常用抗癫痫药物引起的长期体重变化:一项目标试验模拟研究。

Han Yu, Jessica G Young, Joshua Petimar, Sheryl L Rifas-Shiman, Matthew F Daley, William J Heerman, David M Janicke, W Schuyler Jones, Takuya Kawahara, Kristina H Lewis, Pi-I D Lin, Sengwee Toh, Daniel S Weisholtz, Jason P Block
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引用次数: 0

摘要

目的:评估开始和坚持使用常用抗癫痫药物(asm)后的长期体重变化,并检查与托吡酯相比,asm之间体重变化的差异。方法:我们纳入了52,309例开始使用asm的成年患者,采用目标试验模拟方法来控制时变混淆和选择偏差,并研究了在开始使用和坚持不同asm后6个月和12个月的体重变化的长期比较效应。结果:最常见的ASM是托吡酯(41.2%)。与托吡酯相比,我们估计左乙拉西坦和坚持左乙拉西坦的6个月体重变化更高0.94 kg (95% CI 0.20, 1.64),拉莫三嗪1.44 kg(0.74, 1.99),丙戊酸2.42 kg(1.71, 2.88),卡马西平1.32 kg(0.46, 2.16),奥卡西平1.74 kg(0.85, 2.71),在12个月的敏感性和亚组分析中结果相似。这些结果主要是由于使用托吡酯导致体重减轻,而不是使用其他asm导致体重增加。结果相似,但当只考虑药物开始时,结果有所减弱。结论:在起始和后续依从性或仅起始效应下,托吡酯在6个月和12个月时的体重减轻相关;其他药物则与较高的体重变化有关。这些结果为ASM启动决策提供了重要信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Long-Term Medication-Induced Weight Change Across Common Antiseizure Medications: A Target Trial Emulation Study.

Objective: To estimate long-term weight change after initiation and adherence to commonly used antiseizure medications (ASMs) and examine differences in weight change across ASMs compared to topiramate.

Methods: We included 52,309 adult patients who initiated ASMs, applied a target trial emulation approach to control time-varying confounding and selection bias, and examined the long-term comparative effects on weight change after initiating and adhering to different ASMs at 6 and 12 months post initiation.

Results: The most commonly initiated ASM was topiramate (41.2%). In comparison to topiramate, we estimated higher 6-month weight change under initiation and adherence to levetiracetam 0.94 kg (95% CI 0.20, 1.64), lamotrigine 1.44 kg (0.74, 1.99), valproate 2.42 kg (1.71, 2.88), carbamazepine 1.32 kg (0.46, 2.16), and oxcarbazepine 1.74 kg (0.85, 2.71), with similar results at 12 months and in sensitivity and subgroup analyses. These results were driven mostly by weight loss with use of topiramate rather than weight gain with use of other ASMs. Results were similar though attenuated when accounting for medication initiation only.

Conclusions: Topiramate was associated with weight loss at 6 and 12 months under either initiation and subsequent adherence or initiation-only effects; other medications were associated with higher weight change. These results provided important information to help with decision-making regarding ASM initiation.

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