2024-04-19 エディンバラ大学
<関連情報>
- https://www.ed.ac.uk/news/2024/dementia-patients-at-risk-from-antipsychotic-drugs
- https://www.bmj.com/content/385/bmj-2023-076268
認知症患者における抗精神病薬使用に関連する複数の有害転帰:集団ベースのマッチドコホート研究 Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study
Pearl L H Mok, research fellow; Matthew J Carr, research fellow; Bruce Guthrie, professor; Daniel R Morales, Wellcome Trust clinical research fellow; Aziz Sheikh, professor; Rachel A Elliott, professor; Elizabeth M Camacho, senior research fellow; Tjeerd van Staa, professor; Anthony J Avery, professor; Darren M Ashcroft, professor
The BMJ Published: 17 April 2024
DOI:https://doi.org/10.1136/bmj-2023-076268
Abstract
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.
