Thromboembolic, cardiovascular and overall mortality risks of aromatase inhibitors, compared with tamoxifen treatment: an outpatient-register-based retrospective cohort study

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  • dc.contributor.author Pineda-Moncusí, Marta
  • dc.contributor.author Garcia Giralt, Natàlia
  • dc.contributor.author Díez Pérez, Adolfo
  • dc.contributor.author Tusquets Trias de Bes, Ignacio
  • dc.contributor.author Servitja Tormo, Sonia
  • dc.contributor.author Albanell Mestres, Joan
  • dc.contributor.author Prieto-Alhambra, Daniel
  • dc.contributor.author Nogués Solan, Francesc Xavier
  • dc.date.accessioned 2020-06-23T06:58:30Z
  • dc.date.available 2020-06-23T06:58:30Z
  • dc.date.issued 2020
  • dc.description.abstract Background: Tamoxifen (TAM) and aromatase inhibitor (AI) therapies have been associated with increased risk of thromboembolic and cardiovascular events, respectively, in addition to other side effects. This study analysed the risk of these events and the overall survival (OS) benefit in breast cancer patients treated with AI, compared with TAM-treated patients, in a large population-based cohort. Methods: This observational cohort study included women diagnosed with breast cancer and treated with TAM or AI. Data were extracted from primary care records in a population database (SIDIAP, System for the Development of Research in Primary Care). Incidence rates of study outcomes are reported. Survival analyses included Kaplan-Meier estimation and Cox proportional hazards models. Sensitivity analysis was carried out, using Fine and Gray models to account for competing risk of death. Confounding was minimized using propensity score adjustment and inverse probability weighting (IPW) adjustment. Results: Data from 3082 postmenopausal women treated with TAM, and 18,455 treated with AI, were available. Adjusted hazard ratios (HRs) [95% confidence interval (CI)] for AI users, compared with TAM group, were 0.93 (95%CI 0.69-1.26) for thromboembolic events (TEEs); 1.13 (95%CI 0.79-1.63) for cardiovascular events, and 0.76 (95%CI 0.70-0.82) for mortality. Additional analyses using competing risk analysis had similar results, while IPW adjustment showed a potential risk of pulmonary embolism (PE) [2.26 (95%CI 1.02-4.97)] in AI-treated patients. Conclusions: AI users had >20% lower all-cause mortality compared with TAM users, without increasing risk to experience cardiovascular and TEEs. This would locate AI therapy on the first line in clinical practice. Thus, AI might be the most preferable option in adjuvant hormonal therapy choice.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Pineda-Moncusí M, Garcia-Giralt N, Diez-Perez A, Tusquets I, Servitja S, Albanell J, Thromboembolic, cardiovascular and overall mortality risks of aromatase inhibitors, compared with tamoxifen treatment: an outpatient-register-based retrospective cohort study. Ther Adv Med Oncol. 2020 Mar 25; 12:1758835920909660. DOI: 10.1177/1758835920909660
  • dc.identifier.doi http://dx.doi.org/10.1177/1758835920909660
  • dc.identifier.issn 1758-8340
  • dc.identifier.uri http://hdl.handle.net/10230/45025
  • dc.language.iso eng
  • dc.publisher SAGE Publications
  • dc.relation.ispartof Therapeutic Advances in Medical Oncology. 2020 Mar 25;12:1758835920909660
  • dc.rights Copyright © The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri https://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.keyword Aromatase inhibitor
  • dc.subject.keyword Breast cancer
  • dc.subject.keyword Cardiovascular events
  • dc.subject.keyword Overall mortality
  • dc.subject.keyword Tamoxifen
  • dc.subject.keyword Thromboembolic events
  • dc.title Thromboembolic, cardiovascular and overall mortality risks of aromatase inhibitors, compared with tamoxifen treatment: an outpatient-register-based retrospective cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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