Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, NC, USA.
Eur J Neurol. 2020 Jun;27(6):1010-1016. doi: 10.1111/ene.14190. Epub 2020 Mar 17.
Medications that are used for treatment of metabolic disorders have been suggested to be associated with the development of amyotrophic lateral sclerosis (ALS).
To examine the associations of antidiabetics and statins with the subsequent risk of ALS we conducted a population-based nested case-control study of 2475 Swedish residents diagnosed with ALS during July 2006 to December 2013 and 12 375 population controls (five for each ALS case). We extracted information on filled prescriptions of antidiabetics and statins for both cases and controls from the Swedish Prescribed Drug Register during the years before ALS diagnosis. Conditional logistic regression was used to calculate odds ratios (ORs) for the associations of these medications with ALS risk.
Patients with ALS were less likely to have been prescribed with antidiabetics compared with controls [OR, 0.76; 95% confidence intervals (CI), 0.65-0.90]. Conversely, statins were not associated with ALS risk overall (OR, 1.08; 95% CI, 0.98-1.19), although a positive association was noted among women (OR, 1.28; 95% CI, 1.10-1.48). The latter association was mostly explained by ALS cases being more likely to have a first prescription of statins during the year before diagnosis compared with controls (OR, 2.54; 95% CI, 1.84-3.49).
The inverse association of antidiabetics with ALS is consistent with the previously reported inverse association between type 2 diabetes and ALS risk. The increase in prescription of statins during the year before ALS diagnosis deserves attention because it might reflect an acceleration of the course of ALS due to statin use.
用于治疗代谢紊乱的药物被认为与肌萎缩侧索硬化症（ALS）的发展有关。
为了研究抗糖尿病药物和他汀类药物与 ALS 后续风险的关联，我们对 2006 年 7 月至 2013 年 12 月期间在瑞典被诊断患有 ALS 的 2475 名居民（ALS 病例）和 12375 名人群对照（每个 ALS 病例 5 名）进行了一项基于人群的嵌套病例对照研究。我们从瑞典处方药物登记处提取了 ALS 诊断前几年病例和对照者的抗糖尿病药物和他汀类药物处方信息。使用条件逻辑回归计算了这些药物与 ALS 风险关联的比值比（OR）。
与对照者相比，ALS 患者服用抗糖尿病药物的可能性较小[OR，0.76；95%置信区间（CI），0.65-0.90]。相反，他汀类药物总体上与 ALS 风险无关（OR，1.08；95% CI，0.98-1.19），尽管女性中存在正相关（OR，1.28；95% CI，1.10-1.48）。这种关联主要归因于与对照者相比，ALS 病例更有可能在诊断前一年首次开他汀类药物处方（OR，2.54；95% CI，1.84-3.49）。
抗糖尿病药物与 ALS 的负相关与之前报道的 2 型糖尿病与 ALS 风险之间的负相关一致。ALS 诊断前一年他汀类药物处方量的增加值得关注，因为这可能反映了他汀类药物使用加速了 ALS 的进程。
