Benzodiazepine Use and Risk of Developing Alzheimer's Disease: A Case-Control Study Based on Swiss Claims Data
Benzodiazepine Use and Risk of Developing Alzheimer's Disease: A Case-Control Study Based on Swiss Claims Data
复制标题
DOI：
10.1007/s40263-016-0404-x
复制
发表时间：
2017-03-01
期刊：
影响因子：
6
通讯作者：
Meier, Christoph R.
中科院分区：
文献类型：
--
作者：
Bietry, Fabienne A.;Pfeil, Alena M.;Meier, Christoph R.
研究背景在以前的研究中已经假设了苯二氮卓类药物的使用与阿尔茨海默病（AD）之间可能存在关联。我们研究了既往使用苯二氮卓类药物与AD风险之间的关系。对照研究，并根据首次使用用于治疗AD的药物的记录，在2013年至2014年期间确定了1438例AD事件[i.例如，乙酰胆碱酯酶抑制剂（多奈哌齐、卡巴拉汀和加兰他敏）和N-甲基-D-天冬氨酸受体拮抗剂美金刚]，并在年龄、性别、索引日期和居住地（州）方面将一个对照组与每个病例匹配。由于在AD诊断日期前不久开始使用苯二氮卓类药物可能是早期主要神经认知障碍前驱症状对症治疗的结果，因此我们在AD诊断日期前引入了2年的诱导期。此外，我们使用处方，按索引日期前的使用持续时间对药物使用进行分类。我们应用条件Logistic回归分析计算比值比与95%的置信区间和调整使用抗抑郁药。结果的粗比值比（95%的置信区间）的发展AD的患者开始苯二氮卓类药物治疗前一年的诊断和1.19（0.82-1.72）在诊断前的第三年。在解释了前驱期开始使用苯二氮卓类药物后，苯二氮卓类药物的使用与AD发生风险增加无关;长期使用苯二氮卓类药物（>= 30张处方）的调整优势比为0.78（0.53-1.14）.结论在考虑到AD诊断日期前2年可能存在的原发性偏倚后，苯二氮卓类药物的使用与AD发生风险的增加无关。
Background A possible association between benzodiazepine use and Alzheimer's disease (AD) has been hypothesized in previous studies.Objectives Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between previous benzodiazepine use and the risk of AD.Methods We conducted a matched case-control study and identified 1438 incident AD cases between 2013 and 2014 based on recorded first-time use of drugs used to treat AD [i. e., acetylcholinesterase inhibitors (donepezil, rivastigmine, and galantamine) and the N-methyl-D-aspartate receptor antagonist memantine] and matched one control to each case on age, sex, index date, and residence (canton). Because the initiation of benzodiazepine use shortly before the AD diagnosis date may occur as a result of symptomatic treatment of prodromal symptoms of early major neurocognitive disorder, we introduced an induction period of 2 years before the AD diagnosis date. Additionally, we categorized medication use by duration of use prior to the index date using prescriptions. We applied conditional logistic regression analyses to calculate odds ratios with 95% confidence intervals and adjusted for use of antidepressants.Results The crude odds ratio (95% confidence interval) of developing AD for patients starting benzodiazepine treatment was 1.71 (1.17-2.99) in the year before diagnosis and 1.19 (0.82-1.72) in the third year before diagnosis. After accounting for benzodiazepine use initiated during the prodromal phase, benzodiazepine use was not associated with an increased risk of developing AD; long-term benzodiazepine use (>= 30 prescriptions) yielded an adjusted odds ratio of 0.78 (0.53-1.14).Conclusions After taking into consideration a possible protopathic bias in the 2 years preceding the AD diagnosis date, benzodiazepine use was not associated with an increased risk of developing AD.