Faculty of Social Sciences, Tampere University, Tampere, Finland.
Hatanpää Health Center, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
PLoS One. 2023 Feb 28;18(2):e0281979. doi: 10.1371/journal.pone.0281979. eCollection 2023.
Pharmacovigilance reports have suggested that certain commonly used medications may trigger autoimmune diseases (ADs) and immune-mediated inflammatory diseases (IMIDs). We systematically reviewed the literature to evaluate whether psychiatric medication use is associated with ADs and IMIDs.
The protocol was registered in PROSPERO (CRD42022296524) before the start of the study. We searched Medline Ovid and Scopus up to November 28th, 2021, for comparative studies, with any psychiatric medication as exposure and ADs and IMIDs as outcomes. Meta-analysis was performed using DerSimonian-Laird random-effects modeling. The PRISMA 2020 guidelines were followed in reporting. Study-level risk of bias was assessed using the Newcastle-Ottawa Scale, and the overall certainty of evidence using GRADE.
There were 7,265 citations from which 31 studies were eligible, all from high-income countries, covering 15 distinct immune diseases. The evidence for the association between selective serotonin reuptake inhibitor (SSRI) use and higher risk of microscopic colitis (meta-OR 2.60, 95% CI 1.05-6.39, I2 97.5%, 6 studies) was of low certainty. A subgroup analysis by the histological type of microscopic colitis showed a statistically significant association only with lymphocytic colitis (meta-OR 2.88, 95% CI 2.60-3.18, I2 00.00%, three studies). In two case-control studies, SSRI use had no significant association with psoriasis (meta-OR 0.80, 95% CI 0.58-1.10, I2 82.4%). The risk of acute pancreatitis was slightly increased with exposure to SSRIs (meta-OR 1.13, 95% CI 1.01-1.26, I2 00.0%), as was the risk of bullous pemphigoid after exposure to antipsychotics (meta-OR 1.79, 95% CI 1.17-2.73, I2 0%).
We reviewed the literature on whether psychiatric medications associate with the risk of ADs and IMIDs and concluded that, despite several signals, the credibility of evidence remains low at best. Prospective cohort studies would be needed as the next step to confirm the suggestions of increased risk.
药物警戒报告表明，某些常用药物可能会引发自身免疫性疾病（AD）和免疫介导的炎症性疾病（IMID）。我们系统地回顾了文献，以评估精神药物的使用是否与 AD 和 IMID 相关。
该方案在研究开始前已在 PROSPERO（CRD42022296524）中进行了注册。我们检索了 Medline Ovid 和 Scopus，截至 2021 年 11 月 28 日，以任何精神药物作为暴露因素，AD 和 IMID 作为结局，进行了比较研究。采用 DerSimonian-Laird 随机效应模型进行荟萃分析。采用纽卡斯尔-渥太华量表评估研究水平的偏倚风险，并采用 GRADE 评估证据的总体确定性。
从 7265 条引文中筛选出 31 项符合条件的研究，均来自高收入国家，涵盖了 15 种不同的免疫性疾病。使用选择性 5-羟色胺再摄取抑制剂（SSRI）与更高的显微镜结肠炎风险之间存在关联的证据质量为低（汇总 OR 2.60，95%CI 1.05-6.39，I2 97.5%，6 项研究）。显微镜结肠炎的组织学类型亚组分析显示，仅与淋巴细胞性结肠炎存在统计学显著关联（汇总 OR 2.88，95%CI 2.60-3.18，I2 00.00%，3 项研究）。在两项病例对照研究中，SSRI 使用与银屑病无显著关联（汇总 OR 0.80，95%CI 0.58-1.10，I2 82.4%）。暴露于 SSRIs 会略微增加急性胰腺炎的风险（汇总 OR 1.13，95%CI 1.01-1.26，I2 00.0%），暴露于抗精神病药后会增加大疱性类天疱疮的风险（汇总 OR 1.79，95%CI 1.17-2.73，I2 0%）。
我们回顾了有关精神药物是否与 AD 和 IMID 风险相关的文献，得出的结论是，尽管有一些信号，但证据的可信度充其量也很低。需要进行前瞻性队列研究来进一步证实风险增加的提示。
