and CD activity. CONCLUSIONS: Our findings provide evidence that patients with IBD may be at increased risk of rosacea (higher in UC), particularly during phases of increased IBD-associated gastrointestinal tract inflammation. A study on the epidemiology of stevens-johnson syndrome and toxic epidermal necrolysis Research Project | 6 Project MembersStevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions. Due to the rare nature of SJS/TEN, available evidence on the frequency of these diseases and on the role of a potential causal involvement of drugs is scarce. Some hospital based studies provide evidence on a possible role of certain drugs, but further evidence is needed, as SJS/TEN treatment is mainly based on discontinuation of suspected drugs. Previously published incidence rates (IRs) are scarce and vary greatly due to the low numbers of patients studied and due to difficulties in defining the population at risk. In addition, follow-up data on mortality and especially on long-term complications in survivors of SJS/TEN are sparse. The planned epidemiological study will include a case-control part identifying drugs which have been taken at the time of the onset of SJS/TEN, as well as two different cohort studies. In the first cohort study we will assess IRs of SJS/TEN overall as well as in new users of different drugs. In the second cohort analysis we will quantify mortality rates and identify long-term complications of SJS/TEN applying a Cox proportional hazard analysis. The suggested project will involve one of the largest SJS/TEN study populations available, and will be among the first SJS/TEN studies using a large longitudinal database (first one on the Clinical Practice Research Datalink - CPRD). Arzneimittelreport Schweiz Research Project | 2 Project MembersAssessment of and reporting on use of pharmaceuticals in Switzerland based on claims data. The epidemiology of and risk factors for tinnitus: a large epidemiological study in the UK Research Project | 2 Project MembersA large epidemiolgical study will be done to explore the frequency of tinnitus in the general population using the UK-based CPRD. We will idenify exposure parameters which are associated with an alatered risk of developing tinnitus. Treatment outcome and side effects in patients with acute exacerbation of COPD treated in primary care in the UK before and after the introduction of guidelines endorsing 5 rather than 14 days of oral corticosteroids: a hypothesis-testing study Research Project | 5 Project MembersThis study seeks to investigate if the introduction of guidelines introduced in 2015 supporting a shortened OCS course during acute exacerbation of COPD (AECOPD) altered the treatment efficacy and safety. The study population of interest will consist of patients with AECOPD treated with OCS in general practices in the United Kingdom that form part of the CPRD (Clinical Practice Research Datalink). The primary exposure is treatment with OCS before and after the introduction of the guidelines recommending only five days of treatment. The primary outcome is the time to next exacerbation during the 12 months after the index exacerbation. Secondary outcomes will be the number of exacerbations during the 12 months after the index exacerbation; duration of OCS therapy (if available), treatment safety, notably, the number of patients with new onset diabetes during twelve months after AECOPD. 1 1
SwissPandemic&AmR-Health Ecoomy Awareness Detect (SPEARHEAD) - SP1 Research Project | 3 Project MembersFighting Antimicrobial resistance through rapid digital pandemic response Our consortium of 8 public and 4 private Swiss institutions has joined forces to address the silent pandemic of antimicrobial resistance (AMR) by launching the 'Swiss Pandemic & AMR - Health Economy Awareness Detect' (SPEARHEAD) partnership. AMR is the ability of microorganisms (like bacteria, viruses, and some parasites) to prevent antimicrobials (such as antibiotics, antivirals and antimalarials) from working against them. As a result, many treatments are becoming ineffective against infections that were previously easily treatable. SPEARHEAD will leverage lessons learnt to address the steadily worsening, silent pandemic of AMR, with potentially 10M deaths per year globally by 2050 (4 x the 2020 COVID-19 death toll) and the related economic impact on society.
Analyse der Häufigkeit von medizinischen und psychologischen Problemen im Wochenbett in der Schweiz: eine epidemiologische Studie basierend auf der Datenbank des Schweizerischen Hebammenverbandes Research Project | 3 Project MembersIn einer epidemiologischen Studie werden wir eine grosse Kohorte von frisch gebackenen Müttern in der Schweiz hinsichtlich verschiedener medizinischer und psychologischer Probleme, die während dem Wochenbett auftreten können, charakterisieren. Dafür werden wir Analysen mit der 'Hebammenstatistik' durchführen, einer elektronischen Datenbank des Schweizerischen Hebammenverbandes, in welcher alle frei praktizierenden Hebammen in der Schweiz seit 2005 ihre täglichen Tätigkeiten in der Wochenbettbetreuung erfassen. Frei praktizierende Hebammen betreuen in der Schweiz 71% aller Mütter während des Wochenbetts (bis zu 8 Wochen nach Geburt), diese Dienstleistung wird von der Grundversicherung der Krankenkasse bezahlt. Während dieser Zeit konsultieren die Hebammen die Mütter, ihre Säuglinge und ihre Familie zu Hause, überwachen den Gesundheitszustand der Mutter und des Säuglings, triagieren bei auftretenden medizinischen und psychologischen Problemen (z.B. bei Zeichen postpartaler Depressionen oder Infektionen) und beraten und betreuen bei Fragen und Herausforderungen, die während dieser Zeit auftreten können, wie z.B. bei Stimmungsschwankungen, Stillproblemen oder Säuglingen, die sehr häufig schreien.
