Hughes Georgina A, Inacio Maria C, Rowett Debra, Caughey Gillian E, Air Tracy, Lang Catherine E, Corlis Megan, Sluggett Janet K
University of South Australia, UniSA Clinical & Health Sciences, Adelaide, South Australia, Australia.
Registry of Senior Australians Research Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Age Ageing. 2025 Mar 28;54(4). doi: 10.1093/ageing/afaf074.
Antidepressants are used by 60% of residents of long-term care facilities (LTCFs). Mirtazapine and sertraline are the most commonly used antidepressants, despite little safety information for their use in LTCFs.
To investigate risk of adverse outcomes (falls, fractures, cardiovascular-, dementia-, and delirium-related hospitalisations, all-cause mortality) associated with mirtazapine compared to sertraline use post-LTCF entry.
Active new user retrospective cohort study.
Individuals aged 65-105 years entering LTCFs in three Australian states during 1 January 2015 to 31 October 2018, who initiated mirtazapine or sertraline ≤60 days post-LTCF entry, with follow-up to 31 December 2019.
The inverse probability of treatment weighting of individuals' propensity scores was used to adjust Cox and Fine-Gray regression models to estimate the risk of outcomes of interest associated with mirtazapine compared to sertraline use in LTCFs. Weighted (adjusted) hazard ratios (aHRs), subdistribution hazard ratios and 95% confidence intervals (95% CIs) are presented.
A total of 5409 residents initiated mirtazapine (71%, n = 3837) or sertraline (29%, n = 1572) post-LTCF entry. After weighting, mirtazapine was associated with a higher risk of mortality (aHR 1.16, 95% CI 1.05-1.29) compared to sertraline. The risk of falls and fractures within 90 days was not statistically significantly different between the groups but was lower in mirtazapine users thereafter. No differences in risk of cardiovascular-, dementia- or delirium-related hospitalisations were observed.
Compared to sertraline, mirtazapine use is associated with a higher risk of mortality and, after 90 days of use, a lower risk of falls and fractures. This risk of harm should be balanced with limited evidence for effectiveness when considering antidepressant therapy in LTCFs.
长期护理机构（LTCF）中有60%的居民使用抗抑郁药。米氮平和舍曲林是最常用的抗抑郁药，尽管在长期护理机构中使用它们的安全性信息很少。
调查与舍曲林相比，长期护理机构入住后使用米氮平相关的不良结局（跌倒、骨折、心血管疾病、痴呆和谵妄相关住院、全因死亡率）风险。
新使用者主动回顾性队列研究。
2015年1月1日至2018年10月31日期间在澳大利亚三个州进入长期护理机构的65至105岁个体，在长期护理机构入住后≤60天开始使用米氮平或舍曲林，随访至2019年12月31日。
使用个体倾向评分的治疗加权逆概率来调整Cox和Fine-Gray回归模型，以估计与长期护理机构中使用舍曲林相比，使用米氮平相关的感兴趣结局的风险。给出加权（调整后）风险比（aHRs）、亚分布风险比和95%置信区间（95% CIs）。
共有5409名居民在长期护理机构入住后开始使用米氮平（71%，n = 3837）或舍曲林（29%，n = 1572）。加权后，与舍曲林相比，米氮平与更高的死亡风险相关（aHR 1.16，95% CI 1.05 - 1.29）。两组在90天内跌倒和骨折的风险没有统计学显著差异，但此后米氮平使用者的风险较低。未观察到心血管疾病、痴呆或谵妄相关住院风险的差异。
与舍曲林相比，使用米氮平与更高的死亡风险相关，且在使用90天后，跌倒和骨折的风险较低。在考虑长期护理机构中的抗抑郁治疗时，这种伤害风险应与有限的有效性证据相权衡。
