Association Between Phosphodiesterase-5 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy
Association Between Phosphodiesterase-5 Inhibitors and Nonarteritic Anterior Ischemic Optic Neuropathy
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DOI：
10.1097/wno.0000000000000186
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发表时间：
2015-03-01
影响因子：
2.9
通讯作者：
Mikelberg, Frederick S.
中科院分区：
文献类型：
--
作者：
Nathoo, Nawaaz A.;Etminan, Mahyar;Mikelberg, Frederick S.
背景：基于大量病例报告，磷酸二酯酶-5（PDE-5）抑制剂的使用被认为是男性发生非动脉炎性前部缺血性视神经病变（NAION）的危险因素。我们的研究的目的是确定男性谁使用这类药物是否更有可能比匹配的对照组开发NAION.Methods：药物流行病学巢式病例对照研究被用来检查上述协会在健康索赔数据库的医生诊断和处方药配药。NAION病例与相应的对照组相匹配，并与PDE-5抑制剂的使用相关。使用条件Logistic回归模型估计使用PDE-5抑制剂发生NAION的比率。结果：共发现1，109例NAION病例，并与数据库中确定的1，237，290例对照相匹配。在NAION前一年，病例更可能患有高脂血症、糖尿病、高血压、心肌梗死和脑血管意外。NAION前一年内使用任何PDE-5抑制剂的校正率比为1.01（95%置信区间[CI]，0.79-1.28）; NAION前30天内最近使用PDE-5抑制剂也无显著相关性，校正率比为0.96（95% CI，0.75-1.23）。个别PDE-5抑制剂的结果没有达到统计学显着性。结论：我们的研究结果并不表明有一个处方填写PDE-5抑制剂药物和接收诊断代码NAION之间的任何关联。这与文献中的其他研究一致，这些研究未能阐明这些药物可能损害视神经乳头循环的合理机制。
Background:Use of phosphodiesterase-5 (PDE-5) inhibitors has been reported to be a risk factor for development of nonarteritic anterior ischemic optic neuropathy (NAION) in males, based largely on a number of case reports. The objective of our study was to determine whether men who use this class of medications are more likely than a matched control group to develop NAION.Methods:A pharmacoepidemiological nested case-control study was used to examine the above association in a health claims database of physician diagnoses and prescription medication dispensing. Cases of NAION were matched with corresponding controls and correlated with the use of PDE-5 inhibitors. A conditional logistic regression model was used to estimate rate ratios for development of NAION with use of PDE-5 inhibitors.Results:A total of 1,109 cases of NAION were found and matched to 1,237,290 controls identified within the database. Cases were more likely to have hyperlipidemia, diabetes, hypertension, myocardial infarction, and cerebrovascular accident in the year preceding their NAION. The adjusted rate ratio for any use of PDE-5 inhibitor in the year before the NAION was 1.01 (95% confidence interval [CI], 0.79-1.28); recent use of a PDE-5 inhibitor in the 30 days before the NAION also had no significant association, with an adjusted rate ratio of 0.96 (95% CI, 0.75-1.23). Results for individual PDE-5 inhibitors did not achieve statistical significance.Conclusions:Our results do not suggest any association between having a prescription filled for PDE-5 inhibitor medication and receiving a diagnosis code for NAION. This is consistent with other studies in the literature that have failed to elucidate a plausible mechanism by which these drugs might compromise circulation at the optic nerve head.