Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study.
Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study.
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DOI：
10.1136/bmj.e977
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发表时间：
2012-02-23
期刊：
影响因子：
--
通讯作者：
Schneeweiss S
中科院分区：
文献类型：
--
作者：
Huybrechts KF;Gerhard T;Crystal S;Olfson M;Avorn J;Levin R;Lucas JA;Schneeweiss S
目的评估疗养院老年居民使用个体抗精神病药物的死亡风险。设计基于人群的队列研究，相关数据来自医疗补助、医疗保险、最小数据集、国家死亡指数和国家养老院质量评估。在美国的养老院。研究对象为75445例抗精神病药物（氟哌啶醇、阿立哌唑、奥氮平、奎替鲁、利培酮、齐拉西酮）新使用者。所有参与者年龄≥65岁，有资格获得医疗补助，并在2001- 2005年住在养老院。主要结果测量采用考克斯比例风险模型比较180天的风险，所有原因和原因特异性死亡率的个别药物，与倾向评分调整，以控制潜在的混杂因素。结果与利培酮相比，氟哌啶醇使用者死亡风险增加（危险比2.07，95%可信区间1.89 ~ 2.26），而喹硫平使用者死亡风险降低（危险比0.81，0.75 ~ 0.88）。治疗开始后不久，效应最强，调整剂量后仍保持不变，并且在检查的所有死因中均观察到。其他药物未观察到有临床意义的差异。没有证据表明对痴呆症或行为障碍患者的影响措施修改。除奎替利外，所有药物均存在剂量-反应关系。结论虽然这些发现不能证明因果关系，我们不能排除残余混杂的可能性，他们提供了更多的证据，使用这些药物在老年患者的风险，加强的概念，他们不应该使用在没有明确的需要。数据表明，这些药物的死亡风险通常随着剂量的增加而增加，氟哌啶醇似乎最高，奎替利最低。
Objective To assess risks of mortality associated with use of individual antipsychotic drugs in elderly residents in nursing homes. Design Population based cohort study with linked data from Medicaid, Medicare, the Minimum Data Set, the National Death Index, and a national assessment of nursing home quality. Setting Nursing homes in the United States. Participants 75 445 new users of antipsychotic drugs (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone). All participants were aged ≥65, were eligible for Medicaid, and lived in a nursing home in 2001-5. Main outcome measures Cox proportional hazards models were used to compare 180 day risks of all cause and cause specific mortality by individual drug, with propensity score adjustment to control for potential confounders. Results Compared with risperidone, users of haloperidol had an increased risk of mortality (hazard ratio 2.07, 95% confidence interval 1.89 to 2.26) and users of quetiapine a decreased risk (0.81, 0.75 to 0.88). The effects were strongest shortly after the start of treatment, remained after adjustment for dose, and were seen for all causes of death examined. No clinically meaningful differences were observed for the other drugs. There was no evidence that the effect measure modification in those with dementia or behavioural disturbances. There was a dose-response relation for all drugs except quetiapine. Conclusions Though these findings cannot prove causality, and we cannot rule out the possibility of residual confounding, they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need. The data suggest that the risk of mortality with these drugs is generally increased with higher doses and seems to be highest for haloperidol and least for quetiapine.
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影响因子：
120.7
作者：
Patorno, Elisabetta;Bohn, Rhonda L.;Schneeweiss, Sebastian
通讯作者：
Schneeweiss, Sebastian
影响因子：
--
作者：
Briesacher, BA;Limcangco, R;Stuart, B
通讯作者：
Stuart, B
影响因子：
39.2
作者：
Gill, Sudeep S.;Bronskill, Susan E.;Rochon, Paula A.
通讯作者：
Rochon, Paula A.
影响因子：
10.6
作者：
Andreasen, Nancy C.;Pressler, Marcus;Nopoulos, Peg;Miller, Del;Ho, Beng-Choon
通讯作者：
Ho, Beng-Choon
DOI：
10.1111/j.1532-5415.2004.52212.x
发表时间：
2004-05-01
影响因子：
6.3
作者：
Bronskill, SE;Anderson, GM;Rochon, PA
通讯作者：
Rochon, PA