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JAMA:抗惊厥药物或增加患者自杀风险

来源:EurekAlert!中文 2010-04-17 23:14

抗惊厥药是治疗癫痫病人的主要治疗手段,但该药标注的用药指针还包括了躁郁症、狂躁症、神经痛(沿着某一神经走向的突发性的短暂锐痛)、偏头痛以及神经病变性疼痛。

据4月14日刊JAMA上的一则研究披露,一项对处方和临床事例的数据分析表明,使用某些抗惊厥药物可能与患者自杀、企图自杀或暴死风险的增加有关。

文章的作者写道:“这些抗惊厥药物的广泛的用药指针以及它们在同时伴有或不伴有精神性并存疾病的患者中作为抗惊厥药物的经常性的使用都使它们的安全性成为一个具有极大关系的问题。在2008年,美国食品及药物管理局要求在抗惊厥药物上贴上有关该药物会增加自杀性思维以及行为的风险的警示性标签。这项决定是基于一则荟萃分析,因为这些数据不够多所以无法用于对个别药物的调查。”

Brigham and Wom-en's Hospital 和 Harvard Medical School, Boston的Elisabetta Patorno, M.D., M.P.H.及其同僚对这些药物是否会增加患者的自杀企图或成功自杀的风险进行了评估,并将与一系列的抗惊厥药物有关的自杀性行为或暴死与在患者亚分组内的自杀性的行为或暴死结合在了一起。 研究人员对来自HealthCore Integrated Research Database (包括那些领取处方药及临床所遇病例的资讯)的年龄在15岁或以上的患者的数据进行了分析,这些患者是在2001年至2006年12月间服用某种抗惊厥药物的。

这项研究发现了827起自杀性行为(801起自杀企图以及26起完成的自杀)以及另外在29万7620起新的服用某种抗惊厥药物治疗中所发生的41起暴死(868起结合的自杀行为或暴死)事件。 研究人员发现,与topiramate相比,gabapentin、 lamotrigine、 oxcarbazepine、 tiagabine、及 valproate的发生自杀行为的风险会有所增加。 “纳入了暴死事件的分析也产生了类似的结果。在与carbamazepine 进行比较时,Gabapentin服用者在年轻和老年患者、心境障碍患者、癫痫患者等亚组中的自杀风险会有所增加。”

“这一探索性的分析可增进人们对抗惊厥药物的使用与自杀风险之间的复杂而且鲜为人知的关系的了解。”(生物谷Bioon.com)

生物谷推荐原文出处:

JAMA. 2010;303(14):1401-1409.

Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death
Elisabetta Patorno, MD, MPH; Rhonda L. Bohn, MPH, ScD; Peter M. Wahl, MLA, MS; Jerry Avorn, MD; Amanda R. Patrick, MS; Jun Liu, MD, MS; Sebastian Schneeweiss, MD, ScD

Context  In 2008, the US Food and Drug Administration mandated warning labeling for anticonvulsant medications regarding the increased risk of suicidal thoughts and behaviors. The decision was based on a meta-analysis not sufficiently large to investigate individual drugs.

Objective  To evaluate the risk of suicidal acts and combined suicidal acts or violent death associated with individual anticonvulsants.

Design  A cohort study of the risk of suicidal acts and combined suicidal acts or violent death in patients beginning use of anticonvulsant medications compared with patients initiating a reference anticonvulsant drug.

Setting and Patients  Patients 15 years and older from the HealthCore Integrated Research Database (HIRD) who began taking an anticonvulsant between July 2001 and December 2006.

Main Outcome Measures  Cox proportional hazards models and propensity score–matched analyses were used to evaluate risk of attempted or completed suicide and combined suicidal acts or violent death, controlling for psychiatric comorbidities and other risk factors, among individual anticonvulsants compared with topiramate and secondarily carbamazepine.

Results  The study identified 26 completed suicides, 801 attempted suicides, and 41 violent deaths in 297 620 new episodes of treatment with an anticonvulsant (overall median follow-up, 60 days). The incidence of the composite outcomes of completed suicides, attempted suicides, and violent deaths for anticonvulsants used in at least 100 treatment episodes ranged from 6.2 per 1000 person-years for primidone to 34.3 per 1000 person-years for oxcarbazepine. The risk of suicidal acts was increased for gabapentin (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.11-1.80), lamotrigine (HR, 1.84; 95% CI, 1.43-2.37), oxcarbazepine (HR, 2.07; 95% CI, 1.52-2.80), tiagabine (HR, 2.41; 95% CI, 1.65-3.52), and valproate (HR, 1.65; 95% CI, 1.25-2.19), compared with topiramate. The analyses including violent death produced similar results. Gabapentin users had increased risk in subgroups of younger and older patients, patients with mood disorders, and patients with epilepsy or seizure when compared with carbamazepine.

Conclusion  This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths.

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