Department of Biochemistry, University of Otago, Dunedin, New Zealand.
Leeds School of Medicine, University of Leeds, Leeds, UK.
Pharmacoepidemiol Drug Saf. 2020 Jun;29(6):692-700. doi: 10.1002/pds.5007. Epub 2020 Apr 16.
The purpose of this study was to examine the incidence of Parkinsonism in new users of second-generation antipsychotics (SGAs) in older adults (≥65 years). In the secondary analyses, we examined the risk of Parkinsonism by type and dose of SGA and conducted age-sex interactions.
This population-based study included older adults who had a new-onset diagnosis of Parkinsonism and who started taking olanzapine, risperidone or quetiapine between 1 January 2005, and 30 December 2016. The Cox proportional hazard (COXPH) model with inverse probability treatment weighted (IPTW) covariates was used to evaluate the risk of new-onset Parkinsonism associated with SGAs, using quetiapine as the reference. We used the Generalized Propensity Score method to evaluate the dose-response risk of Parkinsonism associated with SGAs.
After IPTW adjustment for covariates, the COXPH model showed that compared to quetiapine, the use of olanzapine and risperidone were associated with an increased risk of Parkinsonism. The IPTW-hazard ratios are 1.76 (95% confidence interval 1.57-1.97) and 1.31 (95%CI 1.16-1.49), respectively. The dose-response risk of Parkinsonism was highest for olanzapine with a hazard ratio of 1.69 (95%CI 1.40-2.05) and the least for quetiapine with a hazard ratio of 1.22 (95%CI 1.14-1.31). The risk of Parkinsonism in the 65 to 74-year age group was higher for both sexes with risperidone compared to olanzapine, but the risk increased with olanzapine for both sexes in the 85+ age group.
The study found that the risk of new-onset Parkinsonism in older adults is 31% and 76% higher with risperidone and olanzapine respectively compared to quetiapine.
本研究旨在探讨第二代抗精神病药物（SGAs）在老年患者（≥65 岁）中新使用者帕金森病的发生率。在次要分析中，我们根据 SGA 的类型和剂量检查了帕金森病的风险，并进行了年龄-性别交互作用分析。
这是一项基于人群的研究，纳入了在 2005 年 1 月 1 日至 2016 年 12 月 30 日期间首次诊断为帕金森病且开始服用奥氮平、利培酮或喹硫平的老年患者。采用逆概率治疗加权（IPTW）协变量的 Cox 比例风险（COXPH）模型，以评估与 SGAs 相关的新发帕金森病的风险，以喹硫平为参照。我们使用广义倾向评分法评估与 SGAs 相关的帕金森病的剂量-反应风险。
在调整协变量后的 IPTW 后，COXPH 模型显示，与喹硫平相比，奥氮平和利培酮的使用与帕金森病的风险增加相关。IPTW 危害比分别为 1.76（95%置信区间 1.57-1.97）和 1.31（95%CI 1.16-1.49）。奥氮平的帕金森病风险最高，危害比为 1.69（95%CI 1.40-2.05），而喹硫平的危害比最低，为 1.22（95%CI 1.14-1.31）。与奥氮平相比，65 至 74 岁年龄组的 risperidone 对男女的帕金森病风险均较高，但在 85 岁以上年龄组，奥氮平对男女的风险均增加。
本研究发现，与喹硫平相比， risperidone 和 olanzapine 分别使老年患者新发帕金森病的风险增加 31%和 76%。
