Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study
Association Between Drug Exposure and Occurrence of Parkinsonism in Korea: A Population-Based Case-Control Study
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DOI：
10.1177/1060028019859543
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发表时间：
2019-11-01
影响因子：
2.9
通讯作者：
Suh, Hae Sun
中科院分区：
文献类型：
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作者：
Kim, Siin;Cheon, Sang-Myung;Suh, Hae Sun
背景：虽然药物诱导的帕金森综合征在大多数情况下是可逆的，但一些患者可能会出现持续/复发的症状。因此，预防是管理药物诱导的帕金森症的最有效方法。然而，很少有研究探讨帕金森症和药物暴露之间的关系。目的：使用韩国人群数据，研究药物暴露与帕金森综合征风险之间的关系。方法：我们使用国家健康保险服务中心-国家样本队列数据库进行配对病例对照研究。病例和对照分别定义为2007年至2013年期间患有和不患有帕金森症的个体。病例组和对照组在性别、年龄组、收入、保险类型和Charlson共病指数方面相匹配。药物暴露，包括推进剂、抗精神病药和氟桂利嗪，在帕金森症首次发病前1年确定，并按近期和累积剂量分层。条件Logistic回归用于估计比值比（OR）和95% CI。结果：我们确定了5496例病例和5496例对照。与未使用组相比，目前使用组的OR分别为2.812（95% CI = 2.466-3.206）、3.009（95% CI = 1.667-5.431）和4.950（95% CI = 2.711-9.037）。在最近暴露和暴露于较高累积剂量的患者中，OR更大。结论和相关性：在人群水平上，使用推进剂、抗精神病药和氟桂利嗪与帕金森综合征风险增加显著相关，这取决于近期和累积剂量。与帕金森症相关的药物应在仔细监测下使用，以防止药物诱发的帕金森症。
Background: Although drug-induced parkinsonism is reversible in most cases, some patients can suffer from persistent/recurrent symptoms. Therefore, prevention is the most efficient way to manage drug-induced parkinsonism. However, there is a paucity of studies exploring the relationship between parkinsonism and drug exposure. Objective: To examine the association between drug exposure and the risk of parkinsonism using Korean population-based data. Methods: We conducted a matched case-control study using the National Health Insurance Service-National Sample Cohort database. Cases and controls were defined as individuals with and without parkinsonism, respectively, between 2007 and 2013. Cases and controls were matched for sex, age group, income, type of insurance, and Charlson comorbidity index. Drug exposures, including propulsives, antipsychotics, and flunarizine, were identified at 1 year before the first date of parkinsonism and stratified by recency and cumulative dose. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% CIs. Results: We identified 5496 cases and 5496 controls. ORs for current use group of propulsives, antipsychotics, and flunarizine compared with those of the never use group were 2.812 (95% CI = 2.466-3.206), 3.009 (95% CI = 1.667-5.431), and 4.950 (95% CI = 2.711-9.037), respectively. ORs were greater in those more recently exposed and those exposed to higher cumulative doses. Conclusion and Relevance: At the population level, use of propulsives, antipsychotics, and flunarizine had a significant association with the increased risk of parkinsonism, depending on recency and cumulative dose. Drugs associated with parkinsonism should be used with careful monitoring to prevent drug-induced parkinsonism.