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題名 Antipsychotic reexposure and recurrent pneumonia in schizophrenia: A nested case-control study 作者 潘俊宏
Hung, Galen Chin Lun
Liu, Hsing Cheng
Yang, Shu Yu
Pan, Chun Hung
Liao, Ya Tang
Chen, Chiao Chicy
Kuo, Chian Jue貢獻者 心理系 關鍵詞 amisulpride; antidepressant agent; aripiprazole; benzodiazepine; chlorpromazine; clozapine; flupentixol; haloperidol; mood stabilizer; neuroleptic agent; olanzapine; quetiapine; risperidone; sulpiride; zotepine; clozapine; neuroleptic agent; adult; Article; case control study; cohort analysis; controlled study; disease association; disease classification; drug efficacy; drug reexposure; drug safety; female; high risk patient; human; major clinical study; male; pneumonia; priority journal; propensity score; recurrent disease; recurrent pneumonia; recurrent pneumonia; schizophrenia; Taiwan; treatment duration; adolescent; aged; chemically induced; complication; dose response; factual database; middle aged; pneumonia; risk factor; schizophrenia; sexual development; young adult; Adolescent; Adult; Aged; Antipsychotic Agents; Case-Control Studies; Clozapine; Databases, Factual; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Pneumonia; Recurrence; Risk Factors; Schizophrenia; Sex Characteristics; Young Adult 日期 2016-01 上傳時間 15-Sep-2017 15:19:34 (UTC+8) 摘要 Objective: Few studies have used systematic datasets to assess the safety of antipsychotic rechallenge after an adverse event. This nested case-control study estimated the risk for recurrent pneumonia after reexposure to antipsychotic treatment. Method: In a nationwide schizophrenia (ICD-9-CM code 295) cohort (derived from the National Health Insurance Research Database in Taiwan) who were hospitalized for pneumonia (ICD-9-CM codes 480-486, 507) between 2000 and 2008 (N = 2,201), we identified 494 subjects that developed recurrent pneumonia after a baseline pneumonia episode. Based on risk-set sampling in a 1:3 ratio, 1,438 matched controls were selected from the cohort. Exposures to antipsychotics were categorized by type, duration, and defined daily dose. Using propensity score-adjusted analysis, we assessed individual antipsychotics for the risk of recurrent pneumonia; we furthermore assessed the effect of reexposure to these antipsychotics on the risk of recurrent pneumonia. Results: Of the antipsychotics studied, current use of clozapine was the only one associated with a clear dose-dependent increase in the risk for recurrent pneumonia (adjusted risk ratio = 1.40, P =.024). Intriguingly, patients reexposed to clozapine had a higher risk for recurrent pneumonia (adjusted risk ratio = 1.99, P =.023) than those receiving clozapine only prior to the baseline pneumonia, and this risk was associated with gender. Women reexposed to clozapine were more susceptible to recurrent pneumonia (adjusted risk ratio = 4.93, P =.050). Conclusions: In patients experiencing pneumonia while undergoing clozapine treatment, physicians should carefully consider the increased risk of pneumonia recurrence when clozapine is reintroduced. Future studies should try to quantify the risk of other medical conditions associated with clozapine reexposure. 關聯 Journal of Clinical Psychiatry, 77(1), 60-66 資料類型 article DOI http://dx.doi.org/10.4088/JCP.14m09301 dc.contributor 心理系 zh_TW dc.creator (作者) 潘俊宏 zh_TW dc.creator (作者) Hung, Galen Chin Lun en_US dc.creator (作者) Liu, Hsing Cheng en_US dc.creator (作者) Yang, Shu Yu en_US dc.creator (作者) Pan, Chun Hung en_US dc.creator (作者) Liao, Ya Tang en_US dc.creator (作者) Chen, Chiao Chicy en_US dc.creator (作者) Kuo, Chian Jue en_US dc.date (日期) 2016-01 dc.date.accessioned 15-Sep-2017 15:19:34 (UTC+8) - dc.date.available 15-Sep-2017 15:19:34 (UTC+8) - dc.date.issued (上傳時間) 15-Sep-2017 15:19:34 (UTC+8) - dc.identifier.uri (URI) http://nccur.lib.nccu.edu.tw/handle/140.119/113036 - dc.description.abstract (摘要) Objective: Few studies have used systematic datasets to assess the safety of antipsychotic rechallenge after an adverse event. This nested case-control study estimated the risk for recurrent pneumonia after reexposure to antipsychotic treatment. Method: In a nationwide schizophrenia (ICD-9-CM code 295) cohort (derived from the National Health Insurance Research Database in Taiwan) who were hospitalized for pneumonia (ICD-9-CM codes 480-486, 507) between 2000 and 2008 (N = 2,201), we identified 494 subjects that developed recurrent pneumonia after a baseline pneumonia episode. Based on risk-set sampling in a 1:3 ratio, 1,438 matched controls were selected from the cohort. Exposures to antipsychotics were categorized by type, duration, and defined daily dose. Using propensity score-adjusted analysis, we assessed individual antipsychotics for the risk of recurrent pneumonia; we furthermore assessed the effect of reexposure to these antipsychotics on the risk of recurrent pneumonia. Results: Of the antipsychotics studied, current use of clozapine was the only one associated with a clear dose-dependent increase in the risk for recurrent pneumonia (adjusted risk ratio = 1.40, P =.024). Intriguingly, patients reexposed to clozapine had a higher risk for recurrent pneumonia (adjusted risk ratio = 1.99, P =.023) than those receiving clozapine only prior to the baseline pneumonia, and this risk was associated with gender. Women reexposed to clozapine were more susceptible to recurrent pneumonia (adjusted risk ratio = 4.93, P =.050). Conclusions: In patients experiencing pneumonia while undergoing clozapine treatment, physicians should carefully consider the increased risk of pneumonia recurrence when clozapine is reintroduced. Future studies should try to quantify the risk of other medical conditions associated with clozapine reexposure. en_US dc.format.extent 204 bytes - dc.format.mimetype text/html - dc.relation (關聯) Journal of Clinical Psychiatry, 77(1), 60-66 en_US dc.subject (關鍵詞) amisulpride; antidepressant agent; aripiprazole; benzodiazepine; chlorpromazine; clozapine; flupentixol; haloperidol; mood stabilizer; neuroleptic agent; olanzapine; quetiapine; risperidone; sulpiride; zotepine; clozapine; neuroleptic agent; adult; Article; case control study; cohort analysis; controlled study; disease association; disease classification; drug efficacy; drug reexposure; drug safety; female; high risk patient; human; major clinical study; male; pneumonia; priority journal; propensity score; recurrent disease; recurrent pneumonia; recurrent pneumonia; schizophrenia; Taiwan; treatment duration; adolescent; aged; chemically induced; complication; dose response; factual database; middle aged; pneumonia; risk factor; schizophrenia; sexual development; young adult; Adolescent; Adult; Aged; Antipsychotic Agents; Case-Control Studies; Clozapine; Databases, Factual; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Pneumonia; Recurrence; Risk Factors; Schizophrenia; Sex Characteristics; Young Adult en_US dc.title (題名) Antipsychotic reexposure and recurrent pneumonia in schizophrenia: A nested case-control study en_US dc.type (資料類型) article dc.identifier.doi (DOI) 10.4088/JCP.14m09301 dc.doi.uri (DOI) http://dx.doi.org/10.4088/JCP.14m09301
