Wammes-van der Heijden E A, Rahimtoola H, Leufkens H G M, Tijssen C C, Egberts A C G
Division of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, The Netherlands.
Neurology. 2006 Oct 10;67(7):1128-34. doi: 10.1212/01.wnl.0000240128.76399.fa.
To investigate whether the intensity of triptan and ergotamine use, in specific overuse, is associated with the risk of ischemic complications.
We conducted a retrospective nested case-control study using data from the PHARMO Record Linkage System. All patients with more than one prescription for either a triptan or ergotamine were initially identified. Cases were all patients who were admitted to the hospital for an ischemic complication. Matched controls were assigned the same index date as the cases. The determinant was the intensity of use of triptans and ergotamine during 1 year preceding the index date. Overuse was defined as use of > or =90 defined daily doses during that year. Conditional logistic regression was used to estimate odds ratios (ORs), adjusting for confounders. Stratified analysis was used to estimate the risk for both patients using and those not using cardiovascular drugs.
A total of 17,439 patients received more than one prescription. A total of 188 cases and 689 controls were identified. Triptan overuse was not associated with an increased risk of ischemic complications (OR 0.96; 95% CI: 0.49 to 1.90). Overuse of triptans in patients concomitantly using cardiovascular drugs did not increase this risk. Overuse of ergotamine turned out to be a risk factor for ischemic complications (OR 2.55; 95% CI: 1.22 to 5.36). Patients overusing ergotamine and concomitantly using cardiovascular drugs were at highest risk (OR 8.52; 95% CI 2.57 to 28.2).
In general practice, triptan overuse does not increase the risk of ischemic complications. Overuse of ergotamine may increase the risk of these complications, especially in those simultaneously using cardiovascular drugs.
研究曲坦类药物和麦角胺在特定过度使用情况下的使用强度是否与缺血性并发症风险相关。
我们使用PHARMO记录链接系统的数据进行了一项回顾性巢式病例对照研究。最初识别出所有开具过不止一张曲坦类药物或麦角胺处方的患者。病例为所有因缺血性并发症入院的患者。匹配的对照组与病例组的索引日期相同。决定因素为索引日期前1年期间曲坦类药物和麦角胺的使用强度。过度使用定义为该年使用≥90规定日剂量。采用条件逻辑回归估计比值比（OR），并对混杂因素进行校正。分层分析用于估计使用和未使用心血管药物患者的风险。
共有17439名患者开具过不止一张处方。共识别出188例病例和689名对照。曲坦类药物过度使用与缺血性并发症风险增加无关（OR 0.96；95%置信区间：0.49至1.90）。同时使用心血管药物的患者过度使用曲坦类药物并未增加此风险。麦角胺过度使用被证明是缺血性并发症的一个危险因素（OR 2.55；95%置信区间：1.22至5.36）。过度使用麦角胺且同时使用心血管药物的患者风险最高（OR 8.52；95%置信区间2.57至28.2）。
在一般医疗实践中，曲坦类药物过度使用不会增加缺血性并发症风险。麦角胺过度使用可能会增加这些并发症的风险，尤其是在同时使用心血管药物的患者中。
