Risk of self-harm and the use of leukotriene receptor antagonists and inhaled corticosteroids: a population-based study.

IF 6.6 1区医学 Q1 ALLERGY

Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2025-09-27 DOI:10.1016/j.jaip.2025.09.025

Boqing Chen, Andrew S C Yuen, Kenneth K C Man, Joseph F Hayes, David P J Osborn, Ian C K Wong, Adrienne Y L Chan, Lok Yin Cheng, Yogini H Jani, Wallis C Y Lau

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引用次数: 0

Abstract

Background: Whether leukotriene receptor antagonists (LTRAs) or inhaled corticosteroids (ICS) use can increase the risk of self-harm remains unclear.

Objective: To evaluate the association between self-harm and use of LTRA and ICS among patients with asthma.

Methods: This self-controlled case series (SCCS) study used data from the UK Clinical Practice Research Datalink linked to hospital and mortality records. We included patients with asthma aged ≥10 years who had at least one prescription of LTRA, one prescription of ICS, and an incident self-harm during 2005-2020. Incidence rate ratios (IRRs) of self-harm during periods of (presented in order of precedence if they overlapped): pre-LTRA, pre-ICS, LTRA-alone, ICS-alone, and combination use of LTRA and ICS, versus non-use, were calculated using conditional Poisson regression model. Additional analyses using SCCS extension, case-case-time-control, and cohort study designs were used to examine robustness of results.

Results: Among 313,943 individuals prescribed LTRA and ICS, 2,900 had incident self-harm. IRRs were 0.77 (95%CI=0.58-1.01) during pre-LTRA, 0.68 (95%CI=0.57-0.82) during LTRA-alone, and 0.70 (95%CI=0.56-0.86) during combination use. Further analysis suggested the self-harm incidence was lower during the first 90 days of LTRA use (IRR=0.74; 95%CI=0.58-0.95), before returning to non-use level (IRR=0.93; 95%CI=0.74-1.17). Comparable incidence to non-use was observed during pre-ICS (IRR=0.99; 95%CI=0.71-1.39) and ICS-alone (IRR=0.88; 95%CI=0.75-1.04). The results were robust across sensitivity analyses and study designs, which did not suggest increased risk of self-harm with LTRA/ICS use.

Conclusion: Using the SCCS design, which was based on comparisons within a population with both the outcome and exposure of interest, our study does not support an association between self-harm and LTRA or ICS in patients with asthma.

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自残风险与白三烯受体拮抗剂和吸入皮质类固醇的使用：一项基于人群的研究

背景：使用白三烯受体拮抗剂（LTRAs）或吸入皮质类固醇（ICS）是否会增加自残风险尚不清楚。目的：探讨哮喘患者使用LTRA和ICS与自我伤害的关系。方法：这项自我控制的病例系列（SCCS）研究使用了英国临床实践研究数据链与医院和死亡率记录相关的数据。我们纳入了2005-2020年期间至少有一次LTRA处方、一次ICS处方和自残事件的≥10岁哮喘患者。使用条件泊松回归模型计算在LTRA前、ICS前、LTRA单独使用、ICS单独使用、LTRA和ICS联合使用与不使用期间的自残发生率比（IRRs）（如果重叠则按优先顺序排列）。使用SCCS扩展、病例-病例-时间对照和队列研究设计进行额外分析，以检验结果的稳健性。结果：313,943名服用LTRA和ICS的患者中，有2,900人有自残行为。ltra术前的IRRs为0.77 (95%CI=0.58-1.01)，单独使用ltra时的IRRs为0.68 (95%CI=0.57-0.82)，联合使用时的IRRs为0.70 （95%CI=0.56-0.86）。进一步分析表明，在使用LTRA的前90天，自伤发生率较低（IRR=0.74; 95%CI=0.58-0.95），然后恢复到未使用水平（IRR=0.93; 95%CI=0.74-1.17）。在ics前（IRR=0.99; 95%CI=0.71-1.39）和单独ics期间（IRR=0.88; 95%CI=0.75-1.04）观察到与未使用的发生率相当。敏感性分析和研究设计的结果是可靠的，并没有表明使用LTRA/ICS会增加自我伤害的风险。结论：使用SCCS设计，该设计基于在人群中对结果和暴露感兴趣的人群进行比较，我们的研究不支持哮喘患者自我伤害与LTRA或ICS之间的关联。

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.