Neuropsychiatric diagnoses after montelukast initiation in paediatric patients with asthma

IF 9 1区医学 Q1 RESPIRATORY SYSTEM

Thorax Pub Date : 2024-11-22 DOI:10.1136/thorax-2024-221590

Tapio Paljarvi, Julian T Forton, Courtney Thompson, Sierra Luciano, Kimmo Herttua, Seena Fazel

{"title":"Neuropsychiatric diagnoses after montelukast initiation in paediatric patients with asthma","authors":"Tapio Paljarvi, Julian T Forton, Courtney Thompson, Sierra Luciano, Kimmo Herttua, Seena Fazel","doi":"10.1136/thorax-2024-221590","DOIUrl":null,"url":null,"abstract":"Background The evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast as an adjunct therapy to inhaled corticosteroids (ICSs) in CYP aged 3–17 years with asthma. Methods This propensity score matched cohort study was conducted using electronic health records between 2015 and 2019 in the TriNetX Analytics Network patient repository in the USA. Neuropsychiatric diagnoses were identified using the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. We estimated risk ratios (RRs), absolute risk increase (ARI) and number needed to harm (NNH) with 95% CIs. Findings The mean age (SD) at index prescription in the 107 384 CYP with asthma was 8.7 (4.0) years (93 461 (87%) mild to moderate asthma; 62 301 (58%) male; 53 485 (50%) white; 33 107 (31%) black/African American). Montelukast was associated with excess incidence of any neuropsychiatric outcome (71 per 1000 persons with montelukast and 54 per 1000 persons with no montelukast; RR 1.32 (95% CI 1.25 to 1.39); ARI per 100 persons, 1.71 (95% CI 1.44 to 1.98); 1-year NNH, 58 patients (95% CI 51 to 69)). The highest excess risk in the montelukast group was for sleep disorders (RR 1.63 (95% CI 1.50 to 1.77); ARI per 100 persons 1.17 (95% CI 1.00 to 1.33); NNH, 85 patients (95% CI 75 to 100)). Montelukast use was also associated with excess incidence of anxiety disorders (RR 1.16 (95% CI 1.08 to 1.24)) and mood disorders (RR 1.16 (95% CI 1.05 to 1.29)). Conclusions In CYP with asthma who were treated with ICSs, adjunct treatment with montelukast was associated with a higher incidence of neuropsychiatric outcomes compared with those who were not exposed to montelukast. Data may be obtained from a third party and are not publicly available. Data were provided by TriNetX (www.trinetx.com), a federated data network. Access to TriNetX’s deidentified patient data is available for the purpose of healthcare research with an approved user license.","PeriodicalId":23284,"journal":{"name":"Thorax","volume":"5 1","pages":""},"PeriodicalIF":9.0000,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Thorax","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/thorax-2024-221590","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Background The evidence base on montelukast-associated adverse outcomes is inconclusive in children and young persons (CYP) with asthma. We aimed to investigate 1-year incidence of neuropsychiatric diagnoses after initiation of montelukast as an adjunct therapy to inhaled corticosteroids (ICSs) in CYP aged 3–17 years with asthma. Methods This propensity score matched cohort study was conducted using electronic health records between 2015 and 2019 in the TriNetX Analytics Network patient repository in the USA. Neuropsychiatric diagnoses were identified using the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. We estimated risk ratios (RRs), absolute risk increase (ARI) and number needed to harm (NNH) with 95% CIs. Findings The mean age (SD) at index prescription in the 107 384 CYP with asthma was 8.7 (4.0) years (93 461 (87%) mild to moderate asthma; 62 301 (58%) male; 53 485 (50%) white; 33 107 (31%) black/African American). Montelukast was associated with excess incidence of any neuropsychiatric outcome (71 per 1000 persons with montelukast and 54 per 1000 persons with no montelukast; RR 1.32 (95% CI 1.25 to 1.39); ARI per 100 persons, 1.71 (95% CI 1.44 to 1.98); 1-year NNH, 58 patients (95% CI 51 to 69)). The highest excess risk in the montelukast group was for sleep disorders (RR 1.63 (95% CI 1.50 to 1.77); ARI per 100 persons 1.17 (95% CI 1.00 to 1.33); NNH, 85 patients (95% CI 75 to 100)). Montelukast use was also associated with excess incidence of anxiety disorders (RR 1.16 (95% CI 1.08 to 1.24)) and mood disorders (RR 1.16 (95% CI 1.05 to 1.29)). Conclusions In CYP with asthma who were treated with ICSs, adjunct treatment with montelukast was associated with a higher incidence of neuropsychiatric outcomes compared with those who were not exposed to montelukast. Data may be obtained from a third party and are not publicly available. Data were provided by TriNetX (www.trinetx.com), a federated data network. Access to TriNetX’s deidentified patient data is available for the purpose of healthcare research with an approved user license.

查看原文本刊更多论文

儿童哮喘患者服用孟鲁司特后的神经精神诊断

背景在哮喘儿童和青少年（CYP）中，有关孟鲁司特相关不良后果的证据基础尚无定论。我们旨在调查 3-17 岁哮喘儿童和青少年在开始使用孟鲁司特作为吸入式皮质类固醇（ICS）的辅助疗法后 1 年的神经精神疾病发病率。方法这项倾向得分匹配队列研究是利用美国 TriNetX 分析网络患者资料库中 2015 年至 2019 年期间的电子健康记录进行的。使用《国际疾病统计分类第十版临床修正》（ICD-10-CM）代码确定神经精神科诊断。我们估算了风险比 (RRs)、绝对风险增加 (ARI) 和伤害所需人数 (NNH) 以及 95% CIs。研究结果 107 384 名患有哮喘的 CYP 开具指数处方时的平均年龄（SD）为 8.7 (4.0) 岁（93 461 (87%)轻度至中度哮喘；62 301 (58%)男性；53 485 (50%)白人；33 107 (31%)黑人/非裔美国人）。孟鲁司特与任何神经精神疾病的超常发生率有关（使用孟鲁司特的每 1000 人中有 71 人，未使用孟鲁司特的每 1000 人中有 54 人；RR 1.32（95% CI 1.25 至 1.39）；每 100 人中 ARI 1.71（95% CI 1.44 至 1.98）；1 年 NNH，58 名患者（95% CI 51 至 69））。孟鲁司特组的最高超额风险是睡眠障碍（RR 1.63（95% CI 1.50 至 1.77）；每 100 人 ARI 1.17（95% CI 1.00 至 1.33）；NNH，85 名患者（95% CI 75 至 100））。使用孟鲁司特还与焦虑症（RR 1.16（95% CI 1.08 至 1.24））和情绪障碍（RR 1.16（95% CI 1.05 至 1.29））的发病率过高有关。结论在接受 ICSs 治疗的哮喘青壮年患者中，与未接触孟鲁司特的患者相比，孟鲁司特的辅助治疗与较高的神经精神疾病发病率相关。数据可能来自第三方，不对外公开。数据由联合数据网络 TriNetX (www.trinetx.com) 提供。在获得批准的用户许可后，可访问 TriNetX 的去身份化患者数据，用于医疗保健研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Thorax 医学-呼吸系统

CiteScore

16.10

自引率

2.00%

发文量

197

审稿时长

1 months

期刊介绍： Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.