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【medical-news】非典型抗精神病药物增加猝死风险
ABSTRACT
Background Users of typical antipsychotic drugs have an increased risk of serious ventricular arrhythmias and sudden cardiac death. However, less is known regarding the cardiac safety of the atypical antipsychotic drugs, which have largely replaced the older agents in clinical practice.
Methods We calculated the adjusted incidence of sudden cardiac death among current users of antipsychotic drugs in a retrospective cohort study of Medicaid enrollees in Tennessee. The primary analysis included 44,218 and 46,089 baseline users of single typical and atypical drugs, respectively, and 186,600 matched nonusers of antipsychotic drugs. To assess residual confounding related to factors associated with the use of antipsychotic drugs, we performed a secondary analysis of users of antipsychotic drugs who had no baseline diagnosis of schizophrenia or related psychoses and with whom nonusers were matched according to propensity score (i.e., the predicted probability that they would be users of antipsychotic drugs).
Results Current users of typical and of atypical antipsychotic drugs had higher rates of sudden cardiac death than did nonusers of antipsychotic drugs, with adjusted incidence-rate ratios of 1.99 (95% confidence interval [CI], 1.68 to 2.34) and 2.26 (95% CI, 1.88 to 2.72), respectively. The incidence-rate ratio for users of atypical antipsychotic drugs as compared with users of typical antipsychotic drugs was 1.14 (95% CI, 0.93 to 1.39). Former users of antipsychotic drugs had no significantly increased risk (incidence-rate ratio, 1.13; 95% CI, 0.98 to 1.30). For both classes of drugs, the risk for current users increased significantly with an increasing dose. Among users of typical antipsychotic drugs, the incidence-rate ratios increased from 1.31 (95% CI, 0.97 to 1.77) for those taking low doses to 2.42 (95% CI, 1.91 to 3.06) for those taking high doses (P<0.001). Among users of atypical agents, the incidence-rate ratios increased from 1.59 (95% CI, 1 .03 to 2.46) for those taking low doses to 2.86 (95% CI, 2.25 to 3.65) for those taking high doses (P=0.01). The findings were similar in the cohort that was matched for propensity score.
Conclusions Current users of typical and of atypical antipsychotic drugs had a similar, dose-related increased risk of sudden cardiac death.
美国《新英格兰医学杂志》1月15日刊登的一项研究成果显示，非典型抗精神病药物将显著增加患者因心律失常及其他心脏疾病而猝死的风险，而且剂量越高，风险也越大。
这项研究由美国卫生与公众服务部卫生保健研究与质量局资助完成。研究人员对年龄在30岁至74岁之间的精神病患者进行了调查研究，结果发现，使用非典型抗精神病药物的精神病患者因心脏疾病而猝死的风险，是未使用该类药物患者的两倍，基本上与使用典型抗精神病药物的患者相当。
卫生保健研究与质量局特别指出4种具有风险的此类药物。其中三种已经在中国上市，分别是强生公司的维思通、阿斯利康公司的思瑞康、礼来公司的再普乐，所涉及的另外一种药物为诺华公司的Clozaril，目前在国内尚无销售，其仿制品通用名为氯氮平。
非典型抗精神病药物主要用于治疗精神分裂症和躁狂抑郁症，也有医务人员和患者将其用于产品说明书以外的用途，如用来治疗焦虑、强迫症等。与典型抗精神病药物相比，此类药一般不会造成使用者颤抖及其他失常行为。
卫生保健研究与质量局局长卡罗琳·克兰西说，这项研究为患者提供了有关非典型抗精神病药物的重要信息，可以帮助医务人员和患者在今后使用此类药物时权衡利弊。
（《新英格兰医学杂志》（NEJM），Volume 360:225-235，Wayne A. Ray，C. Michael Stein） [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-07-05 05:49
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