Lai Chien-Hsu, Yeh Yi-Chun, Chen Yen-Yu
Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.
Research Education and Epidemiology Center, Changhua Christian Hospital, Changhua, Taiwan.
Ther Adv Drug Saf. 2019 Jun 20;10:2042098619854007. doi: 10.1177/2042098619854007. eCollection 2019.
Metoclopramide is used to relieve gastrointestinal symptoms, however, it could cause adverse reactions of motor disorders. The aim of this study was to investigate whether metoclopramide treatment has a duration-response or dose-response effect and to estimate the risk of developing Parkinsonism following different and specific durations of treatment.
A cohort study of newly diagnosed type 2 diabetes mellitus in 45- to 79-year-old patients, between 1999 and 2008, was selected using the Longitudinal Health Insurance Database 2005. A nested case-control study was conducted in the diabetes cohort in which all incident cases of Parkinsonism were identified. We randomly matched each case with up to 10 controls from the risk set. Conditional logistic regression was utilized to estimate odds ratio of Parkinsonism associated with metoclopramide use.
A total of 34,685 patients with diabetes were assembled as the cohort, and 541 incident Parkinsonism cases were identified. There were duration-response and dose-response effects on the risk of developing Parkinsonism. Compared with never-use patients, the adjusted odds ratios (ORs) of continuing therapy for 0-1 month, 1-2 months, 2-3 months, 3-5 months, and more than 5 months were 1.17 [95% confidence interval (CI) 0.93-1.45], 1.44 (95% CI 1.04-2.00), 1.74 (95% CI 1.14-2.65), 1.90 (95% CI 1.23-2.93), and 2.17 (95% CI 1.50-3.12), respectively.
With metoclopramide treatment, regardless of less or more than 3 months of use, the risk of developing Parkinsonism in patients with newly diagnosed diabetes escalated with the duration of therapy. Therefore, we recommend close monitoring for the development of Parkinsonism in patients treated with metoclopramide, particularly (but not limited to) those with prolonged exposure.
甲氧氯普胺用于缓解胃肠道症状，然而，它可能会引起运动障碍的不良反应。本研究的目的是调查甲氧氯普胺治疗是否具有疗程 - 反应或剂量 - 反应效应，并评估在不同特定疗程后发生帕金森症的风险。
使用2005年纵向健康保险数据库，选取了1999年至2008年间45至79岁新诊断为2型糖尿病的患者进行队列研究。在糖尿病队列中进行了一项巢式病例对照研究，其中识别出所有帕金森症的新发病例。我们从风险组中为每个病例随机匹配多达10名对照。采用条件逻辑回归来估计与使用甲氧氯普胺相关的帕金森症的比值比。
总共34,685名糖尿病患者被纳入队列，识别出541例帕金森症新发病例。在发生帕金森症的风险方面存在疗程 - 反应和剂量 - 反应效应。与从未使用过的患者相比，持续治疗0 - 1个月、1 - 2个月（此处原文有误，根据上下文应为1 - 3个月）、2 - 3个月、3 - 5个月和超过5个月的调整后比值比（OR）分别为1.17 [95%置信区间（CI）0.93 - 1.45]、1.44（95% CI 1.04 - 2.00）、1.74（95% CI 1.14 - 2.65）、1.90（95% CI 1.23 - 2.93）和2.17（95% CI 1.50 - 3.12）。
使用甲氧氯普胺治疗时，无论使用时间少于还是多于3个月，新诊断糖尿病患者发生帕金森症的风险都会随着治疗疗程的延长而增加。因此，我们建议对接受甲氧氯普胺治疗的患者，尤其是（但不限于）那些长期用药的患者，密切监测帕金森症的发生情况。
