Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Schizophr Res. 2020 Aug;222:327-334. doi: 10.1016/j.schres.2020.05.013. Epub 2020 Jun 2.
Aim Research regarding the effect of antipsychotic medications on the risk of upper respiratory infection (URI) progression to pneumonia in patients with schizophrenia is rare. This study investigated the effect of antipsychotic use on the risk of URI progression to pneumonia in patients with schizophrenia.
This cohort study used the Taiwan's Nationwide Psychiatric Inpatient Medical Claims Database. From January 1, 1996 to December 31, 2012, 22,771 patients with schizophrenia were diagnosed as having the first URI episode after their first psychiatric admission and 135 of them developed pneumonia within 30 days. The duration and dosage of antipsychotics were assessed before and after URI. Cox regression with time-dependent model was used to assess the risk of antipsychotic use on the progression of URI to pneumonia.
Among first- and second-generation antipsychotics, clozapine was the only medication associated with an increased risk of developing pneumonia before URI (adjusted hazard ratio [aHR] = 2.05, P = .024). Clozapine was also the only drug significantly associated with an increased risk after URI (aHR = 1.92, P = .027). Regarding medication use after URI, the dosage of clozapine was significantly associated with an increased risk based on Cox regression with a time-dependent model (aHR = 1.95, P = .003).
The use of clozapine was associated with URI progression to pneumonia in patients with schizophrenia. The dosage of clozapine used in the post-URI period was also associated with an increased risk. Clinicians should consider lowering clozapine dosage in patients with URI to prevent them developing pneumonia.
关于抗精神病药物对精神分裂症患者上呼吸道感染 (URI) 进展为肺炎风险的影响的研究很少。本研究调查了抗精神病药物使用与精神分裂症患者 URI 进展为肺炎的风险之间的关系。
这项队列研究使用了台湾的全国精神病住院医疗索赔数据库。1996 年 1 月 1 日至 2012 年 12 月 31 日期间，22771 名首次精神病入院后被诊断为首次 URI 发作的精神分裂症患者中有 135 人在 30 天内发展为肺炎。评估了 URI 前后抗精神病药物的持续时间和剂量。使用时变模型的 Cox 回归评估抗精神病药物使用对 URI 进展为肺炎的风险。
在第一代和第二代抗精神病药物中，氯氮平是唯一一种与 URI 前发生肺炎风险增加相关的药物（调整后的危害比 [aHR] = 2.05，P =.024）。氯氮平也是唯一一种与 URI 后发生肺炎风险增加显著相关的药物（aHR = 1.92，P =.027）。关于 URI 后的药物使用，氯氮平的剂量基于时变模型的 Cox 回归与风险增加显著相关（aHR = 1.95，P =.003）。
氯氮平的使用与精神分裂症患者的 URI 进展为肺炎有关。URI 后使用氯氮平的剂量也与风险增加有关。临床医生应考虑降低 URI 患者的氯氮平剂量，以防止他们患上肺炎。
