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The active comparator, new user study design in pharmacoepidemiology: historical foundations and contemporary application.
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Better understanding of biases related to selective prescribing of, and adherence to, preventive treatments has led to improvements in the design and analysis of pharmacoepidemiologic studies. One influential development has been the "active comparator, new user" study design, which seeks to emulate the design of a head-to-head randomized controlled trial. In this review, we first discuss biases that may affect pharmacoepidemiologic studies and describe their direction and magnitude in a variety of settings. We then present the historical foundations of the active comparator, new user study design and explain how this design conceptually mitigates biases leading to a paradigm shift in pharmacoepidemiology. We offer practical guidance on the implementation of the study design using administrative databases. Finally, we provide an empirical example in which the active comparator, new user study design addresses biases that have previously impeded pharmacoepidemiologic studies.
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Peng, Z., Yang, C., Kuo, S., Wu, C., Lin, W., & Ou, H. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.46928 · Cited by 23
Lund, L. C., Støvring, H., Pottegård, A., Andersen, M. T., & Hallas, J. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.02.012 · Cited by 22
Acton, E. K., Hennessy, S., Gelfand, M. A., Leonard, C. E., Bilker, W. B., Shu, D., Willis, A. W., & Kasner, S. E. (2024) · JAMA Neurology · doi:10.1001/jamaneurol.2024.2057 · Cited by 23
Zaccardi, F., Davies, M. J., & Khunti, K. (2020) · Diabetes Obesity and Metabolism · doi:10.1111/dom.13929 · Cited by 22
Funch, D., Mortimer, K., Ziyadeh, N. J., Seeger, J. D., Zhou, L., Ng, E., Ross, D., Major-Pedersen, A., Bosch-Traberg, H., Gydesen, H., et al. (2021) · Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy · doi:10.2147/dmso.s305496 · Cited by 24
Emerging uncertainty on the anti-aging potential of metformin
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Initiator Types and the Causal Question of the Prevalent New-User Design: A Simulation Study
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Comparative Effect of Initiating Metformin Versus Sulfonylureas on Breast Cancer Risk in Older Women
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Gajra, A., Zettler, M. E., & Feinberg, B. A. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2020020 · Cited by 20
Preyra, R., Eddin, L. E., Ahmadi, F., Jafari, A., & Muanda, F. T. (2025) · British Journal of Clinical Pharmacology · doi:10.1002/bcp.70051 · Cited by 19
Metadata
- Authors
- Lund, J. L., Richardson, D. B., & Stürmer, T.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Lund, Jennifer L.
- Venue
- Current Epidemiology Reports
- Published
- 2015-09-30
- Volume
- 2
- Issue
- 4
- Pages
- 221-228
- ISSN
- 2196-2995 (ISSN-L)
- PMC
- PMC4778958
- OpenAlex
- W1849521086
- Cited by
- 739
- References
- 42
- Citations by year
- 2026: 103 · 2025: 125 · 2024: 94 · 2023: 79 · 2022: 98 · 2021: 72 · 2020: 61 · 2019: 44 · 2018: 34 · 2017: 19 · 2016: 10
- FWCI
- 18.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Epidemiology Reports (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (2k12ca120780-16)
- National Institute on Aging (R01AG023178)
- National Cancer Institute (K12-CA120780)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK124723)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Keywords
- bias in observational studies, head-to-head comparison, administrative databases
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