Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms A Pharmacoepidemiological Study
Association of Antidepressant Use With Drug-Related Extrapyramidal Symptoms A Pharmacoepidemiological Study
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DOI：
10.1097/jcp.0000000000000911
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发表时间：
2018-08-01
影响因子：
2.9
通讯作者：
Carleton, Bruce C.
中科院分区：
文献类型：
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作者：
Guo, Michael Y.;Etminan, Mahyar;Carleton, Bruce C.
背景：抗抑郁药是处方最多的一类药物。一些病例报告将这些药物与锥体外系症状（EPS）联系起来，但迄今为止还没有大型流行病学研究检查这种关联。我们试图量化与不同的抗抑郁药的EPS的关联进行大型pharmacoepidemiologicstudy.Methods：一个嵌套的病例对照研究，使用一个大型的健康索赔数据库在美国从2006年6月至2015年12月。排除诊断为原发性帕金森病的受试者和接受左旋多巴、罗匹尼罗、普拉克索、多潘立酮、甲氧氯普胺、恩他卡朋、苯托品、司来吉兰、雷沙吉兰、苯海拉明、苯海索、典型和非典型抗精神病药和三环类抗抑郁药处方的受试者。病例随访至锥体外系事件的第一个账单代码或队列入组的最后日期。对于每种情况，10名对照受试者通过基于密度的抽样，按随访时间、日历时间和年龄进行匹配。率比计算使用条件logistic回归调整其他covariates.Results：我们确定了3,838例受试者与EPS相比，38,380年龄匹配的对照组。EPS的发生率比如下：度洛沙坦，5.68（95%置信区间[CI]，4.29 - 7.53）;米氮平，3.78（95% CI，1.71 - 8.32）;西酞普兰，3.47（95% CI，2.68 - 4.50）;艾司西酞普兰，3.23（95% CI，2.44 - 4.26）;帕罗西汀，3.07（95% CI，2.15 - 4.40）;舍曲林，2.57（95% CI，2.02 - 3.28）;文拉法辛，2.37（95% CI，1.71 - 3.29）;安非他酮，2.31（95% CI，1.67 - 3.21）;氟西汀，2.03（95% CI，1.48 - 2.78）。这项观察性研究证明了帕金森病或相关的EPS的发病率与抗抑郁药的使用之间存在有害的关联度洛西汀、米氮平、西酞普兰、依地普仑、帕罗西汀、舍曲林、文拉法辛、安非他酮和氟西汀。
Background: Antidepressants are one of the most prescribed classes of medications. A number of case reports have linked these drugs to extrapyramidal symptoms (EPSs), but no large epidemiologic study to date has examined this association. We sought to quantify the association of EPSs with different antidepressants by undertaking a large pharmacoepidemiologic study.Methods: A nested case-control study was conducted using a large health claims database in the United States from June 2006 to December 2015. Subjects with a diagnosis of primary Parkinson disease and those who received prescriptions of levodopa, ropinirole, pramipexole, domperidone, metoclopramide, entacapone, benztropine, selegiline, rasagiline, diphenhydramine, trihexyphenidyl, typical and atypical antipsychotics, and tricyclic antidepressants were excluded. Cases were followed to the first billing code for an extrapyramidal event or last date of enrollment in the cohort. For each case, 10 control subjects were matched by follow-up time, calendar time, and age through density-based sampling. Rate ratios were computed using conditional logistic regression adjusting for other covariates.Results: We identified 3,838 subjects with EPSs compared with 38,380 age-matched control subjects. Rate ratios with respect to EPSs were as follows: duloxetine, 5.68 (95% confidence interval [CI], 4.29-7.53); mirtazapine, 3.78 (95% CI, 1.71-8.32); citalopram, 3.47 (95% CI, 2.68-4.50); escitalopram, 3.23 (95% CI, 2.44-4.26); paroxetine, 3.07 (95% CI, 2.15-4.40); sertraline, 2.57 (95% CI, 2.02-3.28); venlafaxine, 2.37 (95% CI, 1.71-3.29); bupropion, 2.31 (95% CI, 1.67-3.21); and fluoxetine, 2.03 (95% CI, 1.48-2.78).Conclusions: This observational study demonstrates a harmful association between the incidence of Parkinson disease or associated EPSs and use of the antidepressants duloxetine, mirtazapine, citalopram, escitalopram, paroxetine, sertraline, venlafaxine, bupropion, and fluoxetine.