Bupropion and the risk of sudden death: a self-controlled case-series analysis using The Health Improvement Network
Bupropion and the risk of sudden death: a self-controlled case-series analysis using The Health Improvement Network
复制标题
DOI：
10.1136/thx.2005.041798
复制
发表时间：
2005-10-01
期刊：
影响因子：
10
通讯作者：
Britton, J
中科院分区：
文献类型：
--
作者：
Hubbard, R;Lewis, S;Britton, J
背景：安非他酮是一种有效的戒烟疗法，但由于担心它可能增加猝死的风险，它在英国的使用受到限制。方法：提取健康改善网络（计算机化的全科医生数据库）中所有处方安非他酮的患者的数据，并采用自控病例系列方法估计治疗前28天的相对死亡率。在此期间还调查了癫痫发作的发生率，这是公认的安非他酮的不良反应。结果：共有9329例患者服用安非他酮，平均年龄44岁，男性48%。首次服用安非他酮后的总时间为17586年，在此期间有121人死亡。2人在治疗的前28天内死亡，与剩余观察期相比，发生率比为0.50(95%可信区间（CI） 0.12至2.05)，低于预期。28人被记录为总共有45次癫痫发作（23人在开始安非他酮之前，2人在治疗的前28天，20人在之后的时间点）。治疗前28天癫痫发作的相对发生率为3.62 (95% CI 0.87至15.09)，相当于每6219名安非他酮首次使用者中增加一次癫痫发作。结论：安非他酮的使用可能与癫痫发作风险增加有关，但没有证据表明该药物与猝死风险增加有关。
Background: Bupropion is an effective smoking cessation therapy but its use in the UK has been limited by concerns that it may increase the risk of sudden death.Methods: Data for all patients prescribed bupropion within The Health Improvement Network (a computerised general practice database) were extracted and the self-controlled case-series method was used to estimate the relative incidence of death during the first 28 days of treatment. The incidence of seizures, a recognised adverse effect of bupropion, was also investigated during this period.Results: A total of 9329 individuals had been prescribed bupropion (mean age 44 years, 48% male). The total person-time after the first prescription for bupropion was 17 586 years, and during this time 121 people died. Two people died within the first 28 days of treatment, which was less than expected in comparison with the remaining observation period by an incidence ratio of 0.50 (95% confidence interval (CI) 0.12 to 2.05). Twenty eight people were recorded as having a total of 45 seizures (23 before starting bupropion, two in the first 28 days of treatment, and 20 at a later point). The relative incidence of seizures during the first 28 days of treatment was 3.62 (95% CI 0.87 to 15.09), equivalent to one additional seizure per 6219 first time bupropion users.Conclusions: Bupropion use is probably associated with an increased risk of seizures, but no evidence was found to suggest that the drug is associated with an increased risk of sudden death.