Diabetes mellitus risk for 102 drugs and drug combinations used in patients with bipolar disorder

PSYCHONEUROENDOCRINOLOGY

卷:112

Article

Nestsiarovich, Anastasiya¹  Kerner, Bent²  Mazurie, Aurelien J.³  Cannon, Daniel C.⁴  Hurwitz, Nathaniel G.⁵  Zhu, Yiliang⁶  Nelson, Stuart J.⁷  Oprea, Tudor I.⁷  Crisanti, Annette S.⁸  Tohen, Mauricio⁸  Perkins, Douglas J.¹  Lambert, Christophe G.^1,7 

[1] Univ New Mexico, Hlth Sci Ctr, Dept Internal Med, Ctr Global Hlth, MSC10-5550,915 Camino Salud NE, Albuquerque, NM 87131 USA

[2] Univ Calif Los Angeles, David Geffen Sch Med, Semel Inst Neurosci & Human Behav, Los Angeles, CA 90095 USA

[3] TwoPoldChange Consulting, Bozeman, MT USA

[4] Iterat Consulting, Albuquerque, NM USA

[5] New Mexico Behav Hlth Inst, Las Vegas, NM USA

[6] Univ New Mexico, Hlth Sci Ctr, Dept Internal Med, Div Epidemiol Biostat & Prevent Med, Albuquerque, NM 87131 USA

[7] Univ New Mexico, Hlth Sci Ctr, Dept Internal Med, Translat Informat Div, Albuquerque, NM 87131 USA

[8] Univ New Mexico, Hlth Sci Ctr, Dept Psychiat & Behav Sci, Albuquerque, NM 87131 USA

关键词: Bipolar;    Diabetes;    Glucose;    Drug;    Polypharmacy;    Treatment;   

DOI  :  10.1016/j.psyneuen.2019.104511

来源: Elsevier

【 摘 要 】

Objective: To compare the largest set of bipolar disorder pharmacotherapies to date (102 drugs and drug combinations) for risk of diabetes mellitus (DM). Methods: The IBM MarketScan (R) database was used to retrospectively analyze data on 565,253 adults with bipolar disorder without prior glucose metabolism-related diagnoses. The pharmacotherapies compared were lithium, mood-stabilizing anticonvulsants, antipsychotics, and antidepressants (monotherapy and multi-class polypharmacy). Cox regression modeling included fixed pre-treatment covariates and time-varying drug exposure covariates to estimate the hazard ratio (HR) of each treatment versus No drug. Results: The annual incidence of new-onset diabetes during the exposure period was 3.09 % (22,951 patients). The HR of drug-dependent DM ranged from 0.79 to 2.37. One-third of the studied pharmacotherapies, including most of the antipsychotic-containing regimens, had a significantly higher risk of DM compared to No drug. A significantly lower DM risk was associated with lithium, lamotrigine, oxcarbazepine and bupropion monotherapies, selective serotonin reuptake inhibitors (SSRI) mono-class therapy and several drug combinations containing bupropion and an SSRI. As additional drugs were combined in more complex polypharmacy, higher HRs were consistently observed. Conclusions: There is an increased risk of diabetes mellitus associated with antipsychotic and psychotropic polypharmacy use in bipolar disorder. The evidence of a lower-than-baseline risk of DM with lamotrigine, oxcarbazepine, lithium, and bupropion monotherapy should be further investigated.

【 授权许可】

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