School of Pharmacy, 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; Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm County Council, Stockholm, Sweden.
J Am Med Dir Assoc. 2019 Jun;20(6):751-758. doi: 10.1016/j.jamda.2018.11.012. Epub 2019 Jan 7.
To compare the accumulation of hospital days between initiators and noninitiators of antiepileptic drugs (AEDs) among persons with Alzheimer's disease (AD).
Exposure-matched cohort study.
Persons newly diagnosed with AD in 2005-2011 (n = 70,718) and initiating AED use identified from Finnish health care registers. For each AED initiator, 1 noninitiator matched on age, sex, and time since AD diagnosis was selected. Persons with epilepsy were excluded from the study.
Association between AED initiation or use of individual AEDs and accumulation of hospital days during a 2-year follow-up was assessed using negative binomial model.
AED initiators (n = 4432) were hospitalized on average for 43.7 (SD: 88.3) days and matched noninitiators for 32.2 (SD: 71.3) days during the 2-year follow-up. Altogether, 27.3% of the AED initiators and 35.6% of the noninitiators had no hospital days during the study period. Number of accumulated hospital days during the follow-up was 31% higher [adjusted incidence rate ratio (aIRR): 1.31, 95% confidence interval (CI): 1.19-1.43] among AED initiators than the noninitiators. Hospital days due to diseases of the nervous system excluding dementia (aIRR: 2.72, 95% CI: 1.72-4.31), musculoskeletal system (aIRR: 2.49, 95% CI: 1.73-3.58), respiratory system (aIRR: 1.89, 95% CI: 1.47-2.43), and mental and behavioral disorders excluding dementia (aIRR: 1.96, 95% CI: 1.02-3.79) were more common among the AED initiators than noninitiators. Among pregabalin (aIRR: 0.65, 95% CI: 0.56-0.77), gabapentin (aIRR: 0.66, 95% CI: 0.49-0.88), and clonazepam (aIRR: 0.73, 95% CI: 0.55-0.96) initiators, the number of accumulated hospital days was 27% to 35% lower than the days accumulated among the initiators of valproic acid.
AED initiators had more hospital days than noninitiators. Pregabalin and gabapentin were associated with a lower number of hospital days than valproic acid. Further research is needed on the reasons for these findings.
比较阿尔茨海默病（AD）患者中开始使用和未开始使用抗癫痫药物（AED）者的住院天数累积情况。
暴露匹配队列研究。
2005-2011 年新诊断为 AD 的患者（n=70718）和从芬兰医疗记录中确定的开始使用 AED 的患者。为每个 AED 使用者，选择 1 名在年龄、性别和 AD 诊断后时间上相匹配的非使用者。排除癫痫患者。
使用负二项式模型评估开始使用 AED 或使用特定 AED 与 2 年随访期间住院天数增加之间的关联。
在 2 年的随访期间，AED 使用者（n=4432）的平均住院天数为 43.7（SD：88.3）天，而匹配的非使用者为 32.2（SD：71.3）天。在整个研究期间，27.3%的 AED 使用者和 35.6%的非使用者没有住院。与非使用者相比，AED 使用者在随访期间累积的住院天数增加了 31%[调整发病率比（aIRR）：1.31，95%置信区间（CI）：1.19-1.43]。AED 使用者因神经系统疾病（不包括痴呆）（aIRR：2.72，95%CI：1.72-4.31）、肌肉骨骼系统疾病（aIRR：2.49，95%CI：1.73-3.58）、呼吸系统疾病（aIRR：1.89，95%CI：1.47-2.43）和精神和行为障碍（不包括痴呆）（aIRR：1.96，95%CI：1.02-3.79）的住院天数比非使用者更常见。与丙戊酸相比，普瑞巴林（aIRR：0.65，95%CI：0.56-0.77）、加巴喷丁（aIRR：0.66，95%CI：0.49-0.88）和氯硝西泮（aIRR：0.73，95%CI：0.55-0.96）使用者的累积住院天数减少了 27%至 35%。
AED 使用者的住院天数多于非使用者。普瑞巴林和加巴喷丁与丙戊酸相比，住院天数更少。需要进一步研究这些发现的原因。
