Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120, USA.
J Am Geriatr Soc. 2012 Mar;60(3):420-9. doi: 10.1111/j.1532-5415.2011.03853.x. Epub 2012 Feb 13.
To compare the risk of major medical events in nursing home residents newly initiated on conventional or atypical antipsychotic medications (APMs).
Cohort study, using linked Medicaid, Medicare, Minimum Data Set, and Online Survey Certification and Reporting data. Propensity score-adjusted proportional hazards models were used to compare risks for medical events at a class and individual drug level.
Nursing homes in 45 U.S. states.
Eighty-three thousand nine hundred fifty-nine Medicaid-eligible residents aged 65 and older who initiated APM treatment after nursing home admission in 2001 to 2005.
Hospitalization for myocardial infarction, cerebrovascular events, serious bacterial infections, and hip fracture within 180 days of treatment initiation.
Risks of bacterial infections (hazard ratio (HR) = 1.25, 95% confidence interval (CI) = 1.05-1.49) and possibly myocardial infarction (HR = 1.23, 95% CI = 0.81-1.86) and hip fracture (HR = 1.29, 95% CI = 0.95-1.76) were higher, and risks of cerebrovascular events (HR = 0.82, 95% CI = 0.65-1.02) were lower in participants initiating conventional APMs than in those initiating atypical APMs. Little variation existed between individual atypical APMs, except for a somewhat lower risk of cerebrovascular events with olanzapine (HR = 0.91, 95% CI = 0.81-1.02) and quetiapine (HR = 0.89, 95% CI = 0.79-1.02) and a lower risk of bacterial infections (HR = 0.83, 95% CI = 0.73-0.94) and possibly a higher risk of hip fracture (HR = 1.17, 95% CI = 0.96-1.43) with quetiapine than with risperidone. Dose-response relationships were observed for all events (HR = 1.12, 95% CI = 1.05-1.19 for high vs low dose for all events combined).
These associations underscore the importance of carefully selecting the specific APM and dose and monitoring their safety, especially in nursing home residents who have an array of medical illnesses and are undergoing complex medication regimens.
比较新启用传统或非典型抗精神病药物（APM）的养老院居民发生主要医疗事件的风险。
使用链接的医疗补助、医疗保险、最低数据集和在线调查认证和报告数据的队列研究。使用倾向评分调整后的比例风险模型比较了在药物类别和个别药物水平上发生医疗事件的风险。
美国 45 个州的养老院。
83959 名符合医疗补助条件的 65 岁及以上居民，他们在 2001 年至 2005 年养老院入院后开始使用 APM 治疗。
治疗开始后 180 天内的心肌梗死、脑血管事件、严重细菌感染和髋部骨折住院。
细菌感染的风险（危险比（HR）=1.25，95%置信区间（CI）=1.05-1.49）和可能的心肌梗死（HR=1.23，95%CI=0.81-1.86）和髋部骨折（HR=1.29，95%CI=0.95-1.76）的风险较高，而传统 APM 起始组的脑血管事件风险（HR=0.82，95%CI=0.65-1.02）较低。除了奥氮平和喹硫平的脑血管事件风险略低（HR=0.91，95%CI=0.81-1.02）和喹硫平的细菌感染风险较低（HR=0.83，95%CI=0.73-0.94）以及髋部骨折风险可能较高（HR=1.17，95%CI=0.96-1.43）外，个别非典型 APM 之间几乎没有差异，与利培酮相比。所有事件均观察到剂量反应关系（所有事件的 HR=1.12，95%CI=1.05-1.19，高剂量与低剂量）。
这些关联强调了仔细选择特定的 APM 和剂量并监测其安全性的重要性，尤其是在患有一系列医疗疾病并接受复杂药物治疗方案的养老院居民中。
