Atypical antipsychotic drugs and the risk of sudden cardiac death.
Atypical antipsychotic drugs and the risk of sudden cardiac death.
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DOI：
10.1056/nejmoa0806994
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发表时间：
2009-01-15
期刊：
影响因子：
--
通讯作者：
Stein CM
中科院分区：
文献类型：
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作者：
Ray WA;Chung CP;Murray KT;Hall K;Stein CM
典型抗精神病药物的使用者发生严重室性心律失常和心源性猝死的风险增加。然而，对于非典型抗精神病药物的心脏安全性知之甚少，这些药物在临床实践中很大程度上取代了旧的药物。我们计算了田纳西州医疗补助计划参保者中当前抗精神病药物服用者调整后的心源性猝死发生率。初步分析分别包括44,218和46,089名基线单一典型和非典型药物使用者，以及186,600名匹配的非使用者对照。为了评估与抗精神病适应症相关的残留混淆，我们对无精神分裂症或相关精神病基线诊断的抗精神病药物使用者进行了二次分析，倾向评分与非使用者相匹配。目前使用典型和非典型抗精神病药物的患者比未使用任何抗精神病药物的患者心脏性猝死的发生率更高，调整后的发病率比（IRRs）分别为2.00 （95% CI, 1.69-2.35）和2.27（1.89-2.73）。前抗精神病药物使用者的风险没有显著增加（IRR = 1.13[0.98-1.30]）。对于这两类药物，当前使用者的风险随着剂量的增加而显著增加。典型抗精神病药物的IRRs由低剂量组的1.31（0.97 ~ 1.77）上升至高剂量组的2.42 (1.91 ~ 3.06)（p< 0.001）。对于非典型药物，IRRs从低剂量的1.59（1.03-2.46）增加到高剂量的2.86 (2.25-3.65)（p= 0.015）。非典型抗精神病药物与典型抗精神病药物的IRR为1.14（0.93 - 1.39）。在倾向评分匹配的队列中也出现了类似的发现。目前使用典型和非典型抗精神病药物的人发生心源性猝死的风险相似，且与剂量相关。
Users of typical antipsychotics have increased risk of serious ventricular arrhythmias and sudden cardiac death. However, less is known regarding the cardiac safety of the atypical antipsychotic drugs, which have largely replaced the older agents in clinical practice. We calculated the adjusted incidence of sudden cardiac death among current users of antipsychotics in a retrospective cohort of Tennessee Medicaid enrollees. The primary analysis included 44,218 and 46,089 baseline users of single typical and atypical drugs, respectively, and 186,600 matched nonuser controls. To assess residual confounding related to antipsychotic indication, we performed a secondary analysis of antipsychotic users with no baseline diagnosis of schizophrenia or related psychoses, propensity-score matched with nonusers. Current users of both typical and atypical antipsychotics had greater rates of sudden cardiac death than did nonusers of any antipsychotic, with adjusted incidence-rate ratios (IRRs) of 2.00 (95% CI, 1.69–2.35) and 2.27 (1.89–2.73), respectively. Former antipsychotic users had no significantly increased risk (IRR = 1.13 [0.98–1.30]). For both classes of drugs, the risk for current users increased significantly with dose. For typical antipsychotics the IRRs increased from 1.31 (0.97–1.77) for low doses to 2.42 (1.91–3.06) for high doses (p<.001). For atypical agents the IRRs increased from 1.59 (1.03–2.46) for low doses to 2.86 (2.25–3.65) for high doses (p=.015). The IRR for atypical vs typical antipsychotics was 1.14 (.93–1.39). Similar findings were present in the propensity-score matched cohort. Current users of both typical and atypical antipsychotics had a similar, dose-related increased risk of sudden cardiac death.