Lai Edward Chia-Cheng, Wong Monera B, Iwata Isao, Zhang Yinghong, Hsieh Cheng-Yang, Kao Yang Yea-Huei, Setoguchi Soko
Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina.
School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan.
J Am Geriatr Soc. 2015 May;63(5):869-76. doi: 10.1111/jgs.13380. Epub 2015 Apr 27.
To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia.
Retrospective cohort study.
Nationally representative 5% sample of Medicare databases.
Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009.
Pneumonia, defined as the presence of a diagnosis code for pneumonia as the primary diagnosis on an inpatient claim or on an emergency department claim followed by dispensing of appropriate antibiotics. Cox proportional hazards models were used to estimate the risk of pneumonia. Subgroup analyses and sensitivity analyses were conducted using alternative pneumonia definitions and adjustments using high-dimensional propensity scores to test the robustness of the results.
The mean age of 35,570 new users of cholinesterase inhibitors (30,174 users of donepezil, 1,176 users of galantamine, 4,220 users of rivastigmine) was 82; 75% were women, and 82% were white. The cumulative incidence of pneumonia was 51.9 per 1,000 person-years. The risk of pneumonia for rivastigmine users was 24% lower than that of donepezil users (hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.60-0.93). Risk in galantamine users (HR=0.87, 95% CI=0.62-1.23) was not significantly different from risk in donepezil users. Results of subgroup and sensitivity analyses were similar to the primary results.
The risk of pneumonia was lower in individuals receiving rivastigmine than in those receiving donepezil. Additional studies are needed to confirm the findings of pneumonia risk between the oral and transdermal forms of rivastigmine and in users of galantamine.
比较接受多奈哌齐、加兰他敏或卡巴拉汀治疗痴呆症的老年人发生肺炎的风险。
回顾性队列研究。
来自医疗保险数据库的具有全国代表性的5%样本。
2006年至2009年间新开始使用胆碱酯酶抑制剂治疗的65岁及以上医疗保险受益人。
肺炎定义为住院索赔或急诊科索赔中以肺炎诊断代码作为主要诊断，随后配发适当抗生素。采用Cox比例风险模型估计肺炎风险。使用替代肺炎定义进行亚组分析和敏感性分析，并使用高维倾向评分进行调整以检验结果的稳健性。
35570名新使用胆碱酯酶抑制剂的患者（30174名使用多奈哌齐、1176名使用加兰他敏、4220名使用卡巴拉汀）的平均年龄为82岁；75%为女性，82%为白人。肺炎的累积发病率为每1000人年51.9例。卡巴拉汀使用者发生肺炎的风险比多奈哌齐使用者低24%（风险比(HR)=0.75，95%置信区间(CI)=0.60-0.93）。加兰他敏使用者的风险（HR=0.87，95%CI=0.62-1.23）与多奈哌齐使用者的风险无显著差异。亚组分析和敏感性分析结果与主要结果相似。
接受卡巴拉汀治疗的个体发生肺炎的风险低于接受多奈哌齐治疗的个体。需要进一步研究以证实口服和透皮形式卡巴拉汀之间以及加兰他敏使用者中肺炎风险的研究结果。
