Atypical antipsychotics and hyperglycemic emergencies: Multicentre, retrospective cohort study of administrative data

SCHIZOPHRENIA RESEARCH

卷:154

Article

Lipscombe, Lorraine L.^1,16  Austin, Peter C.¹  Alessi-Severini, Silvia^2,3  Blackburn, David F.⁴  Blais, Lucie⁵  Bresee, Lauren⁶  Filion, Kristian B.^7,8  Kawasumi, Yuko⁹  Kurdyak, Paul^1,17  Platt, RobertW.^10,11,12,13  Tamimk, Hala^14,15  Paterson, J. Michael¹ 

[1] Inst Clin Evaluat Sci, Toronto, ON M4N 3M5, Canada

[2] Univ Manitoba, Apotex Ctr, Fac Pharm, Winnipeg, MB R3E 0T5, Canada

[3] Manitoba Ctr Hlth Policy, Winnipeg, MB R3E 3P5, Canada

[4] Univ Saskatchewan, Coll Pharm & Nutr, Saskatoon, SK S7N 5C9, Canada

[5] Univ Montreal, Fac Pharm, Montreal, PQ H3T 1J4, Canada

[6] Alberta Hlth Serv, Calgary, AB T2W 1S7, Canada

[7] McGill Univ, Div Clin Epidemiol, Montreal, PQ H3A 1A1, Canada

[8] Jewish Gen Hosp, Lady Davis Res Inst, Montreal, PQ H3T 1E2, Canada

[9] Univ British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC V6T 1Z3, Canada

[10] McGill Univ, Dept Epidemiol, Montreal, PQ H3A 1A2, Canada

[11] McGill Univ, Dept Biostat, Montreal, PQ H3A 1A2, Canada

[12] McGill Univ, Dept Occupat Hlth, Montreal, PQ H3A 1A2, Canada

[13] McGill Univ, Dept Pediat, Montreal, PQ H3A 1A2, Canada

[14] Dalhousie Univ, Dept Community Hlth & Epidemiol, Halifax, NS B3H 1V7, Canada

[15] York Univ, Sch Kinesiol & Hlth Sci, Toronto, ON M3J 1P3, Canada

[16] Univ Toronto, Dept Med, Womens Coll Res Inst, Womens Coll Hosp, Toronto, ON M5G 1N8, Canada

[17] Ctr Addict & Mental Hlth, Toronto, ON M5T 1R8, Canada

关键词: Antipsychotics;    Drug side effects;    Psychosis;    Hyperglycemic emergencies;    Diabetes;    Epidemiology;    Database research;   

DOI  :  10.1016/j.schres.2014.01.043

来源: Elsevier

【 摘 要 】

Objective: To evaluate the relationship between initiation of atypical antipsychotic agents and the risk of hyperglycemic emergencies. Method: We conducted a multicentre retrospective cohort study using administrative health data from 7 Canadian provinces and the UK Clinical Practice Research Datalink. Hospitalizations for hyperglycemic emergencies (hyperglycemia, diabetic ketoacidosis, hyperosmolar hyperglycemic state) were compared between new users of risperidone (reference), and new users of olanzapine, other atypical antipsychotics, and typical antipsychotics. We used propensity scores with inverse probability of treatment weighting and proportional hazard models to estimate the site-specific hazard ratios of hyperglycemic emergencies in the year following drug initiation separately for adults under and over age 66 years. Site-level results were pooled using meta-analytic methods. Results: Among 725,489 patients, 55% were aged 66+ years; 5% of younger and 19% of older patients had preexisting diabetes. Hyperglycemic emergencies were rare (1-2 per 1000 person years), but more frequent in patients with pre-existing diabetes (6-12 per 1000 person years). We did not find a significant difference in risk of hyperglycemic emergencies with initiation of olanzapine versus risperidone; however heterogeneity existed between sites. The risk of an event was significantly lower with other atypical (99% quetiapine) compared to risperidone use in older patients [adjusted hazard ratio, 95% confidence interval (CI): 0.69, 0.53-0.90]. Conclusions: Risk for hyperglycemic emergencies is low after initiation of antipsychotics, but patients with preexisting diabetes may be at greater risk. The risk appeared lower with the use of quetiapine in older patients, but the clinical significance of the findings requires further study. (C) 2014 The Authors. Published by Elsevier B. V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

【 授权许可】

Free