抗精神病藥增加阿茲海默氏症患者的肺炎風險


  【24drs.com】芬蘭的一項大型研究證實,抗精神病藥增加了有(以及沒有)阿茲海默氏症患者的肺炎風險。
  
  開始使用抗精神病藥物治療時的風險最高,但是,長期使用時依舊增加。研究團隊發現,最常使用的抗精神病藥物:quetiapine (商品名Seroquel, AstraZeneca Pharmaceuticals藥廠)、risperidone (商品名Risperdal, Johnson & Johnson藥廠)與haloperidol (商品名Haldol, Janssen Pharmaceuticals藥廠)之間的風險並無顯著差異。
  
  第一作者、Kuopio Eastern Finland大學Anna-Maija Tolppanen博士表示,風險加大本身並不是什麼新鮮事,因為美國食品藥物管理局(FDA)已經在2005年提出使用抗精神病藥物對於失智之行為與精神症狀的警告,該報告已提出,肺炎被列為主要的死亡原因之一。
  
  她解釋,我們的研究增加了個別抗精神病藥物之間的比較,因為安全性比較的研究相對少見。此外,在本次研究之前,我們發現僅有一篇已發表的研究評估了阿茲海默氏症患者的特定關聯。
  
  這篇研究線上發表於8月30日胸腔期刊。
  
  Tolppanen博士表示,研究結果支持目前的治療指引,對於阿茲海默氏症患者開始使用抗精神病藥物,設定一個比較高的閾值,且應仔細衡量風險與利益。如果開始使用抗精神病藥物,應限制使用期間,因為肺炎風險與其他不良結果之風險在長期使用時並不會消失。
  
  研究者使用「Medication and Alzheimer's disease (MEDALZ)」世代評估抗精神病藥物與因為肺炎而住院或死亡的關聯,這個世代包括了60,584名於2005-2011年間診斷有阿茲海默氏症的社區成年居民,包括了12,225例偶發性肺炎病例。為了比較,研究者選了沒有阿茲海默氏症的60,584名對照組,其中有6,195例偶發性肺炎。
  
  不論有無阿茲海默氏症,使用抗精神病藥物都與肺炎風險增加有關。阿茲海默氏症世代中,校正干擾因素之後,抗精神病藥物使用者的肺炎相對風險達2倍(傾向指數校正風險比HR], 2.01; 95%信賴區間[CI], 1.90 - 2.13),無阿茲海默氏症組的此一關聯更強(校正HR, 3.43; 95% CI, 2.99 - 3.93)。
  
  在這兩個世代,使用抗精神病藥物都與各年齡層的肺炎風險持續較高相關,不過,最年輕組(34-74歲組)的關聯性最強。使用期間最短的病患,相對風險增加最高,且風險不會因為長期使用而降低。Quetiapine、risperidone與haloperidol等藥物之間的風險並無顯著差異。
  
  Tolppanen博士等人結論指出,根據觀察的資料,我們無法完全排除肺炎與使用抗精神病藥物之間的因果關係,當處方抗精神病藥物時,應考量風險與利益之間的平衡。
  
  資料來源: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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