Antipsychotic drug prescription sequence analysis in relation to death occurrence and cardiometabolic drug usage: A retrospective longitudinal study

IF 2.5 4区医学 Q2 PSYCHIATRY

European Journal of Psychiatry Pub Date : 2023-01-01 DOI:10.1016/j.ejpsy.2022.06.002

Paweł Zagozdzon , Piotr Dorozynski , Przemysław Waszak , Adam Harasimowicz , Tomasz Dziubich

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引用次数: 1

Abstract

Background and objectives

The potential role of antipsychotics in increasing cardiovascular risk of mortality is still debated. The aim of this study was to assess the death risk associated with sequences of first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) prescriptions, including clozapine and lithium, and drugs for cardiometabolic diseases.

Methods

We conducted a retrospective longitudinal analysis involving 84,881 patients who received antipsychotics between 2008 and 2012. Data on deaths were collected from the National Death Registry. The sequence creation was performed according to an algorithm that iterates prescriptions in chronological order and appends them to the end of the patient's prescription sequence. Fuzzy set qualitative comparative analysis (FsQCA) was also used to produce causal combinations of conditions that best lead to survival.

Results

There were 1,095,518 antipsychotic prescriptions and 16,010 deaths among antipsychotic users. Among the reimbursement data, 85,272 drug sequences were identified. The most prevalent sequence consisted of FGA (69.1%). Subsequent groups consisted of FGA, followed by SGA (13.1%) and SGA-only (12.3%) sequences. The highest occurrence of death and cardiometabolic drug use after introducing antipsychotic treatment was observed for clozapine. The FsQCA analysis revealed the highest coverage for combinations of young age with FGA (40.6%) or with no cardiometabolic risk factors drug therapy (39.5%).

Conclusion

The sequence analysis suggests that clozapine is associated with an increased death risk compared to FGA and SGA.

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抗精神病药物处方序列分析与死亡发生和心脏代谢药物使用的关系：一项回顾性纵向研究

背景和目的抗精神病药物在增加心血管死亡风险中的潜在作用仍存在争议。本研究的目的是评估与第一代抗精神病药物（FGA）和第二代抗精神疾病药物（SGA）处方序列相关的死亡风险，包括氯氮平和锂，以及治疗心脏代谢疾病的药物。方法我们对2008年至2012年间接受抗精神病药物治疗的84881名患者进行了回顾性纵向分析。死亡数据是从国家死亡登记处收集的。序列创建是根据一种算法执行的，该算法按时间顺序迭代处方，并将其附加到患者处方序列的末尾。模糊集定性比较分析（FsQCA）也被用于产生最能导致存活的条件的因果组合。结果抗精神病药物使用者共开出1095518张抗精神病药处方，16010人死亡。在报销数据中，确定了85272个药物序列。最常见的序列是FGA（69.1%）。随后的组由FGA组成，其次是SGA（13.1%）和仅SGA（12.3%）序列。氯氮平在引入抗精神病药物治疗后死亡和心脏代谢药物使用的发生率最高。FsQCA分析显示，年轻时有FGA（40.6%）或没有心脏代谢危险因素药物治疗（39.5%）的组合覆盖率最高。结论序列分析表明，与FGA和SGA相比，氯氮平与死亡风险增加有关。

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

European Journal of Psychiatry PSYCHIATRY-

CiteScore

2.90

自引率

0.00%

发文量

审稿时长

43 days

期刊介绍： The European journal of psychiatry is a quarterly publication founded in 1986 and directed by Professor Seva until his death in 2004. It was originally intended to report “the scientific activity of European psychiatrists” and “to bring about a greater degree of communication” among them. However, “since scientific knowledge has no geographical or cultural boundaries, is open to contributions from all over the world”. These principles are maintained in the new stage of the journal, now expanded with the help of an American editor.