The epidemiology of pre-existing chronic kidney disease in pregnant women Research Project | 6 Project MembersChanges In Serum Creatinine Values During And After Pregnancy In A Cohort Of Women With Or Without Pre-existing Chronic Kidney Disease Background: Chronic kidney disease (CKD) occurs in up to 3.3% of women of childbearing age. Impaired kidneys may not sufficiently adapt to physiological changes during pregnancy that may result in accelerated CKD progression. Objective: To describe changes in renal filtration during and after pregnancy in women with or without CKD. Methods: We performed a longitudinal descriptive study using data from the UK-based Clinical Practice Research Datalink (2000-2018). We included pregnancies ending in live birth if they had ≥ 1 serum creatinine (SCr) value during a 1-year baseline period before the estimated last menstrual period or during trimester 1. Pregnancies were categorized into 3 groups based on the mean estimated glomerular filtration rate (eGFR [ml/min/1.73m 2 ], CKD-EPI formula) during baseline/trimester 1: no CKD (eGFR ≥ 90), mild CKD (eGFR = 60-90), moderate-severe CKD (GFR < 60). We captured demographics and risk factors for CKD and calculated percentage changes of mean SCr levels (group means) as a proxy for renal filtration in 3-month intervals during and until 1 year after pregnancy. We quantified the difference between the mean baseline eGFR and the mean eGFR 6-12 months after delivery. Results: Of 169'855 included pregnancies, maternal moderate-severe CKD was present in 981 (0.6%), mild CKD in 29'433 (17.3%), and no CKD in 139'441 (82.1%) pregnancies. Pre-existing hypertension, diabetes, and/or obesity was recorded in 37% in moderate-severe CKD, and in 30% in the other 2 groups. Autoimmune diseases pre-existed in 3-4% in all groups. Mean reduction in SCr levels were larger between baseline and the end of trimester 2 in women without CKD (-22%) and with mild CKD (-24%) than in women with moderate-severe CKD (-14%). Thereafter, mean SCr levels increased, to level off around 6 months after delivery. In women without CKD, mean eGFR levels 6-12 month after delivery (118 ml/min, SD 15) were comparable to baseline SCr levels (119 ml/min, SD 13). Women with mild CKD revealed an increased eGFR (97 ml/min, SD 18) after delivery (baseline eGFR 88 ml/min, SD 9). In women with moderate-severe CKD, the post-pregnancy eGFR (55 ml/min, SD 23) was similar as in baseline (50 ml/min, SD 14), but sample size was small due to incomplete lab data. Conclusions: Our results suggest that kidneys of women with moderate-severe CKD adapted to a lesser degree to physiological changes during pregnancy, but sample size was small. Renal filtration was not decreased within 1 year after delivery in all groups. The increased post-pregnancy eGFR in women with mild CKD may reflect continued hyperfiltration or random variability. Future projects: Prevalence of Chronic Kidney Disease in Women of Childbearing Age Effect of Pregnancy on Chronic Kidney Disease Progression after Pregnancy
Extracting an analytic cohort using Swiss administrative claims data to evaluate drug use and safety in pregnancy Research Project | 6 Project MembersEvidence on drug utilization and safety during pregnancy in Switzerland is sparse. The goal of this 1-year pilot study was to evaluate whether different Swiss data sources (administrative claims data of the Helsana database, inpatient hospital data captured in the Swiss Medical Hospital Statistics,and post-partum care data captured in the Swiss Statistics of Freelance Midwifes) may be used to validly evaluate drug utilization and safety during pregnancy in Switzerland. Therefore, we aimed to extract and validate an analytic cohort of pregnant women linked to their newborns in longitudinal administrative claims data of the largest Swiss health insurance company 'Helsana'. We further aimed to link mothers and children contained in this cohort to data from the Swiss Medical Hospital Statistics (MEDSTAT) as well as to data from the Swiss Statistics of Freelance Midwifes (MID). Both, MEDSTAT and MID, contain additional important information, which are not captured by administrative claims data, such as the exact gestational age at birth, weight and height of the child at birth, APGAR scores, or information on congenital malformations. This analytic cohort will then be the basis of a grant application to the Swiss National Science Foundation (SNSF) for long-term funding of a project to evaluate drug use and safety during pregnancy in Switzerland. During the past 12 months, we have achieved several of our goals: We have established a collaboration with PD Dr. Alice Panchaud, a clinical researcher at the University of Lausanne (Section sciences pharmaceutiques, Secteur Maternité) who is specialized in perinatal clinical pharmacy. Dr. Panchaud will collaborate on the project with us. We have established a collaboration with the analytic research team of the Helsana group, in collaboration with whom we are currently in the process of extracting the analytic cohort. In collaboration with Dr Panchaud and the Helsana Group, we have extracted the Helsana analytic cohort. We have published a study on the use of antiseizure medication during pregnancy in Switzerland. Two more publicatoins are in the pipline (1 is currently submitted, 1 is in review with co-authors). We have also established a collaboration with the Swiss Midwives Association (Schweizerischer Hebammenverband) and have received a dataset for analysis. We are currently undertaking a master thesis with a student with the aim to validate this dataset for research purposes. Results will be published in a peer-reviewed journal. We have developed a linkage algorithm to link the Helsana analytic cohort to the data of the Swiss midwives association and the data of the Swiss Federal Statistical Office (MEDSTAT). However, we still need to clear some legal and practical aspects, before such a linkage can take place. The main reason why it has not happened yet, are concerns over privacy protection by different stakeholders and a locak of a larger framework to guide such an undertaking. Several research groups, including us, are working on advancing this important research field.
