a Department of Pharmacy , Taichung Veterans General Hospital , Taichung , Taiwan.
b Critical care center and Cardiovascular Medical Center, Kaohsiung Veterans General Hospital , Kaohsiung , Taiwan.
Curr Med Res Opin. 2019 May;35(5):903-907. doi: 10.1080/03007995.2018.1541447. Epub 2018 Nov 23.
Although classic anti-epileptic drugs have been associated with increased fracture risk, data are lacking on the outcomes of newer anti-epileptic drugs, such as gabapentin (GBP), levetiracetam, pregabalin, oxcarbazepine (OXC), and topiramate. This study was designed to determine fracture risks in the elderly associated with newly-developed anti-epileptic drugs.
A total of 2,169 patients (median age = 71.01 years, SD = 11.25 years) who experienced fractures between 2006 and 2013 were selected. For each case, age-, sex-, and comorbidity-matched controls were selected. The assessed clinical outcome was any fracture, and the use of anti-epileptic drugs was used as an exposure variable.
There were no differences in age, sex, or comorbidities between patients and controls, but patients with fractures often lived in urban areas (odds ratio [OR] = 1.17; 95% confidence interval [CI] = 1.05-1.29) and had low income (OR = 1.14; 95% CI = 1.01-1.29) compared to controls. A significant increase in fractures was associated with OXC (OR = 3.31; 95% CI = 1.59-6.92), carbamazepine (CBZ; OR = 2.18; 95% CI = 1.31-3.61), and GBP (OR = 1.79; 95% CI = 1.01-3.18). Phenobarbital (OR = 1.97; 95%CI = 0.53-7.34), phenytoin (OR = 0.52; 95% CI = 0.23-1.16), levetiracetam (OR = 1.84; 95% CI = 0.55-6.16), valproic acid (OR = 1.01; 95% CI = 0.53-1.92), lamotrigine (OR = 1.44; 95% CI = 0.12-16.65), and topiramate (OR = 0.47; 95% CI = 0.10-2.31) were not associated with fracture risk.
CBZ, GBP, and OXC users have a significantly higher risk of fracture. Most recently-developed anti-epileptic drugs are not associated with an increased risk of fracture in individuals aged ≥50 years.
虽然经典的抗癫痫药物与骨折风险增加有关，但关于新型抗癫痫药物（如加巴喷丁（GBP）、左乙拉西坦、普瑞巴林、奥卡西平（OXC）和托吡酯）的结局的数据尚缺乏。本研究旨在确定与新开发的抗癫痫药物相关的老年患者骨折风险。
共纳入 2169 例（中位年龄=71.01 岁，标准差=11.25 岁）2006 年至 2013 年期间发生骨折的患者。为每个病例选择年龄、性别和合并症匹配的对照组。评估的临床结局为任何骨折，抗癫痫药物的使用作为暴露变量。
患者和对照组在年龄、性别或合并症方面无差异，但与对照组相比，骨折患者通常居住在城市地区（比值比[OR] = 1.17；95%置信区间[CI] = 1.05-1.29）且收入较低（OR = 1.14；95%CI = 1.01-1.29）。与对照组相比，OXC（OR = 3.31；95%CI = 1.59-6.92）、卡马西平（CBZ；OR = 2.18；95%CI = 1.31-3.61）和 GBP（OR = 1.79；95%CI = 1.01-3.18）与骨折风险显著增加相关。苯巴比妥（OR = 1.97；95%CI = 0.53-7.34）、苯妥英（OR = 0.52；95%CI = 0.23-1.16）、左乙拉西坦（OR = 1.84；95%CI = 0.55-6.16）、丙戊酸（OR = 1.01；95%CI = 0.53-1.92）、拉莫三嗪（OR = 1.44；95%CI = 0.12-16.65）和托吡酯（OR = 0.47；95%CI = 0.10-2.31）与骨折风险无关。
CBZ、GBP 和 OXC 使用者的骨折风险显著增加。在年龄≥50 岁的个体中，大多数新开发的抗癫痫药物与骨折风险增加无关。
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