OptumRx, Irvine, California 92614, USA.
J Am Geriatr Soc. 2012 Mar;60(3):474-9. doi: 10.1111/j.1532-5415.2011.03842.x. Epub 2012 Jan 30.
To examine the association between atypical antipsychotic medications and incident treatment for diabetes mellitus or hyperlipidemia in elderly adults without diagnoses of schizophrenia or bipolar disorder.
Two case-control studies using medical and pharmacy claims data.
United States managed care population from multiple insurance plans.
Individuals aged 65 and older enrolled in a Medicare Advantage or commercial (health maintenance organization) managed care health plan in the western United States with no claims indicating diagnosis of schizophrenia or bipolar disorder in the 1 year pre-index period. Cases were defined as persons newly initiated on an antidiabetic (n = 13,075) or antihyperlipidemic (n = 63,829) medication on the index date. For the new diabetes mellitus analysis, 65,375 controls were matched to cases based on age, sex, health-plan type, and index date year. In the new hyperlipidemia analysis, 63,829 controls were matched to cases based on the same variables.
Conditional logistic regressions were performed to determine the odds of initiated antidiabetic or antihyperlipidemic medication for participants exposed to atypical antipsychotics compared with those with no exposure. The models included comorbidities possibly associated with the outcome.
Exposure to atypical antipsychotics was associated with significantly greater adjusted odds of starting an antidiabetic medication (1.32, 95% confidence interval (CI) = 1.10-1.59) but significantly lower odds of starting an antihyperlipidemic medication (0.76, 95% CI = 0.67-0.87).
Use of atypical antipsychotics in older adults for conditions other than schizophrenia and bipolar disorder was associated with incident treatment of diabetes mellitus but not of hyperlipidemia, suggesting that older adults may be susceptible to the adverse metabolic consequences of these agents.
研究在没有精神分裂症或双相情感障碍诊断的老年患者中，使用非典型抗精神病药物与新发糖尿病或血脂异常治疗之间的关联。
两项病例对照研究，使用医疗和药房理赔数据。
美国多个保险计划的管理式医疗人群。
年龄在 65 岁及以上，参加美国西部医疗保险优势计划或商业（健康维护组织）管理式医疗健康计划的个人，在索引前 1 年内没有理赔表明患有精神分裂症或双相情感障碍。病例定义为索引日期新开始使用抗糖尿病（n = 13075）或抗血脂异常药物（n = 63829）的患者。在新的糖尿病分析中，根据年龄、性别、健康计划类型和索引日期年份，与病例匹配了 65375 名对照。在新的血脂异常分析中，根据相同的变量与病例匹配了 63829 名对照。
使用条件逻辑回归确定与未暴露于非典型抗精神病药物的患者相比，暴露于非典型抗精神病药物的患者开始使用抗糖尿病或抗血脂异常药物的可能性。这些模型包括可能与结果相关的合并症。
与未暴露于非典型抗精神病药物的患者相比，暴露于非典型抗精神病药物与开始使用抗糖尿病药物的调整后比值比显著增加（1.32，95%置信区间（CI）=1.10-1.59），但开始使用抗血脂异常药物的比值比显著降低（0.76，95%CI=0.67-0.87）。
在老年患者中，除精神分裂症和双相情感障碍以外的疾病使用非典型抗精神病药物与新发糖尿病的治疗相关，但与血脂异常的治疗无关，这表明老年患者可能易受这些药物的不良代谢后果的影响。
