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Do β-adrenoreceptor blocking drugs associate with reduced risk of symptomatic osteoarthritis and total joint replacement in the general population?: A primary-care based prospective cohort study using the Clinical Practice Research Datalink

Nakafero, Georgina; Grainge, Matthew; Valdes, Anna; Townsend, Nick; Mallen, Christian; Zhang, Weiya; Doherty, Michael; Mamas, Mamas; Abhishek, Abhishek

Authors

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ANA VALDES Ana.Valdes@nottingham.ac.uk
Professor of Molecular & Genetic Epidemiology

Nick Townsend

Christian Mallen

Michael Doherty

Mamas Mamas



Abstract

© Author(s) (or their employer(s)) 2019. Introduction: To investigate if β-adrenoreceptor blocking drug (β-blocker) prescription reduces the risk of knee or hip osteoarthritis, total joint replacement and analgesic prescription. Setting: Primary care. Methods and analysis: This is a cohort study using data from the Clinical Practice Research Datalink. Two separate analyses will be performed. Study 1 will be on the association between β-blocker prescription and incident knee/hip osteoarthritis. Inclusion criteria will be age ≥40 years. Exposed participants will be those with ≥2 continuous β-blocker prescriptions, and the index date will be the date of the first prescription of β-blocker. Unexposed participants will include up to four controls matched for age, sex, general practice surgery and propensity score for β-blocker prescription. Exclusion criteria will include contraindications to β-blockers, consultations for osteoarthritis or potent analgesic prescription before the index date. Outcomes will be knee osteoarthritis (primary outcome), hip osteoarthritis, knee pain and hip pain. Study 2 will be on the association between β-blocker prescription and total joint replacement and analgesic prescription in people with osteoarthritis. Inclusion criteria will be age ≥40 years, knee or hip osteoarthritis, and index date will be as in study 1. Unexposed participants will be as in study 1, additionally matched for consultation for knee or hip osteoarthritis prior to the index date. Exclusion criteria will include contraindications to β-blockers and osteoarthritis in other joints prior to the index date. Outcomes will be total knee replacement (primary outcome), total hip replacement and new analgesic prescription. Statistical analysis: Kaplan-Meier curves will be plotted, and Cox proportional HRs and 95% CIs will be calculated. Stratified analysis will be performed by class of β-blocker, intrinsic sympathomimetic effect and indication(s) for prescription. Ethics and dissemination: This study was ethically approved by the Independent Scientific Advisory Committee of the Medicines and Healthcare Authority (Ref 18-227R). The results of this study will be published in peer-reviewed journals and presented at conferences. Summary: This prospective cohort study will evaluate the analgesic potential of commonly used drugs for osteoarthritis pain.

Citation

Nakafero, G., Grainge, M., Valdes, A., Townsend, N., Mallen, C., Zhang, W., …Abhishek, A. (2019). Do β-adrenoreceptor blocking drugs associate with reduced risk of symptomatic osteoarthritis and total joint replacement in the general population?: A primary-care based prospective cohort study using the Clinical Practice Research Datalink. BMJ Open, 9(8), https://doi.org/10.1136/bmjopen-2019-032050

Journal Article Type Article
Acceptance Date Jun 25, 2019
Online Publication Date Aug 1, 2019
Publication Date Aug 1, 2019
Deposit Date Jul 1, 2019
Publicly Available Date Aug 7, 2019
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 9
Issue 8
Article Number e032050
DOI https://doi.org/10.1136/bmjopen-2019-032050
Keywords Osteoarthritis, Pain, Total joint replacement, Anti-hypertensives, Analgesia
Public URL https://nottingham-repository.worktribe.com/output/2246537
Publisher URL https://bmjopen.bmj.com/content/9/8/e032050

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Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/





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