Ryan Patrick B, Schuemie Martijn J, Ramcharran Darmendra, Stang Paul E
Janssen Research & Development, LLC, Global Research and Development Epidemiology, 1125 Trenton Harbourton Road, Rm K30205, Titusville, NJ, 08560, USA.
Drugs Aging. 2017 Mar;34(3):211-219. doi: 10.1007/s40266-016-0430-x.
A recently published analysis of population-based claims data from Ontario, Canada reported higher risks of acute kidney injury (AKI) and related outcomes among older adults who were new users of atypical antipsychotics (AAPs) compared with unexposed patients. In light of these findings, the objective of the current study was to further investigate the risks of AKI and related outcomes among older adults receiving AAPs.
A replication of the previously published analysis was performed using the US Truven MarketScan Medicare Supplemental database (MDCR) among patients aged 65 years and older. Compared with non-users of AAPs, the study compared the risk of AKI and related outcomes with users of AAPs (quetiapine, risperidone, olanzapine, aripiprazole, or paliperidone) using a 1-to-1 propensity score matched analysis. In addition, we performed adapted analyses that: (1) included all covariates used to fit propensity score models in outcome models; and (2) required patients to have a diagnosis of schizophrenia, bipolar disorder, or major depression and a healthcare visit within 90 days prior to the index date.
AKI effect estimates [as odds ratios (ORs) with 95% confidence intervals (CIs)] were significantly elevated in our MDCR replication analyses (OR 1.45, 95% CI 1.32-1.60); however, in adapted analyses, associations were not significant (OR 0.91, 95% CI 0.78-1.07)). In analyses of AKI and related outcomes, results were mostly consistent between the previously published and the MDCR replication analyses. The primary change that attenuated associations in adapted analyses was the requirement for patients to have a mental health condition and a healthcare visit prior to the index date.
The MDCR analysis yielded similar results when the methodology of the previously published analysis was replicated, but, in adapted analyses, we did not find significantly higher risks of AKI and related outcomes. The contrast of results between our replication and adapted analyses may be due to the analytic approach used to compare patients (and potential confounding by indication). Further research is warranted to evaluate these associations, while also examining methods to account for differences in older adults who do and do not use these medications.
最近一项对加拿大安大略省基于人群的索赔数据的分析报告称，与未使用非典型抗精神病药物（AAPs）的老年患者相比，新使用AAPs的老年患者发生急性肾损伤（AKI）及相关结局的风险更高。鉴于这些发现，本研究的目的是进一步调查接受AAPs治疗的老年患者发生AKI及相关结局的风险。
使用美国Truven MarketScan医疗保险补充数据库（MDCR）对65岁及以上的患者进行了一项重复先前发表的分析。与未使用AAPs的患者相比，本研究采用1:1倾向评分匹配分析，比较了使用AAPs（喹硫平、利培酮、奥氮平、阿立哌唑或帕利哌酮）的患者发生AKI及相关结局的风险。此外，我们还进行了适应性分析：（1）在结局模型中纳入所有用于拟合倾向评分模型的协变量；（2）要求患者在索引日期前90天内被诊断为精神分裂症、双相情感障碍或重度抑郁症且有医疗就诊记录。
在我们的MDCR重复分析中，AKI效应估计值[以比值比（ORs）及95%置信区间（CIs）表示]显著升高（OR 1.45，95% CI 1.32 - 1.60）；然而，在适应性分析中，相关性不显著（OR 0.91，95% CI 0.78 - 1.07）。在AKI及相关结局的分析中，先前发表的分析和MDCR重复分析的结果大多一致。适应性分析中减弱相关性的主要变化是要求患者在索引日期前有心理健康状况和医疗就诊记录。
当重复先前发表分析的方法时，MDCR分析得出了相似的结果，但在适应性分析中，我们未发现AKI及相关结局的风险显著更高。我们的重复分析和适应性分析结果的差异可能归因于用于比较患者的分析方法（以及潜在的指征性混杂因素）。有必要进行进一步研究以评估这些关联，同时也需研究如何解释使用和未使用这些药物的老年患者之间的差异。
