Hagberg Katrina Wilcox, Divan Hozefa A, Nickel J Curtis, Jick Susan S
Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, Massachusetts.
New England Research Institutes, Inc., Watertown, Massachusetts.
Pharmacotherapy. 2017 May;37(5):517-527. doi: 10.1002/phar.1925. Epub 2017 May 2.
To estimate the risk of incident antidepressant-treated depression in men with benign prostatic hyperplasia (BPH) who were prescribed 5α-reductase inhibitors (5-ARIs) compared with those prescribed an active comparator, α-blockers (ABs).
Retrospective cohort study with a nested case-control analysis.
United Kingdom's Clinical Practice Research Datalink.
A total of 77,732 men with a diagnosis of BPH who received a prescription for a 5-ARI only and/or AB between January 1, 1992, and December 31, 2013. Of these men, 2842 had a first-time (incident) diagnosis of depression and received a prescription for an antidepressant within 90 days of the depression diagnosis date (cases); 11,333 controls without a diagnosis of depression were matched to the cases for the case-control analysis.
Exposures were classified as 5-ARI only, 5ARI + AB, or AB only. We calculated incidence rates of antidepressant-treated depression and compared rates among users of 5-ARIs only and 5-ARIs + ABs with rates among users of ABs only (i.e., incidence rate ratios [IRRs]). We also calculated odds ratios (ORs) to estimate the risk of incident depression with use of 5-ARIs only and 5-ARIs + ABs compared with ABs only. In this population of men with BPH, the risk of depression was not increased with use of 5-ARIs only (IRR 0.94, 95% confidence interval [CI] 0.85-1.04) or 5-ARIs + ABs (IRR 1.04, 95% CI 0.89-1.21) compared with use of ABs only. In the case-control analysis, exposure to 5-ARIs only (adjusted OR 0.88, 95% CI 0.78-1.01) or 5-ARIs + ABs (adjusted OR 0.90, 95% CI 0.73-1.10) was not associated with the risk of treated depression compared with exposure to ABs only, and results remained null regardless of number of prescriptions or timing of exposure. The risk of incident antidepressant-treated depression increased with longer duration of BPH, independent of study drug exposure.
In this population of men with treated BPH, use of 5-ARIs, alone or in combination with ABs, did not increase the risk of incident antidepressant-treated depression compared with use of ABs only. Risk of treated depression increased with longer duration of BPH.
评估与服用活性对照药物α受体阻滞剂（ABs）的良性前列腺增生（BPH）男性相比，服用5α还原酶抑制剂（5-ARIs）的BPH男性发生接受抗抑郁药治疗的抑郁症的风险。
采用巢式病例对照分析的回顾性队列研究。
英国临床实践研究数据链。
共有77732名诊断为BPH的男性，他们在1992年1月1日至2013年12月31日期间仅接受了5-ARI和/或AB的处方。在这些男性中，2842人首次（新发）诊断为抑郁症，并在抑郁症诊断日期后的90天内接受了抗抑郁药处方（病例组）；11333名未诊断出抑郁症的对照者与病例组进行匹配以进行病例对照分析。
暴露情况分为仅使用5-ARI、5-ARI+AB或仅使用AB。我们计算了接受抗抑郁药治疗的抑郁症的发病率，并比较了仅使用5-ARIs和5-ARIs+ABs的使用者与仅使用ABs的使用者的发病率（即发病率比[IRRs]）。我们还计算了比值比（ORs），以评估仅使用5-ARIs和5-ARIs+ABs与仅使用ABs相比发生新发抑郁症的风险。在这群BPH男性中，与仅使用ABs相比，仅使用5-ARIs（IRR 0.94，95%置信区间[CI] 0.85-1.04）或5-ARIs+ABs（IRR 1.04，95%CI 0.89-1.21）时抑郁症风险并未增加。在病例对照分析中，与仅暴露于ABs相比，仅暴露于5-ARIs（校正OR 0.88，95%CI 0.78-1.01）或5-ARIs+ABs（校正OR 0.90，95%CI 0.73-1.10）与接受治疗的抑郁症风险无关，且无论处方数量或暴露时间如何，结果均无差异。接受抗抑郁药治疗的新发抑郁症风险随BPH病程延长而增加，与研究药物暴露无关。
在这群接受治疗的BPH男性中，与仅使用ABs相比，单独使用或与ABs联合使用5-ARIs不会增加接受抗抑郁药治疗的新发抑郁症风险。接受治疗的抑郁症风险随BPH病程延长而增加。
