Comparative Effectiveness Research in the Canadian Partnership for Tomorrow Cohort
We are primarily interested in answering the following queries:
Q1. Are thiazide diuretics effective in the treatment of non-diabetic hypertension?
This query was raised by provincial health plan decision-makers earlier in 2012. Thiazide diuretics (i.e. hydrochlorothiazide) have been shown to be at least as effective as calcium channel blockers (CCBs) (e.g. amlodipine), angiotensin converting enzyme (ACE) inhibitors (e.g. lisinopril) and angiotensin receptor blockers (ARBs) (e.g. losartan). In response to this query, we will evaluate the comparative effectiveness of antihypertensive treatments among older adults without diabetes, focusing on thiazides monotherapy compared with other monotherapy.
Q2. What is the comparative effectiveness and safety of sitagliptan and NPH insulin for the management of type 2 DM not controlled by metformin plus sulfonylurea?
A review by the Canadian Agency for Drugs and Technologies in Health (CADTH) places NPH insulin ahead of
long acting insulin analogues and stiagliptan in the order of therapies for diabetes. However clinicians and patients do not always agree with this. Our analyses will focus on severe hypoglycemia, though we will also explore the comparative effectiveness of these two agents by assessing switches between agents as a marker of drug ineffectiveness and/or intolerance (i.e., adverse event).
Q3. What is the safety of bevacizumab when injected intravitreally for the treatment of patients in Canada with neovascular (wet) age-related macular degeneration and visual impairment due to diabetic macular edema?
The advent and widespread use of anti-vascular endothelial growth factor (anti-VEGF, e.g.: bevacizumab) has dramatically changed the management of neovascular age-related macular degeneration (AMD) and other retinal conditions. Drug-related adverse events associated with anti-VEGF agents have been reported, but there is a paucity of real-world safety data. This study will examine ocular complications of anti-VEGF injections (including endophthamitis) given for neovascular AMD and other retinal conditions in population-based cohorts.