抗抑郁药与非甾体抗炎药联合使用者患消化性溃疡的差异风险

Differential Risk of Peptic Ulcer Among Users of Antidepressants Combined With Nonsteroidal Anti-inflammatory Drugs.

作者信息

Shin Ju-Young, Song Inmyung, Lee Jin-Ho, Yoon Jong Lull, Kwon Jun Soo, Park Byung-Joo

机构信息

From the *School of Pharmacy, Sungkyunkwan University, Suwon; †Korea Centers for Disease Control and Prevention, Division of Risk Assessment and International Cooperation, Cheongju; ‡Department of Internal Medicine, Dongguk University College of Medicine, Goyang; §Department of Family Medicine, Hallym University College of Medicine, Hwasung; and Departments of ∥Psychiatry and ¶Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.

出版信息

J Clin Psychopharmacol. 2017 Apr;37(2):239-245. doi: 10.1097/JCP.0000000000000676.

DOI:10.1097/JCP.0000000000000676

PMID:28166082

Abstract

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) have been reported to have an increased risk of gastrointestinal adverse events, and the risk may be further increased by combined use of nonsteroidal anti-inflammatory drugs (NSAIDs). However, little has been known about the risk of peptic ulcer associated with other classes of antidepressants or individual antidepressants combined with NSAIDs.

METHODS

We conducted a retrospective cohort study to define the risk of peptic ulcer associated with combined use of antidepressants and NSAIDs, as compared with use of antidepressants alone. Using the Korean Health Insurance Review and Assessment Service database, we identified a total of 1,127,622 patients who began receiving antidepressants between 2009 and 2012. Propensity-based matching and Cox proportional hazards models were used to compare the risk of peptic ulcer between antidepressant users with NSAIDs and those without NSAIDs matched in a 1:1 ratio, for a total of 768,850 patients.

RESULTS

The risk of peptic ulcer did not increase with combined use of overall antidepressants and NSAIDs, as compared with antidepressant use alone (hazard ratio [HR], 1.02; 95% confidence interval [CI], 0.99-1.06). A slightly increased risk was observed for combined use of NSAIDs with tricyclic antidepressants (HR, 1.15; 95% CI, 1.09-1.21) and with SSRIs (HR, 1.08; 95% CI, 1.01-1.16).

CONCLUSION

We found that although concomitant use of NSAIDs and antidepressants was not associated with an increased risk of peptic ulcer for antidepressants in general, it was so for some specific classes including tricyclic antidepressants and SSRIs. However, we cannot rule out the possibility that the increased risk was solely due to NSAID use.

摘要

背景

据报道，选择性5-羟色胺再摄取抑制剂（SSRI）会增加胃肠道不良事件的风险，并且非甾体抗炎药（NSAID）联合使用可能会进一步增加该风险。然而，对于与其他类别的抗抑郁药或与NSAID联合使用的个别抗抑郁药相关的消化性溃疡风险，人们知之甚少。

方法

我们进行了一项回顾性队列研究，以确定与单独使用抗抑郁药相比，抗抑郁药与NSAID联合使用相关的消化性溃疡风险。利用韩国健康保险审查与评估服务数据库，我们共识别出1,127,622名在2009年至2012年间开始接受抗抑郁药治疗的患者。采用倾向匹配和Cox比例风险模型，比较了768,850名1:1比例匹配的使用NSAID的抗抑郁药使用者和未使用NSAID的抗抑郁药使用者之间的消化性溃疡风险。

结果

与单独使用抗抑郁药相比，总体抗抑郁药与NSAID联合使用时消化性溃疡风险并未增加（风险比[HR]，1.02；95%置信区间[CI]，0.99 - 1.06）。NSAID与三环类抗抑郁药联合使用（HR，1.15；95% CI，1.09 - 1.21）以及与SSRI联合使用（HR，1.08；95% CI，1.01 - 1.16）时，观察到风险略有增加。