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Background

Obesity is a growing global health burden, previously with few effective treatments. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were originally approved for diabetes but are increasingly prescribed for treatment of overweight and obesity. The increasing expenditure has led to ethical debates surrounding the utilization of these drugs. Few studies have investigated the attitudes to GLP-1 RAs among prescribing physicians. This study aimed to assess the attitudes to GLP-1 RAs for treatment of overweight and obesity among Swedish primary care physicians.

Methods

This was a cross-sectional survey with descriptive quantitative analysis and thematic analysis of free-text responses. A mix of multiple-choice questions and rating scales, including the Likert scale was employed. The study was conducted in October 2024 among physicians working in primary care in the Swedish regions of Gävleborg, Uppsala, Västernorrland, Västmanland and Örebro. The survey was distributed through the Drug and Therapeutics Committees (DTCs) in the regions.

Results

The 190 responses yielded a response rate of 28%. Of these, 163 responses could be included in the final analysis. Almost all respondents (98%) agreed that GLP-1 RAs are effective drugs for treating obesity, and 91% believed they will be important for obesity treatment in the future. Main identified barriers for prescribing GLP-1 RAs were high patient co-payment (69%) and low drug availability due to supply shortages at the time of conducting this survey (86%).

Conclusion

Physicians working in primary care in Sweden consider GLP-1 RAs effective for treating obesity and believe these drugs will play an important role in obesity treatment in the future. These findings should be interpreted in the light of the low response rate and possible self-selection bias.

Antipsychotics are mainly used for severe psychiatric disorders. Risperidone is the only antipsychotic approved for younger children. Aripiprazole is approved for older children, ziprasidone and lurasidone for adolescents. To describe paediatric utilisation of antipsychotic drugs in Sweden. Dispensations of antipsychotic drugs to children aged 5–17 years from 2008 to 2021 were analysed using the National Prescribed Drug Register and recorded diagnoses were obtained from the National Patient Register. Overall, dispensations of antipsychotics to children increased from 16.7 to 36.9/10,000 between 2008 and 2021. The increase was larger in girls, from 12.3 to 36.6/10,000. New users of antipsychotics increased by 121% in the same period, from 7.9 to 17.5/10.000. In 2019, in children aged 12–17, 63% of girls and 71% of boys were dispensed had at least three dispensations of antipsychotics, while the corresponding proportion in children aged 5–11 were 52% for girls and 63% for boys. Risperidone was the most common drug in boys of all ages and in girls aged 5–11. In girls aged 12–17, aripiprazole and quetiapine were most common. The proportion of on-label antipsychotic use was 21% in girls and 15% in boys based in authorised product information and increased to 37% and 45%, respectively, when aligning with national guidelines. The use of antipsychotics has increased, with the proportion of girls starting treatment at the end of study period exceeding that of boys. A considerable proportion of prescriptions was off-label, even when considering national guidelines.

Purpose This study aims to assess the risk of metabolic side effects among paediatric new users of antipsychotics in Sweden, focusing on differences between substances and sexes.Methods Children aged 5-17 years, who were new users of antipsychotics between 2014 and 2021, were identified using Swedish national health registers. Cox' models were fitted for children during first treatment with an antipsychotic, excluding those with eating disorders, yielding hazard ratios (HRs) for metabolic side effects with 95% confidence intervals (CIs).Results A total of 5441 children were new users of antipsychotics. Of these, 399 (7.3%; 42% girls) received a new diagnosis or new treatment indicating a metabolic side effect, of which 139 cases during first-line treatment and without an eating disorder diagnosis. Obesity was the most common metabolic side effect, accounting for 69% of the cases. In girls, significantly increased risks were observed for aripiprazole (HR 3.52, 95% CI 1.58-7.80), olanzapine (HR 6.99, 95% CI 2.34-20.93) and quetiapine (HR 4.87, 95% CI 1.97-12.04), compared with risperidone. Younger girls had higher risks. In boys, a significantly increased risk was found for aripiprazole (HR 2.21, 95% CI 1.37-3.56).Conclusion The overall risk of metabolic side effects is considerable, with higher relative risks in girls, especially younger girls. These findings highlight the need for carefully considered treatment and attentive monitoring when initiating antipsychotics in children.

Aim: We aimed to investigate whether genetic variation is associated with venous thromboembolism after immunization with SARS-CoV-2 vaccines.

Methods: We conducted a genome-wide association study (GWAS) on cases of venous thromboembolism within 42 days after SARS-CoV-2 vaccination, recruited from reports of adverse drug reactions sent to the Swedish Medical Products Agency. Two hundred one cases (43% women, 91% Swedish) were compared with 4891 Swedish population controls. Analyses were performed on two candidate variants in coagulation factor II (rs1799963) and coagulation factor V (rs6025), on 14 prespecified candidate genes and across the whole genome. To support the findings, we conducted an observational register study of the Swedish general population with/without a diagnosis of thrombophilia and the risks of venous thromboembolism after SARS-CoV-2 vaccination.

Results: In the GWAS, the main findings were that the candidate variants of coagulation factors II rs1799963 and V rs6025 were significantly associated with venous thromboembolism (odds ratio [OR] 2.4 [95% confidence interval (CI) 1.2–4.8], p = .015 and OR 1.8 [95% CI 1.3–2.6], p = .0022). No genetic marker passed the significance threshold in the candidate gene analysis or the full genome-wide analysis. In the register study, people with a thrombophilia diagnosis had a five-fold elevated risk of venous thromboembolism within 42 days after vaccination, adjusted for potential confounders, OR 5.06 [95% CI 3.98–6.44].

