Antipsychotics and Risk of Acute Respiratory Failure in U.S. Medicare Beneficiaries with Chronic Obstructive Pulmonary Disease.

Autor: Perez-Vilar S; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. silvia.perezvilar@fda.hhs.gov., Mosholder AD; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA., Smith ER; Acumen LLC, Burlingame, CA, USA., Lee HS; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA., Lo AC; Acumen LLC, Burlingame, CA, USA., Stone M; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA., Brehm A; Acumen LLC, Burlingame, CA, USA., Zhao Y; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA., Avagyan A; Acumen LLC, Burlingame, CA, USA., Leishear K; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA., Wernecke M; Acumen LLC, Burlingame, CA, USA., MaCurdy TE; Acumen LLC, Burlingame, CA, USA.; Department of Economics, Stanford University, Stanford, CA, USA., Kelman JA; Centers for Medicare & Medicaid Services, Washington, DC, USA., Graham DJ; Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Nov 25. Date of Electronic Publication: 2024 Nov 25.
DOI: 10.1007/s11606-024-09208-5
Abstrakt: Importance: Acute respiratory failure (ARF) associated with antipsychotic use has been documented through case reports and population-based studies.
Objective: To assess whether the recent use of antipsychotics is associated with an increased risk of ARF in U.S. Medicare beneficiaries with chronic obstructive pulmonary disease.
Design, Setting, and Participants: Case-crossover study conducted among U.S. Fee-for-Service Medicare beneficiaries with chronic obstructive pulmonary disease hospitalized with ARF, from January 1, 2007, through December 31, 2019.
Exposure: Oral antipsychotics.
Main Outcome(s) and Measure(s): Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for ARF requiring invasive mechanical ventilation associated with the use of antipsychotics in the case period (days -14 to -1) compared to the control period (days -75 to -88).
Results: We identified 145,018 cases (mean age 69.4 years, 57.2% female). Of these, 2,003 had antipsychotic use only during the case period and 1,728 only during the control period. The aOR of ARF within 14 days after antipsychotic use was 1.13 (95% CI, 1.06, 1.20). The risk increased with increasing age, being statistically significant in patients ages 75-84 years (aOR: 1.37 [95% CI, 1.17, 1.60]) and 85 + years (aOR: 1.50 [95% CI, 1.20, 1.89]), but not in beneficiaries under 75 years of age (aOR 18-49 years: 1.01 [95% CI, 0.85, 1.20]; 50-64 years: 1.03 [95% CI, 0.92, 1.15]; 65-74 years: 1.12 [95% CI, 0.98, 1.27]).
Conclusions and Relevance: Recent antipsychotic use by Medicare beneficiaries with chronic obstructive pulmonary disease was associated with an increased risk of ARF in those aged 75 years and older.
Competing Interests: Declarations:. Financial Support:: The U.S. Food and Drug Administration funded this study through an interagency agreement with the Centers for Medicare & Medicaid Services (Contract number: GS-10F-0133S). The authors who were employees or contractors of the U.S. Food and Drug Administration and the Centers for Medicare & Medicaid Services played a role in the design; however, other officials at the U.S. Food and Drug Administration and the Centers for Medicare & Medicaid Services had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of Interest:: Amy Brehm’s spouse owns stocks in Bristol Myers, Abbvie, and Johnson & Johnson. All other authors have no conflicts of interest to disclose. Previous Presentation:: Preliminary results of this work were presented at CHEST Annual Meeting 2022, October 16–19, 2022, Nashville, TN, USA. Disclaimer:: The manuscript was subject to administrative review before submission, but this review did not alter its content. The views expressed are those of the authors and not necessarily those of the Department of Health and Human Services, the U.S. Food and Drug Administration, or the Centers for Medicare & Medicaid Services.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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