Mehta Sandhya, Pulungan Zulkarnain, Jones Barton T, Teigland Christie
Quintiles, Inc., Cambridge, MA, USA.
Inovalon, Inc., Bowie, MD, USA.
Pharmacoepidemiol Drug Saf. 2015 Dec;24(12):1271-80. doi: 10.1002/pds.3882. Epub 2015 Oct 7.
Previous studies have documented increased risk of pneumonia with antipsychotic use in the elderly; however, differential risk across individual atypical antipsychotics remains unaddressed. This study examines the effect of individual atypical antipsychotics on risk of pneumonia in elderly patients.
This retrospective cohort study was conducted using a large claims database. The study population included new users of atypical antipsychotics (≥65 years). The multiple propensity-score adjusted survival model was used to examine risk of pneumonia within a 1-year follow-up period.
A total of 92 234 patients newly prescribed atypical antipsychotic medication were identified. Of these, 41 780 (45.30%) were quetiapine users, 31 048 (33.66%) risperidone users, 11 375 (12.33%) olanzapine users, 6790 (7.36%) aripiprazole users, and 1241 (1.35%) ziprasidone users. Within the 1-year follow-up period, 12 411 (13.46%) patients taking atypical antipsychotics had a diagnosis of pneumonia. The multiple propensity-score-adjusted survival model revealed increased risk of pneumonia with the use of risperidone (hazard ratios (HR) 1.14, 95%CI 1.10-1.18) and olanzapine (HR 1.10, 95%CI 1.04-1.16) compared with the use of quetiapine.
This large population-based study suggests that use of risperidone and olanzapine increases risk of pneumonia compared with use of quetiapine in elderly patients. This study provides new information on the comparative risk of pneumonia associated with different atypical antipsychotics in the elderly to support optimal treatment decisions.
既往研究已证明老年人使用抗精神病药物会增加患肺炎的风险；然而，不同个体非典型抗精神病药物的风险差异仍未得到解决。本研究旨在探讨个体非典型抗精神病药物对老年患者肺炎风险的影响。
本回顾性队列研究使用了一个大型理赔数据库。研究人群包括非典型抗精神病药物的新使用者（≥65岁）。采用多重倾向评分调整生存模型来检查1年随访期内的肺炎风险。
共识别出92234名新开具非典型抗精神病药物的患者。其中，41780名（45.30%）使用喹硫平，31048名（33.66%）使用利培酮，11375名（12.33%）使用奥氮平，6790名（7.36%）使用阿立哌唑，1241名（1.35%）使用齐拉西酮。在1年随访期内，12411名（13.46%）服用非典型抗精神病药物的患者被诊断为肺炎。多重倾向评分调整生存模型显示，与使用喹硫平相比，使用利培酮（风险比[HR]1.14，95%CI 1.10-1.18）和奥氮平（HR 1.10，95%CI 1.04-1.16）会增加肺炎风险。
这项基于大量人群的研究表明，与喹硫平相比，老年患者使用利培酮和奥氮平会增加患肺炎的风险。本研究提供了关于不同非典型抗精神病药物与老年人肺炎相关比较风险的新信息，以支持最佳治疗决策。
