Pisa Federica Edith, Reinold Jonas, Kollhorst Bianca, Haug Ulrike, Schink Tania
Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany,
Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy,
Clin Epidemiol. 2019 Feb 15;11:185-196. doi: 10.2147/CLEP.S173667. eCollection 2019.
To determine the association of individual antidepressants (ADs) with the risk of traumatic brain injury (TBI) in the elderly.
We conducted a case-control study nested in a cohort of new users of ADs aged ≥65 years, identified in the German Pharmacoepidemiological Research Database during 2005-2014. Cases were patients first hospitalized for TBI. Up to 100 controls per case were selected using incidence density sampling. AD use was ascertained at the index date based on the supply of last dispensing (adding 150% of the defined daily doses [DDDs]; in sensitivity analysis, no additional DDDs were considered). We estimated adjusted ORs (aORs) and 95% CIs using conditional logistic regression.
Among 701,309 cohort members, 16,750 cases were identified and matched to 1,673,320 controls (in both groups: 70.4% women; median age 80 years). Compared with remote users of the same AD, current users had an aOR (95% CI) of 1.87 (1.56-2.24) for duloxetine, 1.74 (1.41-2.15) for escitalopram, 1.70 (1.58-1.83) for citalopram, 1.66 (1.40-1.97) for sertraline, 1.64 (1.24-2.15) for fluoxetine and 1.57 (1.20-2.06) for paroxetine. The aOR was lower for amitriptyline (1.45; 1.32-1.58), trimipramine (1.17; 0.99-1.38) and opipramol (1.11; 0.99-1.25). Mirtazapine had an aOR of 1.03 (0.94-1.12). Sensitivity analysis confirmed the findings.
The large variability between individual ADs shows the importance of considering the safety of individual agents rather than focusing on class alone.
确定老年人群中个体抗抑郁药（ADs）与创伤性脑损伤（TBI）风险之间的关联。
我们开展了一项病例对照研究，该研究嵌套于一个年龄≥65岁的ADs新使用者队列中，这些使用者于2005年至2014年期间在德国药物流行病学研究数据库中被识别出来。病例为首次因TBI住院的患者。采用发病密度抽样为每个病例选取多达100名对照。根据最后一次配药的供应情况（加上规定日剂量[DDD]的150%；在敏感性分析中，未考虑额外的DDD）在索引日期确定ADs的使用情况。我们使用条件逻辑回归估计调整后的比值比（aORs）和95%置信区间（CIs）。
在701,309名队列成员中，识别出16,750例病例，并与1,673,320名对照进行匹配（两组中：女性占70.4%；中位年龄80岁）。与使用相同AD的非近期使用者相比，度洛西汀的当前使用者的aOR（95%CI）为1.87（1.56 - 2.24），艾司西酞普兰为1.74（1.41 - 2.15），西酞普兰为1.70（1.58 - 1.83），舍曲林为1.66（1.40 - 1.97），氟西汀为1.64（1.24 - 2.15），帕罗西汀为1.57（1.20 - 2.06）。阿米替林（1.45；1.32 - 1.58）、曲米帕明（1.17；0.99 - 1.38）和奥匹哌醇（1.11；0.99 - 1.25）的aOR较低。米氮平的aOR为1.03（0.94 - 1.12）。敏感性分析证实了这些发现。
个体ADs之间的巨大差异表明考虑个体药物安全性而非仅关注药物类别很重要。
