Comparative Risk of Neuropsychiatric Adverse Events Associated With Leukotriene-Receptor Antagonists Versus Inhaled Corticosteroids.

IF 8.2 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-10-04 DOI:10.1016/j.jaip.2024.09.028

Tsung-Chieh Yao, Jing-Long Huang, Chi-Shin Wu, Henry Horng-Shing Lu, Yen-Chen Chang, Wei-Yu Chen, Hui-Fang Kao, Ann Chen Wu, Hui-Ju Tsai

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引用次数: 0

Abstract

Background: Leukotriene-receptor antagonists (LTRA) and inhaled corticosteroids (ICS) are common controller medications for asthma, but limited studies examine their comparative risks on neuropsychiatric adverse events (NAEs) in patients with asthma.

Objective: To investigate the comparative risks of LTRA versus ICS on 7 distinct categories of NAEs in patients with asthma at a nationwide level.

Methods: We conducted a nationwide cohort study during 2010-2021. Incident NAEs and their clinical subgroups (eg, psychotic disorders, anxiety disorders, movement disorders, behavioral and emotional disorders, mood disorders, sleep-related disorders, and personality disorders) were assessed. Cox proportional hazards regressions were used to quantify the comparative risks.

Results: There were 1,249,897 patients with asthma aged 6 to 64 years. Incidence rates for NAEs were 25.10 per 1000 person-years among patients treated with LTRA and 23.46 per 1000 person-years among those treated with ICS. The incidence rate difference was 1.64 (95% confidence interval [CI]: 0.30-2.98) per 1000 person-years. Positive associations of NAEs and 3 clinical subgroups were found in patients treated with LTRA compared with ICS (hazard ratios [HR]: 1.06 [95% CI: 1.00-1.12] for NAEs; HR: 1.88 [95% CI: 1.24-2.84] for psychotic disorders; HR: 1.10 [95% CI: 1.01-1.20] for anxiety disorders; and HR: 1.27 [95% CI: 1.02-1.58] for behavioral and emotional disorders), but not for movement disorders, mood disorders, sleep-related disorders, and personality disorders.

Conclusions: This nationwide cohort study identified heightened risks, ranging from 6% to 88%, of NAEs and 3 clinical subgroups in patients with asthma treated with LTRA compared with ICS. These findings underscore the necessity for clinicians to communicate with patients regarding potential neuropsychiatric harms when prescribing LTRA.

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白三烯受体拮抗剂与吸入性皮质类固醇相关神经精神不良事件的风险比较。

背景：白三烯受体拮抗剂（LTRA）和吸入性皮质类固醇（ICS）是治疗哮喘的常用控制药物，但对这两种药物在哮喘患者神经精神不良事件（NAEs）方面的风险比较研究有限：在全国范围内调查 LTRA 与 ICS 对哮喘患者七类不同神经精神不良事件的比较风险：方法：我们在 2010-2021 年间开展了一项全国性队列研究。我们对哮喘患者的非哮喘急性发作及其临床亚组（如精神障碍、焦虑障碍、运动障碍、行为和情感障碍、情绪障碍、睡眠相关障碍和人格障碍）进行了评估。采用 Cox 比例危险度回归来量化比较风险：共有 1,249,897 名 6-64 岁的哮喘患者。在接受 LTRA 治疗的患者中，NAE 的发病率为每 1000 人年 25.10 例，而在接受 ICS 治疗的患者中，NAE 的发病率为每 1000 人年 23.46 例。发病率差异为每千人年 1.64 [95%CI: 0.30-2.98]。与接受 ICS 治疗的患者相比，接受 LTRA 治疗的患者出现 NAEs 与三个临床亚组呈正相关（危险比（HR）：NAEs：1.06 [95%CI：1.00-1.12]；精神病性障碍：HR：1.88 [95%CI：1.24-2.84]；HR：1.10[95%CI：1.01-1.20]；行为和情绪障碍 HR：1.27[95%CI：1.02-1.58]），而运动障碍、情绪障碍、睡眠相关障碍和人格障碍则没有：这项全国范围的队列研究发现，与 ICS 相比，接受 LTRA 治疗的哮喘患者发生 NAEs 和三个临床亚组的风险更高，从 6% 到 88% 不等。这些发现强调了临床医生在开具 LTRA 处方时与患者沟通潜在神经精神伤害的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.