By B.-E. Wiholm (auth.), Dr. Michael Kurowski (eds.)
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Additional resources for Adverse Reactions to Non-Steroidal Anti-Inflammatory Drugs: Clinical Pharmacoepidemiology
48 For any given drug, the evaluation is seldom complete when only one outcome has been studied; moreover, judgments can only be made if comparable data is available for alternative drugs . If one drug is to be replaced by another, the relative risks must be known. The availability of comparable quantitative data for all major adverse events to NSAIDs and the identification of subpopulations carrying higher risks should be goals for the coming decade. A change from pharmacopolitics to pharmacoepidemiology is a formidable challenge for the pharmaceutical industry, health authorities, and academia.
These data are of two types: those on hospital admissions due to ADRs to analgesies and NSAIDs, and those on ADRs to the same drugs occurring in-hospital, The first set of data is an expansion of that published in collaboration with Professor M. Levy in 1980 on ADR hospital admissions in Jerusalem and Berlin . In the Boston Collaborative Drug Surveillanee Program, data were colleeted on all conseeutive admissions without further seleetion. Patients were questioned about the medications they used during the 4 weeks prior to admission, and the admitting doctor was asked whether the present admission could have been eaused by an ADR.
Both patients were concomitantly exposed to aspirin and pyrazolones, again totally confounding the analysis. A number of cases of nephropathy caused by chronic and/or heavy use of analgesics are diagnosed every year. In OUf study we encountered five such cases, three due to phenacetin and two due to paracetamol, all in fixed combinations with aspirin and caffeine. Therefore, the effects of phenacetin and paracetamol vis-ä-vis nephropathy were totally confounded by both aspirin and caffeine . Other investi- 36 Table 3.