接受米那普明、文拉法辛或阿米替林治疗的患者心血管风险的流行病学评估：来自法国健康数据的证据。

Epidemiologic Evaluation of Cardiovascular Risk in Patients Receiving Milnacipran, Venlafaxine, or Amitriptyline: Evidence from French Health Data.

作者信息

Mease Philip J, Zimetbaum Peter J, Duh Mei Sheng, Vekeman Francis, Guérin Annie, Boerstoel-Streefland Mariette, Jiang Wenjun, Lefebvre Patrick

机构信息

Philip J Mease MD, Seattle Rheumatology Associates, Swedish Medical Center, Seattle, WA

Peter J Zimetbaum MD, Associate Professor of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.

出版信息

Ann Pharmacother. 2011 Feb;45(2):179-88. doi: 10.1345/aph.1P391.

DOI:10.1345/aph.1P391

PMID:21304035

Abstract

BACKGROUND

Milnacipran, a selective serotonin and norepinephrine reuptake inhibitor, is approved by the Food and Drug Administration for the management of fibromyalgia. It has been available for many years in several countries outside the US for the treatment of depression.

OBJECTIVE

To conduct population-based analyses comparing the risk of serious cardiovascular (CV) events (eg, acute myocardial infarction, stroke, congestive heart failure) associated with treatment with milnacipran compared with venlafaxine and amitriptyline, 2 other commonly prescribed drugs that also inhibit reuptake of norepinephrine and serotonin.

METHODS

Information from the French Thales electronic health record database from 2001 to 2007 was used. Patients with 1 or more prescriptions for milnacipran, venlafaxine, or amitriptyline; 180 or more days of continuous eligibility prior to the first prescription; and no prior CV event diagnoses during the 180-day baseline period were included. A retrospective, matched-cohort design was employed. The incidence rates of CV events between cohorts receiving milnacipran, venlafaxine, and amitriptyline were compared using unadjusted incidence rate ratio (IRR) and adjusted conditional IRR based on Poisson regression.

RESULTS

We identified 4452 milnacipran-venlafaxine and 3761 milnacipran-amitriptyline matched pairs. The matched cohorts had similar baseline characteristics. The unadjusted IRRs of any CV events, comparing milnacipran with venlafaxine or amitriptyline, were 1.02 (95% CI 0.73 to 1.44) and 1.30 (95% CI 0.90 to 1.89), respectively. Adjusted IRRs confirmed the statistical similarity in the CV event risk between milnacipran and venlafaxine (adjusted IRR = 1.29, 95% CI 0.76 to 2.17) or amitriptyline (adjusted IRR = 1.06, 95% CI 0.59 to 1.89).

CONCLUSIONS

This French population-based study found that the risk of CV events was not significantly different for patients receiving milnacipran versus those receiving venlafaxine or amitriptyline.

摘要

背景

米那普明是一种选择性5-羟色胺和去甲肾上腺素再摄取抑制剂，已获美国食品药品监督管理局批准用于治疗纤维肌痛。在美国以外的几个国家，它已上市多年用于治疗抑郁症。

目的

进行基于人群的分析，比较米那普明与文拉法辛及阿米替林治疗相关的严重心血管（CV）事件（如急性心肌梗死、中风、充血性心力衰竭）风险，后两者是另外两种常用的也抑制去甲肾上腺素和5-羟色胺再摄取的药物。

方法

使用来自法国泰利斯电子健康记录数据库2001年至2007年的信息。纳入有1张或更多张米那普明、文拉法辛或阿米替林处方的患者；首次处方前连续符合条件180天或更长时间；且在180天基线期内无先前CV事件诊断。采用回顾性匹配队列设计。使用未调整发病率比（IRR）和基于泊松回归的调整后条件IRR比较接受米那普明、文拉法辛和阿米替林治疗的队列之间CV事件的发病率。

结果

我们确定了4452对米那普明-文拉法辛匹配对和3761对米那普明-阿米替林匹配对。匹配队列具有相似的基线特征。将米那普明与文拉法辛或阿米替林相比，任何CV事件的未调整IRR分别为1.02（95%CI 0.73至1.44）和1.30（95%CI 0.90至1.89）。调整后的IRR证实了米那普明与文拉法辛（调整后IRR = 1.29，95%CI 0.76至2.17）或阿米替林（调整后IRR = 1.06，95%CI 0.59至1.89）之间CV事件风险的统计学相似性。