Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients
Risk of death associated with the use of conventional versus atypical antipsychotic drugs among elderly patients
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DOI：
10.1503/cmaj.061250
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发表时间：
2007-02-27
影响因子：
14.6
通讯作者：
Wang, Philip S.
中科院分区：
文献类型：
--
作者：
Schneeweiss, Sebastian;Setoguchi, Soko;Wang, Philip S.
背景资料：公共卫生专家警告说，使用非典型抗精神病药物会增加老年患者的死亡风险。我们评估了短期死亡率在人口为基础的队列中的老年人在不列颠哥伦比亚省谁是规定的常规和非典型的抗精神病药物medications.Methods：我们使用了相关的医疗保健利用数据的所有BC省居民，以确定一个队列的人年龄在65岁及以上的人开始服用抗精神病药物在1996年1月至2004年12月之间，是免费的癌症。我们比较了180天的全因死亡率之间的居民服用传统的抗精神病药物和那些服用非典型抗精神病药物。结果：在研究队列的37 241名老年人，12 882人开了一个传统的抗精神病药物和24 359非典型配方。在使用的前180天内，常规药物组有1822名患者（14.1%）死亡，而非典型药物组有2337名患者（9.6%）死亡（死亡率比1.47，95%置信区间[CI] 1.39-1.56）。多变量调整导致180天死亡率为1.32（1.23-1.42）。与利培酮相比，氟哌啶醇与死亡率增加最大（死亡率比2.14，95% CI 1.86-2.45），洛沙坦最低（死亡率比1.29，95% CI 1.19-1.40）。死亡率增加最多的是服用较高剂量（高于中位数）常规抗精神病药物的患者（死亡率比1.67，95% CI 1.50-1.86）和开始药物治疗后的前40天（死亡率比1.60，95% CI 1.42-1.80）。结果证实了倾向评分分析和工具变量估计，尽量减少残留confounding.Interpretation：在老年患者中，与常规抗精神病药物相关的死亡风险是可比的，并可能大于与非典型抗精神病药物相关的死亡风险。在进一步的证据可用之前，医生应该考虑所有抗精神病药物对老年患者的风险相同。
Background: Public health advisories have warned that the use of atypical antipsychotic medications increases the risk of death among elderly patients. We assessed the short-term mortality in a population-based cohort of elderly people in British Columbia who were prescribed conventional and atypical antipsychotic medications.Methods: We used linked health care utilization data of all BC residents to identify a cohort of people aged 65 years and older who began taking antipsychotic medications between January 1996 and December 2004 and were free of cancer. We compared the 180-day all-cause mortality between residents taking conventional antipsychotic medications and those taking atypical antipsychotic medications.Results: Of 37 241 elderly people in the study cohort, 12 882 were prescribed a conventional antipsychotic medication and 24 359 an atypical formulation. Within the first 180 days of use, 1822 patients (14.1%) in the conventional drug group died, compared with 2337 (9.6%) in the atypical drug group (mortality ratio 1.47, 95% confidence interval [CI] 1.39-1.56). Multi-variable adjustment resulted in a 180-day mortality ratio of 1.32 (1.23-1.42). In comparison with risperidone, haloperidol was associated with the greatest increase in mortality (mortality ratio 2.14, 95% CI 1.86-2.45) and loxapine the lowest (mortality ratio 1.29, 95% CI 1.19-1.40). The greatest increase in mortality occurred among people taking higher (above median) doses of conventional antipsychotic medications (mortality ratio 1.67, 95% CI 1.50-1.86) and during the first 40 days after the start of drug therapy (mortality ratio 1.60, 95% CI 1.42-1.80). Results were confirmed in propensity score analyses and instrumental variable estimation, minimizing residual confounding.Interpretation: Among elderly patients, the risk of death associated with conventional antipsychotic medications is comparable to and possibly greater than the risk of death associated with atypical antipsychotic medications. Until further evidence is available, physicians should consider all antipsychotic medications to be equally risky in elderly patients.