Evidence map›Paper›PMID 30043552›Full record

Observational studyPharmacoepidemiology and drug safety2018

Effectiveness of risk minimization measures for the use of cilostazol in United Kingdom, Spain, Sweden, and Germany.

Jordi Castellsague, Beatriz Poblador-Plou, Maria Giner-Soriano, Marie Linder, Oliver Scholle, Brian Calingaert, Christine Bui, Alejandro Arana, Clara Laguna, Francisca Gonzalez-Rubio and 3 more

Open access · hybridAbstract readObservational Study
In one paragraph

Observational study in Pharmacoepidemiology and drug safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 2 pooled it
0.2field-weighted citation impact, top 41% 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

3 citing papers in PubMed, 2 syntheses or guidelines pooled it, 2 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Observational
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

13 authors at 6 institutions in 4 countries.

Jordi CastellsagueEpidemiology, RTI Health Solutions, Barcelona, Spain.
Beatriz Poblador-PlouAragon Health Sciences Institute (IACS), IIS Aragon, Hospital Universitario Miguel Servet, University of Zaragoza, Zaragoza, Spain.
Maria Giner-SorianoInstitut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.ORCID 0000-0003-3750-9233
Marie LinderCentre for Pharmacoepidemiology, Unit of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Oliver ScholleDepartment of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
Brian CalingaertEpidemiology, RTI Health Solutions, Research Triangle Park, NC, USA.
Christine BuiEpidemiology, RTI Health Solutions, Research Triangle Park, NC, USA.
Alejandro AranaEpidemiology, RTI Health Solutions, Barcelona, Spain.
Clara LagunaAragon Health Sciences Institute (IACS), IIS Aragon, Hospital Universitario Miguel Servet, University of Zaragoza, Zaragoza, Spain.
Francisca Gonzalez-RubioAragon Health Sciences Institute (IACS), IIS Aragon, Hospital Universitario Miguel Servet, University of Zaragoza, Zaragoza, Spain.ORCID 0000-0001-5939-4436
Albert Roso-LlorachInstitut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
Alexandra Prados-TorresAragon Health Sciences Institute (IACS), IIS Aragon, Hospital Universitario Miguel Servet, University of Zaragoza, Zaragoza, Spain.
Susana Perez-GutthannEpidemiology, RTI Health Solutions, Barcelona, Spain.ORCID 0000-0001-5798-3691
RTI Health Solutions · USUniversidad de Zaragoza · ESInstitut Universitari d'Investigació en Atenció Primària Jordi Gol · ESKarolinska Institutet · SELeibniz Institute for Prevention Research and Epidemiology - BIPS · DEUniversitat Autònoma de Barcelona · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe purpose of the study is to evaluate the effectiveness of risk minimization measures-labeling changes and communication to health care professionals-recommended by the European Medicines Agency for use of cilostazol for the treatment of intermittent claudication in Europe.

methodsObservational study of cilostazol in The Health Improvement Network (United Kingdom), EpiChron Cohort (Spain), SIDIAP (Spain), Swedish National Databases, and GePaRD (Germany). Among new users of cilostazol, we compared the prevalence of conditions targeted by the risk minimization measures in the periods before (2002-2012) and after (2014) implementation. Conditions evaluated were prevalence of smoking, cardiovascular conditions, concurrent use of ≥2 antiplatelet agents, concurrent use of potent CYP3A4/CYP2C19 inhibitors and high-dose cilostazol, early monitoring of all users, and continuous monitoring of users at high cardiovascular risk.

resultsWe included 22 593 and 1821 new users of cilostazol before and after implementation of risk minimization measures, respectively. After implementation, the frequency of several conditions related to the labeling changes improved in all the study populations: prevalence of use decreased between 13% (EpiChron) and 57% (SIDIAP), frequency of cardiovascular contraindications decreased between 8% (GePaRD) and 84% (EpiChron), and concurrent use of high-dose cilostazol and potent CYP3A4/CYP2C19 inhibitors decreased between 6% (Sweden) and 100% (EpiChron). The frequency of other conditions improved in most study populations, except smoking, which decreased only in EpiChron (48% reduction).

conclusionsThis study indicates that the risk minimization measures implemented by the EMA for the use of cilostazol have been effective in all European countries studied, except for smoking cessation before initiating cilostazol, which remains an area of improvement.

Indexed as

AgedCardiovascular DiseasesCilostazolDatabases, FactualDose-Response Relationship, DrugDrug LabelingFemaleGermanyHealth Plan ImplementationHumansIntermittent ClaudicationMalePlatelet Aggregation InhibitorsPrevalencePreventive Health ServicesProgram EvaluationCilostazolPlatelet Aggregation Inhibitorscilostazoldatabase studyintermittent claudicationperipheral artery diseasepharmacoepidemiologyrisk minimization

Identifiers

PMID30043552
PMCPMC6175151
OpenAlexW2884192463

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.