College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon, Republic of Korea.
Neuroepidemiology. 2019;52(3-4):220-226. doi: 10.1159/000497613. Epub 2019 Mar 4.
The prevalence of drug-induced parkinsonism (DIP) has been reported with the use of trimetazidine (TMZ), an antianginal medication available in Asian and European countries. Very few studies have evaluated the association between DIP and TMZ use, and studies using population-based data from national databases are lacking.
To investigate the association between DIP and use of TMZ in patients with angina using data from a national healthcare claims database and to determine the predictive factors of DIP in TMZ use.
A cross-sectional study was conducted on patients aged 40 years or more diagnosed with angina, using the Korean National Healthcare claims 2014 database. The association between TMZ use and DIP was evaluated using multivariate logistic regression analysis, adjusting for confounders, including age; sex; insurance type; comorbidities; and concurrent medications known to be commonly associated with DIP, such as typical and atypical antipsychotics.
Of the patients included in the study, 19% were prescribed TMZ. In addition, 2.5% of TMZ users had preexisting extrapyramidal and movement disorders. TMZ use was found to be a significant predictor of a new diagnosis of parkinsonism (adjusted OR [aOR] 1.39; 95% CI 1.06-1.81; p = 0.016). Age ≥65 years (aOR 2.07; 95% CI 1.13- 3.74; p = 0.017) and stroke as comorbid disease (aOR 3.23; 95% CI 1.87-5.61; p < 0.001) were also significantly associated with a new diagnosis of parkinsonism in TMZ users.
Treatment with TMZ was a statistically significant predictor of a new diagnosis of parkinsonism. Efforts should focus on close monitoring of, and education on, TMZ use in relation to DIP in all patients who are prescribed TMZ, including those with preexisting extrapyramidal and movement disorders.
曲美他嗪（TMZ）是一种在亚洲和欧洲国家使用的抗心绞痛药物，已有报道称其会引起药物性帕金森病（DIP）。仅有少数研究评估了 DIP 与 TMZ 使用之间的关联，且缺乏使用国家数据库的基于人群数据的研究。
使用国家医疗保健索赔数据库中的数据，调查心绞痛患者中 DIP 与 TMZ 使用之间的关联，并确定 TMZ 使用中 DIP 的预测因素。
使用 2014 年韩国国家医疗保健索赔数据库，对年龄在 40 岁及以上被诊断为心绞痛的患者进行了一项横断面研究。使用多变量逻辑回归分析评估 TMZ 使用与 DIP 之间的关联，调整了混杂因素，包括年龄、性别、保险类型、合并症以及与 DIP 常见相关的同时使用的药物，如典型和非典型抗精神病药。
在所纳入的患者中，有 19%的患者处方了 TMZ。此外，有 2.5%的 TMZ 用户有预先存在的锥体外系和运动障碍。TMZ 使用是新诊断为帕金森病的一个显著预测因子（调整后的比值比[aOR] 1.39；95%置信区间[CI] 1.06-1.81；p = 0.016）。年龄≥65 岁（aOR 2.07；95% CI 1.13-3.74；p = 0.017）和合并脑卒中疾病（aOR 3.23；95% CI 1.87-5.61；p < 0.001）也是 TMZ 用户新诊断为帕金森病的显著相关因素。
TMZ 治疗是新诊断为帕金森病的一个具有统计学意义的预测因子。应努力密切监测所有使用 TMZ 的患者（包括有预先存在的锥体外系和运动障碍的患者），并就 DIP 问题对其进行教育。
