抗精神病药增加阿兹海默氏症患者的肺炎风险


  【24drs.com】芬兰的一项大型研究证实,抗精神病药增加了有(以及没有)阿兹海默氏症患者的肺炎风险。
  
  开始使用抗精神病药物治疗时的风险最高,但是,长期使用时依旧增加。研究团队发现,最常使用的抗精神病药物:quetiapine (商品名Seroquel, AstraZeneca Pharmaceuticals药厂)、risperidone (商品名Risperdal, Johnson & Johnson药厂)与haloperidol (商品名Haldol, Janssen Pharmaceuticals药厂)之间的风险并无显著差异。
  
  第一作者、Kuopio Eastern Finland大学Anna-Maija Tolppanen博士表示,风险加大本身并不是什么新鲜事,因为美国食品药物管理局(FDA)已经在2005年提出使用抗精神病药物对于失智之行为与精神症状的警告,该报告已提出,肺炎被列为主要的死亡原因之一。
  
  她解释,我们的研究增加了个别抗精神病药物之间的比较,因为安全性比较的研究相对少见。此外,在本次研究之前,我们发现仅有一篇已发表的研究评估了阿兹海默氏症患者的特定关联。
  
  这篇研究在线发表于8月30日胸腔期刊。
  
  Tolppanen博士表示,研究结果支持目前的治疗指引,对于阿兹海默氏症患者开始使用抗精神病药物,设定一个比较高的阈值,且应仔细衡量风险与利益。如果开始使用抗精神病药物,应限制使用期间,因为肺炎风险与其它不良结果之风险在长期使用时并不会消失。
  
  研究者使用「Medication and Alzheimer's disease (MEDALZ)」世代评估抗精神病药物与因为肺炎而住院或死亡的关联,这个世代包括了60,584名于2005-2011年间诊断有阿兹海默氏症的社区成年居民,包括了12,225例偶发性肺炎病例。为了比较,研究者选了没有阿兹海默氏症的60,584名对照组,其中有6,195例偶发性肺炎。
  
  不论有无阿兹海默氏症,使用抗精神病药物都与肺炎风险增加有关。阿兹海默氏症世代中,校正干扰因素之后,抗精神病药物使用者的肺炎相对风险达2倍(倾向指数校正风险比HR], 2.01; 95%信赖区间[CI], 1.90 - 2.13),无阿兹海默氏症组的此一关联更强(校正HR, 3.43; 95% CI, 2.99 - 3.93)。
  
  在这两个世代,使用抗精神病药物都与各年龄层的肺炎风险持续较高相关,不过,最年轻组(34-74岁组)的关联性最强。使用期间最短的病患,相对风险增加最高,且风险不会因为长期使用而降低。Quetiapine、risperidone与haloperidol等药物之间的风险并无显著差异。
  
  Tolppanen博士等人结论指出,根据观察的资料,我们无法完全排除肺炎与使用抗精神病药物之间的因果关系,当处方抗精神病药物时,应考量风险与利益之间的平衡。
  
  资料来源:http://www.24drs.com/
  
  Native link:Antipsychotics Boost Pneumonia Risk in Alzheimer's Patients

Antipsychotics Boost Pneumonia Risk in Alzheimer's Patients

By Megan Brooks
Medscape Medical News

Antipsychotic medications raise the risk for pneumonia in patients with (and without) Alzheimer's disease (AD), a large Finnish study confirms.

The risk is highest at the start of antipsychotic treatment but remains increased with long-term use. There are no marked differences in risk between the most commonly used antipsychotic drugs: quetiapine (Seroquel, AstraZeneca Pharmaceuticals), risperidone (Risperdal, Johnson & Johnson), and haloperidol (Haldol, Janssen Pharmaceuticals), the study team found.

"The risk increase per se is nothing new, as the FDA [US Food and Drug Administration] issued a warning about the use of antipsychotics for behavioral and psychological symptoms of dementia already in 2005, and pneumonia was listed as one of the leading causes of death already in that report," first author Anna-Maija Tolppanen, PhD, from the University of Eastern Finland in Kuopio, told Medscape Medical News.

"What our study adds to the literature is the comparison between individual antipsychotics, as studies on the comparative safety have been relatively rare. In addition, we were able to find only one published study that had assessed this association specifically in persons with Alzheimer's disease [prior to this study]," she explained.

The study was published online August 30 in Chest.

"The findings support current treatment guidelines on setting a high threshold for initiating antipsychotic use among persons with Alzheimer's disease, and also the risks and benefits should be weighted carefully," Dr Tolppanen said. "If antipsychotic use is initiated, the duration should be limited, as the risk of pneumonia, as well as the risk of other adverse outcomes, does not disappear with long-term use."

The Finnish MEDALZ Study

The researchers used the Medication and Alzheimer's disease (MEDALZ) cohort to assess the association between antipsychotic medication and hospitalization or death due to pneumonia. The cohort included 60,584 community-dwelling adults diagnosed with AD from 2005 to 2011, including 12,225 incident pneumonia cases. For comparison, the investigators selected a matched cohort of 60,584 patients without AD, among whom there were 6195 incident pneumonia cases.

Antipsychotic use was associated with increased pneumonia risk in both AD and non-AD cohorts. In the AD cohort, antipsychotic users had a twofold relative risk for pneumonia after adjusting for confounders (propensity score adjusted hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.90 - 2.13). The association was stronger in the non-AD cohort (adjusted HR, 3.43; 95% CI, 2.99 - 3.93).

In both cohorts, antipsychotic use was consistently associated with higher pneumonia risk in all age groups, but the associations were strongest in the youngest group (those aged 34 to 74 years). Patients with the shortest duration of use had the highest relative risk increase, but the risk was not attenuated with long-term use. There were no marked differences in risk with quetiapine, risperidone, and haloperidol.

"With observational data we cannot fully rule out a shared causality between pneumonia and antipsychotic use, but the risk-benefit balance should be considered when antipsychotics are prescribed," Dr Tolppanen and colleagues conclude.

The study had no funding. Dr Tolppanen has disclosed no relevant financial relationships. Three coauthors report having financial relationships with various pharmaceutical companies, as listed in the original article.

Chest. Published online August 30, 2016.

    
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