Tolppanen Anna-Maija, Koponen Marjaana, Tanskanen Antti, Lavikainen Piia, Sund Reijo, Tiihonen Jari, Hartikainen Sirpa, Taipale Heidi
School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland; Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Chest. 2016 Dec;150(6):1233-1241. doi: 10.1016/j.chest.2016.06.004. Epub 2016 Jun 11.
The use of antipsychotic agents has been associated with increased pneumonia risk, but although people with dementia are particularly susceptible to pneumonia, only one small study has assessed the risk of pneumonia in relation to the use of antipsychotic agents among people with Alzheimer disease (AD).
We investigated whether the incident use of antipsychotic agents, or specific antipsychotic agents, are related to a higher risk of hospitalization or death due to pneumonia in the Medication and Alzheimer Disease (MEDALZ) cohort. The cohort includes all individuals with AD who received a clinically verified AD diagnosis in Finland in 2005 to 2011 (N = 60,584; incident pneumonia, n = 12,225). A matched comparison cohort without AD (N = 60,584; incident pneumonia, n = 6,195) was used to compare the magnitude of risk. Results were adjusted for a propensity score derived from comorbidities, concomitant medications, and sociodemographic characteristics. Sensitivity analyses with case-crossover design were conducted.
The use of antipsychotic agents was associated with a higher risk of pneumonia (adjusted hazard ratio [HR], 2.01; 95% CI, 1.90-2.13) in the AD cohort and a somewhat higher risk in the non-AD cohort (adjusted HR, 3.43; 95% CI, 2.99-3.93). Similar results were observed with case-crossover analyses (OR, 2.02; 95% CI, 1.75-2.34 in the AD cohort and OR, 2.59; 95% CI, 1.77-3.79 in the non-AD cohort). The three most commonly used antipsychotic agents (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.
Regardless of applied study design, treatment duration, or the choice of drug, the use of antipsychotic agents was associated with a higher risk of pneumonia. With observational data, we cannot fully rule out a shared causality between pneumonia and the use of antipsychotic agents, but the risk to benefit balance should be considered when antipsychotic agents are prescribed.
使用抗精神病药物与肺炎风险增加有关，但尽管痴呆症患者特别容易患肺炎，但仅有一项小型研究评估了阿尔茨海默病（AD）患者中使用抗精神病药物与肺炎风险之间的关系。
我们在药物与阿尔茨海默病（MEDALZ）队列中调查了抗精神病药物或特定抗精神病药物的首次使用是否与因肺炎住院或死亡的较高风险相关。该队列包括2005年至2011年在芬兰接受临床确诊AD诊断的所有个体（N = 60,584；新发肺炎患者，n = 12,225）。使用一个无AD的匹配对照队列（N = 60,584；新发肺炎患者，n = 6,195）来比较风险程度。结果根据由合并症、伴随用药和社会人口学特征得出的倾向得分进行了调整。采用病例交叉设计进行了敏感性分析。
在AD队列中，使用抗精神病药物与肺炎风险较高相关（调整后的风险比[HR]，2.01；95%可信区间[CI]，1.90 - 2.13），在非AD队列中风险略高（调整后的HR，3.43；95%CI，2.99 - 3.93）。病例交叉分析也观察到了类似结果（AD队列中的比值比[OR]，2.02；95%CI，1.75 - 2.34；非AD队列中的OR，2.59；95%CI，1.77 - 3.79）。三种最常用的抗精神病药物（喹硫平、利培酮、氟哌啶醇）与肺炎风险的关联相似。
无论应用的研究设计、治疗持续时间或药物选择如何，使用抗精神病药物均与较高的肺炎风险相关。基于观察性数据，我们不能完全排除肺炎与使用抗精神病药物之间存在共同因果关系，但在开具抗精神病药物处方时应考虑风险与获益的平衡。
