| アブストラクト | OBJECTIVE: To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN: Population based matched cohort study. SETTING: Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION: Adults (>/=50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES: The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS: Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS: Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment. |
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| ジャーナル名 | BMJ (Clinical research ed.) |
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| 投稿日 | 2024/4/18 |
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| 投稿者 | Mok, Pearl L H; Carr, Matthew J; Guthrie, Bruce; Morales, Daniel R; Sheikh, Aziz; Elliott, Rachel A; Camacho, Elizabeth M; van Staa, Tjeerd; Avery, Anthony J; Ashcroft, Darren M |
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| 組織名 | Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and;Optometry, University of Manchester, Manchester, M13 9PT, UK.;Manchester Academic Health Science Centre, Manchester, UK.;NIHR Greater Manchester Patient Safety Research Collaboration, University of;Manchester, Manchester, UK.;Advanced Care Research Centre, Usher Institute, College of Medicine and;Veterinary Medicine, University of Edinburgh, Edinburgh, UK.;Population Health and Genomics, University of Dundee, Dundee, UK.;Usher Institute, College of Medicine and Veterinary Medicine, University of;Edinburgh, Edinburgh, UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK.;Manchester Centre for Health Economics, Division of Population Health,;Manchester, UK.;Division of Informatics, Imaging and Data Sciences, University of Manchester,;Centre for Primary Care, School of Medicine, University of Nottingham,;Nottingham, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38631737/ |
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