Conclusion: Well-characterized genetic variants in the genes of coagulation factors II and V were associated with thromboembolism after SARS-CoV-2 immunization. Further research is recommended to elucidate their potential role in vaccine-related thromboembolic events.

Purpose

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have gained considerable media attention, but there is limited knowledge about those receiving the drugs. This study aimed to assess demographic characteristics and previous diagnoses in patients dispensed GLP-1 RAs in Region Stockholm, Sweden, between 2019 and 2023, with a focus on off-label prescribing.

Methods

This was a register-based cross-sectional study including all inhabitants in Region Stockholm, Sweden, who were dispensed a GLP-1 RA between 2019 and 2023. Patient characteristics were assessed through record linkage with administrative healthcare data on demographics, healthcare consultations, diagnoses, and other dispensed drugs.

Results

The prevalence proportion of GLP-1 RA dispensations in Region Stockholm increased from 4.7 patients/1000 inhabitants in 2019 to 17.5 patients/1000 inhabitants in 2023, and the incidence proportion from 1.8 patients/1000 inhabitants in 2019 to 7.4 patients/1000 inhabitants in 2023. GLP-1 RAs have become more common among a younger and female population, with women constituting 47% of incident patients in 2019 compared to 53% in 2023. The most common diagnosis shifted from type 2 diabetes mellitus (T2DM) (82% in 2019) to obesity (47% in 2023). During the same period, obesity without T2DM notably increased from 10 to 31%. Almost one-third (31%) of all patients dispensed the drugs in 2023 had no recorded diagnosis of either diabetes or obesity, compared to 8% in 2019.

Conclusion

This study showed an increase in the dispensation of GLP-1 RA, with characteristics of patients changing towards a higher degree of off-label use. The effectiveness and safety of the increasing prescriptions warrant future studies.

Background and Objectives: Reports of suspected adverse drug reactions are of a great importance for the safety monitoring of new vaccines to identify potential safety risks promptly and to ensure necessary measures for risk mitigation. We reviewed the reports of fatal adverse drug reactions after coronavirus disease 2019 (COVID-19) vaccination with Comirnaty (R), Spikevax (R), and Vaxzevria (R) during the national vaccination campaign in Sweden.

Methods: Swedish reports of suspected adverse drug reactions with fatal outcomes after COVID-19 vaccines were retrieved from the EudraVigilance database. Vaccination data were obtained from the National vaccination register. Reporting rates were calculated by dividing the number of adverse drug reaction reports with fatal outcomes by the number of people exposed to at least one dose of the COVID-19 vaccines or by the number of vaccine doses given. A causality assessment of adverse drug reaction reports was performed by clinically qualified reviewers.

Results: More than 26 million doses of COVID-19 vaccines were administered and 456 reports of suspected adverse drug reactions with fatal outcomes were reported during 27 December, 2020-31 May, 2023. The reporting rate was 5.7 fatal outcomes per 100,000 persons vaccinated with at least one dose of any COVID-19 vaccine or 1.7 per 100,000 vaccine doses given. Most of the fatalities were related to patients' pre-existing conditions, predominantly among people aged 70 years or older. Only ten of the reported fatalities (0.1 per 100,000 persons vaccinated) were assessed as consistent with a causal association to COVID-19 vaccination.

Conclusions: Adverse drug reactions with fatal outcomes after COVID-19 vaccines in Sweden were very rare. No new safety concerns were observed in this study.

Background: During the COVID-19 vaccination campaign in Sweden, pulmonary embolism (PE) was a frequently reported suspected serious adverse drug reaction. The aim was to estimate risk of PE following vaccination for COVID-19 in the Swedish population aged 18 to 84 years.

Methods: Population-based cohort study using the CoVacSafe-SE established platform including national registers. PE-case definition: Individuals discharged from inpatient-care or visiting specialized outpatient-care with a main diagnosis of PE occurring between 27-Dec-2020 and 31-Dec-2022 without simultaneous diagnosis of COVID-19 infection. Time-to-event analysis was performed using multi-variable Cox' proportional hazard's models. Hazard Ratios (HR) adjusted for age, sex and co-morbidities were modelled. The vaccines were BNT162b2/Comirnaty (R), mRNA1273/Spikevax (R) and ChAdOx1 nCoV-19/Vaxzevria (R) without regard to variants. Doses number one to five were studied.

Results: Eighty percent of the study-population (approximate to 6.1 million people) received at least two doses of COVID-19 vaccine. A total of 12,456 cases of PE were identified. Twenty-eight days after vaccinations we observed 99 cases after 701,455 1st doses of ChAdOx1 nCoV-19, HRadj, 1.29 (95%-CI, 1.05-1.59). Corresponding for BNT162b2 was 361 cases after 4,708,284 1st doses of BNT162b2 HR adj of 1.19 (95%-CI, 1.06-1.34) driven by age group 65-84; HR adj, 1.24 (95%-CI, 1.07-1.44). No increased risks were observed for mRNA1273.

Conclusion: In this nation-wide study, no strong associations were found between COVID-19 vaccinations and pulmonary embolism. Small increases in relative risk for the earliest doses of vaccines may be associated with prioritizing the frailest groups of people in the vaccination campaign, thus selection bias or unmeasured residual confounding is possible.