Angelo d'Errico, Elena Strippoli, Samuel M Goldman, Paul D Blanc
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The outcome was incident parkinsonism identified through multiple prescriptions of levodopa or a hospital admission for Parkinson's disease or atypical parkinsonism. Exposure to disulfiram and to neuroleptics was assessed through regional drug prescription archives. The association between disulfiram and parkinsonism onset was assessed using Cox proportional hazards models, adjusted for gender, age and neuroleptic use.</p><p><strong>Results: </strong>The study population included 2,498,491 individuals (mean age: 62 years). During follow-up, 19,072 parkinsonism cases were identified, 8 of whom had been prescribed disulfiram. Exposure to disulfiram was associated with a three-fold increased risk of parkinsonism (HR = 3.10, 95% CI = 1.55-6.21) that remained significant when adjusted for neuroleptic use (HR = 2.04, 95% CI = 1.01-4.10). The association was stronger among persons unexposed to neuroleptics and among those with more than four disulfiram prescriptions.</p><p><strong>Conclusions: </strong>These results support the hypothesis that disulfiram may cause parkinsonism. Clinicians and drug regulatory agencies should consider parkinsonism when assessing the risks and benefits of disulfiram use.</p>","PeriodicalId":48903,"journal":{"name":"Journal of Occupational Medicine and Toxicology","volume":"20 1","pages":"8"},"PeriodicalIF":2.9000,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899656/pdf/","citationCount":"0","resultStr":"{\"title\":\"Exposure to disulfiram and incidence of parkinsonism.\",\"authors\":\"Angelo d'Errico, Elena Strippoli, Samuel M Goldman, Paul D Blanc\",\"doi\":\"10.1186/s12995-025-00454-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Case reports implicate disulfiram treatment in causing parkinsonism, but these observations lack epidemiological confirmation. Aim of the present study was to estimate the risk of incident parkinsonism associated with disulfiram dispensing in a large Italian population.</p><p><strong>Methods: </strong>In this observational cohort study, administrative data were used, linking records at the individual level from civic registries, population census, mortality registers, hospital admissions, archives of drug prescriptions, and direct ambulatory drug distribution. Participants included all residents in the Piedmont region of Italy aged ≥ 40 years participating in 2011 census, still resident and alive at the beginning of 2013, followed-up from 2013 to 2019. The outcome was incident parkinsonism identified through multiple prescriptions of levodopa or a hospital admission for Parkinson's disease or atypical parkinsonism. Exposure to disulfiram and to neuroleptics was assessed through regional drug prescription archives. The association between disulfiram and parkinsonism onset was assessed using Cox proportional hazards models, adjusted for gender, age and neuroleptic use.</p><p><strong>Results: </strong>The study population included 2,498,491 individuals (mean age: 62 years). During follow-up, 19,072 parkinsonism cases were identified, 8 of whom had been prescribed disulfiram. Exposure to disulfiram was associated with a three-fold increased risk of parkinsonism (HR = 3.10, 95% CI = 1.55-6.21) that remained significant when adjusted for neuroleptic use (HR = 2.04, 95% CI = 1.01-4.10). The association was stronger among persons unexposed to neuroleptics and among those with more than four disulfiram prescriptions.</p><p><strong>Conclusions: </strong>These results support the hypothesis that disulfiram may cause parkinsonism. 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引用次数: 0
摘要
背景:病例报告暗示双硫仑治疗导致帕金森病,但这些观察结果缺乏流行病学证实。本研究的目的是估计在意大利大量人群中与双硫仑配药相关的帕金森病发生风险。方法:在这项观察性队列研究中,使用了行政数据,将来自公民登记、人口普查、死亡登记、住院记录、药物处方档案和直接门诊药物分配的个人记录联系起来。参与2011年人口普查的意大利皮埃蒙特地区所有年龄≥40岁的居民,2013年初仍居住并活着,2013年至2019年随访。结果是通过多次服用左旋多巴或因帕金森氏病或非典型帕金森氏病住院而确定的偶发性帕金森氏症。通过区域药物处方档案评估双硫仑和抗精神病药的暴露情况。使用Cox比例风险模型评估双硫仑与帕金森病发病之间的关系,并根据性别、年龄和抗精神病药使用情况进行调整。结果:研究人群包括2,498,491人(平均年龄:62岁)。在随访期间,发现了19072例帕金森病例,其中8例服用了双硫仑。暴露于双硫仑与帕金森病风险增加3倍相关(HR = 3.10, 95% CI = 1.55-6.21),在调整使用抗精神病药物后,这一风险仍然显著(HR = 2.04, 95% CI = 1.01-4.10)。在未接触过抗精神病药和服用过四次以上双硫仑的人群中,这种关联更强。结论:这些结果支持双硫仑可能导致帕金森病的假设。临床医生和药物监管机构在评估使用双硫仑的风险和益处时应考虑帕金森病。
Exposure to disulfiram and incidence of parkinsonism.
Background: Case reports implicate disulfiram treatment in causing parkinsonism, but these observations lack epidemiological confirmation. Aim of the present study was to estimate the risk of incident parkinsonism associated with disulfiram dispensing in a large Italian population.
Methods: In this observational cohort study, administrative data were used, linking records at the individual level from civic registries, population census, mortality registers, hospital admissions, archives of drug prescriptions, and direct ambulatory drug distribution. Participants included all residents in the Piedmont region of Italy aged ≥ 40 years participating in 2011 census, still resident and alive at the beginning of 2013, followed-up from 2013 to 2019. The outcome was incident parkinsonism identified through multiple prescriptions of levodopa or a hospital admission for Parkinson's disease or atypical parkinsonism. Exposure to disulfiram and to neuroleptics was assessed through regional drug prescription archives. The association between disulfiram and parkinsonism onset was assessed using Cox proportional hazards models, adjusted for gender, age and neuroleptic use.
Results: The study population included 2,498,491 individuals (mean age: 62 years). During follow-up, 19,072 parkinsonism cases were identified, 8 of whom had been prescribed disulfiram. Exposure to disulfiram was associated with a three-fold increased risk of parkinsonism (HR = 3.10, 95% CI = 1.55-6.21) that remained significant when adjusted for neuroleptic use (HR = 2.04, 95% CI = 1.01-4.10). The association was stronger among persons unexposed to neuroleptics and among those with more than four disulfiram prescriptions.
Conclusions: These results support the hypothesis that disulfiram may cause parkinsonism. Clinicians and drug regulatory agencies should consider parkinsonism when assessing the risks and benefits of disulfiram use.
期刊介绍:
Aimed at clinicians and researchers, the Journal of Occupational Medicine and Toxicology is a multi-disciplinary, open access journal which publishes original research on the clinical and scientific aspects of occupational and environmental health.
With high-quality peer review and quick decision times, we welcome submissions on the diagnosis, prevention, management, and scientific analysis of occupational diseases, injuries, and disability. The journal also covers the promotion of health of workers, their families, and communities, and ranges from rehabilitation to tropical medicine and public health aspects.