Risk of diabetic ketoacidosis after exposure to risperidone or olanzapine
Risk of diabetic ketoacidosis after exposure to risperidone or olanzapine
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DOI：
10.2165/00002018-200730070-00004
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发表时间：
2007-01-01
期刊：
影响因子：
4.2
通讯作者：
Nasrallah, Henry
中科院分区：
文献类型：
--
作者：
Ramaswamy, Krishnan;Kozma, Chris M.;Nasrallah, Henry
背景资料：非典型抗精神病药物与代谢异常相关，包括糖代谢受损、现有糖尿病加重和新发2型糖尿病。并不是所有的非典型抗精神病药物似乎都有相同的倾向，导致这些并发症。目的：评估接受利培酮或奥氮平治疗的患者发生糖尿病酮症酸中毒的风险。方法：对加州医疗补助数据进行了评估，以确定是否存在糖尿病酮症酸中毒医院索赔（第9版国际疾病分类编码2501 x）1997年7月至2000年9月期间接受非典型抗精神病药物治疗的患者。确定了利培酮、奥氮平、氯氮平、奎替卡松和多种非典型药物的初始处方声明;然而，由于氯氮平和奎替卡松组的样本量挑战，最终分析仅限于利培酮和奥氮平。如果在抗精神病药物分发后45天内发生索赔，则指定病例。潜在的混杂变量和持续时间的抗精神病药物exposed.Results：初始用户的利培酮（n = 51330; 31糖尿病酮症酸中毒）和奥氮平（n = 51302; 55糖尿病酮症酸中毒）被确定在1997年7月至2000年9月。奥氮平与利培酮的糖尿病酮症酸中毒校正风险为1.62（p = 0.033）。糖尿病酮症酸中毒的风险与较长的药物暴露时间相关。在治疗的前30天后，观察到两个治疗组之间的风险存在进行性和统计学显著性差异。对于利培酮患者，糖尿病酮症酸中毒风险在前90天后稳定;对于奥氮平患者，糖尿病酮症酸中毒风险持续增加，直至360天（研究持续时间）。对于> 30天、> 90天和> 180天的暴露，奥氮平的糖尿病酮症酸中毒风险分别是利培酮的1.7（p = 0.026）、2.4（p = 0.004）和3.5（p = 0.001）倍。治疗组，年龄，非裔美国人的种族和精神分裂症或糖尿病的存在显着的预测糖尿病酮症酸中毒。结论：糖尿病酮症酸中毒的风险似乎是更大的患者暴露于奥氮平与利培酮调整混杂因素后。这种风险似乎随着奥氮平暴露持续时间的延长而增加。
Background: Atypical antipsychotics have been associated with metabolic abnormalities including impaired glucose metabolism, exacerbation of existing diabetes mellitus and new-onset type 2 diabetes. Not all atypical antipsychotic agents appear to have the same propensity to cause these complications.Objective: To assess diabetic ketoacidosis risk in patients receiving risperidone or olanzapine.Methods: California Medicaid data were evaluated for the presence of a diabetic ketoacidosis hospital claim (9th Edition of the International Classification of Diseases code 2501x) for patients receiving an atypical antipsychotic agent between July 1997 and September 2000. Initial prescription claims were identified for risperidone, olanzapine, clozapine, quetiapine and multiple atypical medications; however, the final analysis was restricted to risperidone and olanzapine owing to sample size challenges in the clozapine and quetiapine groups. Cases were specified if a claim occurred within 45 days after antipsychotic dispensation. Potential confounding variables and duration of antipsychotic exposure were included.Results: Initial users of risperidone (n = 51330; 31 diabetic ketoacidosis) and olanzapine (n = 51302; 55 diabetic ketoacidosis) were identified between July 1997 and September 2000. The adjusted risk of diabetic ketoacidosis for olanzapine versus risperidone was 1.62 (p = 0.033). The risk of diabetic ketoacidosis was associated with a longer duration of drug exposure. A progressive and statistically significant divergence in risk was observed between the two treatment groups after the first 30 days of therapy. For risperidone patients, diabetic ketoacidosis risk stabilised after the first 90 days; for olanzapine patients, diabetic ketoacidosis risk continued to increase until 360 days (study duration). For exposures of > 30 days, > 90 days and > 180 days, diabetic ketoacidosis risk was 1.7 (p = 0.026), 2.4 (p = 0.004) and 3.5 (p = 0.001) times greater for olanzapine than risperidone. Treatment group, age, African American race and the presence of schizophrenia or diabetes were significant predictors of diabetic ketoacidosis.Conclusion: The risk of diabetic ketoacidosis appears to be greater for patients exposed to olanzapine compared with risperidone after adjusting for confounding factors. This risk appears to increase with longer duration of exposure to olanzapine.