No abstract

Introduction Statin medications have anti-inflammatory effects. We sought to determine whether statin use in persons with inflammatory bowel disease (IBD) was associated with reduced rates of steroid use or other markers of disease activity. Methods We performed a retrospective cohort study using administrative data. Statin users with IBD were compared to statin-unexposed IBD subjects. The primary outcome was an oral steroid prescription; secondary outcomes included anti-TNF initiation, hospitalization, or abdominal surgery. Cox proportional hazard models were used to estimate hazard ratios (HR) adjusted for potential confounders. Results The study cohort included 1,986 statin-exposed and 9,871 unexposed subjects. Statin use was associated with an 18% reduction in the rate of steroid initiation [HR 0.82 (95% CI 0.71, 0.94)]. A statistically significant result was seen with atorvastatin only [HR 0.76 (95% CI 0.60, 0.96)]. Statins were associated with a reduced rate of steroids in ulcerative colitis [HRs 0.75 (95% CI 0.62, 0.91)], but not in Crohn’s disease [HR 0.91 (95% CI 0.74, 1.12)]. Statin use was associated with reduced hazard of anti-TNF use [HR 0.72 (95% CI 0.46, 1.11)], abdominal surgery [HR 0.80 (95% CI 0.63, 1.02)], and hospitalization [HR 0.88 (95% CI 0.74, 1.05)], but these results did not reach statistical significance. Conclusion In this large retrospective cohort study, statin use amongst persons with IBD was associated with reduced use of oral steroids, particularly for UC. Prospective clinical trials are needed to confirm whether adjuvant treatment of IBD with statin drugs may spare immunosuppressant therapy or ameliorate flares.

We did not find evidence to suggest that SCH is associated with increased MI risk among a population of predominantly older postmenopausal women with no prior history of MI.

Background Nationwide estimates examining Bone Morphogenetic Protein (BMP) use with cervical spine fusions have been limited to perioperative outcomes. Purpose Determined the one-year risk of complications, cervical revision fusions, hospital re-admissions and healthcare services utilization. Study Design/Setting A retrospective cohort study from 2002 to 2009 utilizing a nationwide claims database. Patient Sample There were 61,937 primary cervical spine fusions of which 1,677 received BMP. Outcome Measures Complications, revision fusions, 30-day hospital readmission and healthcare utilization. Methods Data for these analyses come from the Thompson Reuters MarketScan® Commercial Claims and Encounters Database © 2010. Patients were aged 18 to 64 receiving and not receiving BMP with a primary (C2–C7) cervical spine fusion. All outcomes were defined by ICD-9 and CPT codes. Complications were analyzed as any complication and stratified by nervous system, wound, and dysphagia or hoarseness. Cervical revision fusions were determined in the one-year follow-up. Hospital re-admission discharge records defined thirty-day hospital re-admission and reason for re-admission. The utilization of at least one healthcare service of cervical spine imaging, epidural usage or rehabilitation service was examined. Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (CI). Linear regression was used to determine time to hospital re-admission. Results were stratified by anterior or posterior and circumferential approach. Results Patients receiving BMP were 29% more likely to have a complication (adjusted relative risk [aRR]=1.29 ((95% CI 1.14 to 1.46)) and nervous system complication (aRR=1.42 ((95% CI 1.10 to 1.83)). Cervical revision fusions were more likely among patients receiving BMP (aRR=1.69 ((95% CI 1.35 to 2.13)). The risk of 30-day re-admission was greater with BMP use (aRR=1.37 ((95% CI 1.07 to 1.73)), and re-admission occurred on average 27.4% sooner. Patients receiving BMP were more likely to receive computed tomography scans (aRR=1.34 ((95% CI 1.06 to 1.70)) and epidurals with anterior surgical approaches (aRR=1.29 ((95% CI 1.00 to 1.65)). Conclusions These findings question both the safety and effectiveness of off-label BMP use in primary cervical spine fusions.