Arzneimittelreport Schweiz Research Project | 5 Project MembersAnalysis of drug use in Switzerland based on claims data from Helsana. Each year, a report is made publicly available.
The risk of rosacea in patients with inflammatory bowel diseases Research Project | 2 Project MembersBACKGROUND: Cutaneous manifestations are common in patients with inflammatory bowel diseases (IBDs) (ulcerative colitis [UC] and Crohn's disease [CD]). Previous case reports described patients with IBD who developed rosacea . IBD and rosacea are inflammatory epithelial diseases, presumably associated with changes in the innate immune system. We explored the association between IBD and incident rosacea . METHODS: We conducted a population-based matched (1:1) case-control analysis on the association between IBD and rosacea , stratified by IBD disease duration and severity. We used data from the UK-based Clinical Practice Research Datalink. Cases had an incident diagnosis of rosacea recorded between 1995 and 2013. RESULTS: Among 80,957 rosacea cases and the same number of controls, a history of UC was associated with an increased risk of rosacea (odds ratio [OR] 1.65, 95% confidence interval [CI], 1.43-1.90), with the highest OR in those with short UC duration (OR 2.85, 95% confidence interval, 1.80-4.50 for patients with <2 years of disease history). A history of CD yielded an overall OR of 1.49 (95% CI, 1.25-1.77), which did not correlate with disease duration. Additional analyses on IBD disease severity yielded evidence for a higher risk of rosacea in those with higher UC and CD activity. CONCLUSIONS: Our findings provide evidence that patients with IBD may be at increased risk of rosacea (higher in UC), particularly during phases of increased IBD-associated gastrointestinal tract inflammation.
A study on the epidemiology of stevens-johnson syndrome and toxic epidermal necrolysis Research Project | 6 Project MembersStevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse drug reactions. Due to the rare nature of SJS/TEN, available evidence on the frequency of these diseases and on the role of a potential causal involvement of drugs is scarce. Some hospital based studies provide evidence on a possible role of certain drugs, but further evidence is needed, as SJS/TEN treatment is mainly based on discontinuation of suspected drugs. Previously published incidence rates (IRs) are scarce and vary greatly due to the low numbers of patients studied and due to difficulties in defining the population at risk. In addition, follow-up data on mortality and especially on long-term complications in survivors of SJS/TEN are sparse. The planned epidemiological study will include a case-control part identifying drugs which have been taken at the time of the onset of SJS/TEN, as well as two different cohort studies. In the first cohort study we will assess IRs of SJS/TEN overall as well as in new users of different drugs. In the second cohort analysis we will quantify mortality rates and identify long-term complications of SJS/TEN applying a Cox proportional hazard analysis. The suggested project will involve one of the largest SJS/TEN study populations available, and will be among the first SJS/TEN studies using a large longitudinal database (first one on the Clinical Practice Research Datalink - CPRD).
Arzneimittelreport Schweiz Research Project | 2 Project MembersAssessment of and reporting on use of pharmaceuticals in Switzerland based on claims data.
The epidemiology of and risk factors for tinnitus: a large epidemiological study in the UK Research Project | 2 Project MembersA large epidemiolgical study will be done to explore the frequency of tinnitus in the general population using the UK-based CPRD. We will idenify exposure parameters which are associated with an alatered risk of developing tinnitus.
Treatment outcome and side effects in patients with acute exacerbation of COPD treated in primary care in the UK before and after the introduction of guidelines endorsing 5 rather than 14 days of oral corticosteroids: a hypothesis-testing study Research Project | 5 Project MembersThis study seeks to investigate if the introduction of guidelines introduced in 2015 supporting a shortened OCS course during acute exacerbation of COPD (AECOPD) altered the treatment efficacy and safety. The study population of interest will consist of patients with AECOPD treated with OCS in general practices in the United Kingdom that form part of the CPRD (Clinical Practice Research Datalink). The primary exposure is treatment with OCS before and after the introduction of the guidelines recommending only five days of treatment. The primary outcome is the time to next exacerbation during the 12 months after the index exacerbation. Secondary outcomes will be the number of exacerbations during the 12 months after the index exacerbation; duration of OCS therapy (if available), treatment safety, notably, the number of patients with new onset diabetes during twelve months after AECOPD.
