Antipsychotic Medication and Risk of Metabolic Disorders in People With Schizophrenia: A Longitudinal Study Using the UK Clinical Practice Research Datalink

被引:4
|
作者
Eyles, Emily [1 ,2 ,5 ]
Margelyte, Ruta [1 ,2 ]
Edwards, Hannah B. [1 ,2 ]
Moran, Paul A. [2 ]
Kessler, David S. [2 ]
Davies, Simon J. C. [2 ,3 ]
Bolea-Alamanac, Blanca [4 ]
Redaniel, Maria Theresa [1 ,2 ]
Sullivan, Sarah A. [2 ]
机构
[1] Univ Hosp Bristol & Weston NHS Fdn Trust, Natl Inst Hlth Res Appl Res Collaborat West NIHR A, Bristol, England
[2] Univ Bristol, Bristol Med Sch, Populat Hlth Sci, Bristol, England
[3] Univ Toronto, Ctr Addict & Mental Hlth, Toronto, ON, Canada
[4] Univ Toronto, Womens Coll Hosp, Toronto, ON, Canada
[5] 9th Floor,Whitefriars, Bristol BS1 2NT, England
关键词
antipsychotics; hyperlipidemia; hypertension; diabetes; CPRD; time-varying; 2ND-GENERATION; MORTALITY; UPDATE; TRIAL;
D O I
10.1093/schbul/sbad126
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background and Hypothesis Antipsychotics are first-line drug treatments for schizophrenia. When antipsychotic monotherapy is ineffective, combining two antipsychotic drugs is common although treatment guidelines warn of possible increases in side effects. Risks of metabolic side effects with antipsychotic polypharmacy have not been fully investigated. This study examined associations between antipsychotic polypharmacy and risk of developing diabetes, hypertension, or hyperlipidemia in adults with schizophrenia, and impact of co-prescription of first- and second-generation antipsychotics. Study Design A population-based prospective cohort study was conducted in the United Kingdom using linked primary care, secondary care, mental health, and social deprivation datasets. Cox proportional hazards models with stabilizing weights were used to estimate risk of metabolic disorders among adults with schizophrenia, comparing patients on antipsychotic monotherapy vs polypharmacy, adjusting for demographic and clinical characteristics, and antipsychotic dose. Study Results Median follow-up time across the three cohorts was approximately 14 months. 6.6% developed hypertension in the cohort assembled for this outcome, with polypharmacy conferring an increased risk compared to monotherapy, (adjusted Hazard Ratio = 3.16; P = .021). Patients exposed to exclusive first-generation antipsychotic polypharmacy had greater risk of hypertension compared to those exposed to combined first- and second-generation polypharmacy (adjusted HR 0.29, P = .039). No associations between polypharmacy and risk of diabetes or hyperlipidemia were found. Conclusions Antipsychotic polypharmacy, particularly polypharmacy solely comprised of first-generation antipsychotics, increased the risk of hypertension. Future research employing larger samples, follow-up longer than the current median of 14 months, and more complex methodologies may further elucidate the association reported in this study.
引用
收藏
页码:447 / 459
页数:13
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