Chung Ying-Shan, Shao Shih-Chieh, Chi Mei-Hong, Lin Swu-Jane, Su Chien-Chou, Kao Yang Yea-Huei, Yang Yen-Kuang, Lai Edward Chia-Cheng
School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan.
Department of Pharmacy, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Eur Child Adolesc Psychiatry. 2021 May;30(5):769-783. doi: 10.1007/s00787-020-01560-1. Epub 2020 May 29.
Understanding different cardiometabolic safety profiles of antipsychotics helps avoid unintended outcomes among young patients. We conducted a population-based study to compare cardiometabolic risk among different antipsychotics in children, adolescents and young adults. From Taiwan's National Health Insurance Database, 2001-2013, we identified two patient cohorts aged 5-18 (children and adolescents) and 19-30 (young adults), diagnosed with psychiatric disorders and newly receiving antipsychotics, including haloperidol and sulpiride, and second generation antipsychotics (SGA, including olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, paliperidone, and ziprasidone). Risperidone users were considered the reference group. We analyzed electronic medical records from seven hospitals in Taiwan and confirmed findings with validation analyses of identical design. Primary outcomes were composite cardiometabolic events, including type 2 diabetes mellitus, hypertension, dyslipidemia, and major adverse cardiovascular events. Multivariable Cox proportional hazards regression models compared cardiometabolic risk among antipsychotics. Among 29,030 patients aged 5-18 and 50,359 patients aged 19-30 years, we found 1200 cardiometabolic event cases during the total follow-up time of 37,420 person-years with an incidence of 32.1 per 1000 person-years. Compared to risperidone, olanzapine was associated with a significantly higher risk of cardiometabolic events in young adults (adjusted hazard ratio, 1.57; 95% CIs 1.13-2.18) but not in children and adolescents (1.85; 0.79-4.32). Specifically, we found young adult patients receiving haloperidol (1.52; 1.06-2.20) or olanzapine (1.75; 1.18-2.61) had higher risk of hypertension compared with risperidone users. Results from validation analyses concurred with main analyses. Antipsychotics' various risk profiles for cardiometabolic events merit consideration when selecting appropriate regimes. Due to cardiometabolic risk, we suggest clinicians may consider to select alternative antipsychotics to olanzapine in children, adolescents and young adults.
了解抗精神病药物不同的心脏代谢安全性特征有助于避免年轻患者出现意外后果。我们开展了一项基于人群的研究，以比较儿童、青少年和青年中不同抗精神病药物的心脏代谢风险。从台湾2001年至2013年的国民健康保险数据库中，我们确定了两个患者队列，年龄分别为5至18岁（儿童和青少年）以及19至30岁（青年），他们被诊断患有精神疾病且新开始使用抗精神病药物，包括氟哌啶醇和舒必利，以及第二代抗精神病药物（SGA，包括奥氮平、喹硫平、利培酮、氨磺必利、阿立哌唑、帕利哌酮和齐拉西酮）。使用利培酮的患者被视为参照组。我们分析了台湾七家医院的电子病历，并通过相同设计的验证分析来确认研究结果。主要结局为复合心脏代谢事件，包括2型糖尿病、高血压、血脂异常和主要不良心血管事件。多变量Cox比例风险回归模型比较了抗精神病药物之间的心脏代谢风险。在29,030名5至18岁的患者和50,359名19至30岁的患者中，我们在总计37,420人年的随访时间内发现了1200例心脏代谢事件病例，发病率为每1000人年32.1例。与利培酮相比，奥氮平在青年中与显著更高的心脏代谢事件风险相关（校正风险比，1.57；95%置信区间1.13 - 2.18），但在儿童和青少年中并非如此（1.85；0.79 - 4.32）。具体而言，我们发现与使用利培酮的患者相比，使用氟哌啶醇（1.52；1.0
