Evidence mapPaperPMID 40820442Full record

ArticlePharmacoepidemiology and drug safety2025

Potential Drug Dose-Specific Adverse Three-Drug Combinations: A US Insurance Claims Data-Based Study.

Y Shi, A Sun, C W Chiang, Y Yang, K M Hunold, J Xu, M Russo, J Caterino, M T Eadon, L Li and 3 more

Abstract read
In one paragraph

Article in Pharmacoepidemiology and drug safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Y ShiDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.ORCID https://orcid.org/0000-0003-0145-2968
A SunDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.
C W ChiangDepartment of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
Y YangDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.
K M HunoldDepartment of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
J XuDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.
M RussoDepartment of Statistics, The Ohio State University, Columbus, Ohio, USA.ORCID https://orcid.org/0000-0003-4953-9341
J CaterinoDepartment of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA.
M T EadonDepartment of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
L LiDepartment of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
J SuDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.
M DonneyongCollege of Pharmacy, The Ohio State University, Columbus, Ohio, USA.ORCID https://orcid.org/0000-0003-2710-913X
P ZhangDepartment of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana, USA.

Funding

Significant high order drug interactions in the emergency department setting among older patient populationR01AG071018 · NIA · OHIO STATE UNIVERSITY · 2023 to 2025
$1.0M
Revealing Health Trajectories of Chronic Kidney Disease for Precision MedicineR01LM013771 · INDIANA UNIVERSITY INDIANAPOLIS · 2025 to 2025
$329k
NIA NIH HHS R01 AG071018NIGMS NIH HHS R01 GM141279NIH HHS R01AG071018NIH HHS R01GM141279NIH HHS R01LM013771NLM NIH HHS R01 LM013771
6 · The paper itself

Abstract

introductionUse of three-drug combinations is increasingly prevalent and associated with an increased risk of adverse drug events (ADEs). While real-world data-based pharmacovigilance and pharmacoepidemiology studies have derived knowledge on potential adverse three-drug combinations, the relationship between doses of each drug in three-drug combination exposure and the risk of ADEs remains unclear.

methodsWe derived matched case-control datasets from US nationwide health insurance claims data for potential ADEs including acute kidney injury, acute myocardial infarction, gastrointestinal bleeding, hypoglycemia, and opioid-related ADE. We used the conditional logistic regression model to investigate the relationship between the dose of three-drug combination exposure and the risk of ADE. We used Benjamini and Hochberg's procedure to control the false discovery rate (FDR). We explored the relationship between the reduction of drug dose and the risk of ADE.

resultsWe identified over 500 potential adverse three-drug combinations from approximately two million case-control pairs (all odds ratios ≥ 1.3 and FDR < 0.05). For the signals, compared with a high-dose level of all three drugs, 74% of three-drug combinations had a lower risk by decreasing the dose of one drug without any drug discontinuation (p value < 0.05).

conclusionsCertain three-drug combinations are associated with an increased risk of ADE. Dose of exposure might be used to evaluate the risk of ADE for a majority of adverse three-drug combinations. PLAIN LANGUAGE SUMMARY: Use of three-drug combinations is increasingly prevalent and associated with an increased risk of adverse drug events (ADEs). We identified potential adverse three-drug combinations from real-world data, and revealed the corresponding relationships between doses and risks of ADEs. We find doses might be used to evaluate the risk of ADE for many adverse three-drug combinations. Additionally, we find risk of many adverse three-drug combinations might be decreased by reducing the dose of one drug without any drug discontinuation.

Indexed as

Drug-Related Side Effects and Adverse ReactionsAdolescentAdultAgedCase-Control StudiesDatabases, FactualDose-Response Relationship, DrugDrug CombinationsFemaleHumansInsurance Claim ReviewMaleMiddle AgedPharmacoepidemiologyPharmacovigilanceUnited StatesDrug Combinationsadverse drug eventsdosedrug combinationpharmacoepidemiologytoxicity

Identifiers

PMID40820442
PMCPMC12358767

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.