Evidence map›Paper›PMID 28905202›Full record

ArticleEndocrine2018

Drug interactions in users of tablet vs. oral liquid levothyroxine formulations: a real-world evidence study in primary care.

Valeria Guglielmi, Alfonso Bellia, Elisa Bianchini, Gerardo Medea, Iacopo Cricelli, Paolo Sbraccia, Davide Lauro, Claudio Cricelli, Francesco Lapi

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Article in Endocrine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.8field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 19 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Valeria GuglielmiDepartment of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Alfonso BelliaDepartment of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Elisa BianchiniHealth Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Gerardo MedeaItalian College of General Practitioners and Primary Care, Florence, Italy.
Iacopo CricelliHealth Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
Paolo SbracciaDepartment of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Davide LauroDepartment of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
Claudio CricelliItalian College of General Practitioners and Primary Care, Florence, Italy.
Francesco LapiHealth Search, Italian College of General Practitioners and Primary Care, Florence, Italy. lapi.francesco@simg.it.
Società Italiana di Medicina Generale · ITUniversity of Rome Tor Vergata · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSeveral medications may interact with levothyroxine (LT4) intestinal absorption or metabolism, thus reducing its bioavailability. We investigated the variability of thyroid stimulating hormone (TSH) levels and prescribed daily dosages (PDDs) of LT4 before and during potential drug-drug interactions (DDIs) in users of tablets vs. oral liquid LT4 formulations.

methodsBy using the Italian general practice Health Search Database (HSD), we retrospectively selected adult patients with at least one LT4 prescription from 2012 to 2015 and at least 1 year of clinical history recorded. The incident prescription of interacting medications (e.g., proton pump inhibitors, calcium or iron salts) was the index date. Analysis was carried out using a self-controlled study design.

resultsOverall, 3965 users of LT4 formed the study cohort (84.1% women, mean age 56 ± 16.5 years). TSH variability on the entry date was greater among liquid LT4 users than in those prescribed with tablets as shown by the difference between 75th and 25th centile, which were 3.01 and 3.8, respectively. The incidence rate ratio (IRR) for TSH variability did not differ between groups, before and during exposure to DDIs. In contrast, PDDs less likely increased during the exposure to DDI with oral liquid LT4 compared with tablets (IRR = 0.84; 95% CI: 0.77-0.92), especially in patients with post-surgical hypothyroidism (IRR = 0.75; 95% CI: 0.64-0.85).

conclusionsIn clinical practice, the use of oral liquid LT4 is not associated with increased PDDs, compared with tablets formulation, during exposure to DDIs. These results support the need for individualizing LT4 formulation to prescribe, especially in patients with various comorbidities and complex therapeutic regimens.

Indexed as

Administration, OralAdultAgedDrug InteractionsFemaleHumansHypothyroidismMaleMiddle AgedPrimary Health CareRetrospective StudiesTabletsThyroxineTabletsThyroxineDrug–drug interactionsGastrointestinal absorptionOral liquid levothyroxinePrescribed daily dosagesPrimary careTablet levothyroxine

Identifiers

PMID28905202
OpenAlexW2754969245

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.