PLoS Med:加巴喷丁是否增加阿片类药物相关死亡风险?

2017-11-21 吴星 环球医学

2017年10月,发表在《PLoS Med》上的一项基于人群的巢式病例对照研究,调查了加巴喷丁和阿片类药物联用与阿片类药物相关死亡风险增加的相关性。研究结果表明:同时使用加巴喷丁与阿片类药物相关死亡风险的大幅增加相关,因此医师应慎重开具处方。其他相关药物的使用风险也应被进一步探究。

2017年10月,发表在《PLoS Med》上的一项基于人群的巢式病例对照研究,调查了加巴喷丁和阿片类药物联用与阿片类药物相关死亡风险增加的相关性。研究结果表明:同时使用加巴喷丁与阿片类药物相关死亡风险的大幅增加相关,因此医师应慎重开具处方。其他相关药物的使用风险也应被进一步探究。

背景:阿片类药物的使用与阿片类药物相关死亡的风险高度相关,每550个长期使用者就有1人在首次使用阿片类药物的约2.5年内死亡。虽然加巴喷丁是一种广泛使用的安全药物,但是当加巴喷丁单独使用或与其他药物联用时,会发生药物诱导的呼吸抑制。由于加巴喷丁和阿片类药物都常用于疼痛,因此同时使用的可能性非常高。然而,至今还没有检测加巴喷丁和阿片类药物联用是否与阿片类药物相关死亡风险的增加相关的研究被发表,因此本研究的目的就是考察加巴喷丁和阿片类药物联用是否与阿片类药物相关死亡风险的增加相关。

方法和结果:研究人员使用处方数据库进行了一项基于人群的巢式病例对照研究,研究对象为1997年8月1日~2013年12月31日在加拿大安大略居住的阿片类药物使用者。病例被定义为死于阿片类药物相关原因的阿片类药物使用者。并根据年龄、性别、指数日期的年份、慢性肾疾病史、疾病风险指数,将病例与4个同样使用阿片类药物的对照者进行了配对。配对后,研究人员纳入了1256个病例和4619个对照。首要暴露为指数日期前的120天同时使用加巴喷丁。二次分析将加巴喷丁的剂量分为低(每天<900mg)、中(每天900~1799mg)、高(每天≥1800mg)。敏感性分析检测了120天前同时使用非甾体抗炎药(NSAID)的影响。总体来说,12.3%的病例(155/1256)和6.8%的对照(313/4619)在120天前服用了加巴喷丁。多变量调整后,与单独使用阿片类药物相比,同时使用加巴喷丁和阿片类药物与阿片类药物相关死亡几率的显着增加相关(OR,1.99;95% CI,1.61~2.47;P<0.001;调整OR,1.49;1.18~1.99;P<0.001)。剂量效应分析中,与不使用加巴喷丁相比,中等剂量(OR,2.05;1.46~2.87;P<0.001;aOR,1.56;1.06~2.28;P=0.024)和高等剂量(OR,2.20;1.58~3.08;P<0.001;aOR,1.58;1.09~2.27;P=0.015)的加巴喷丁与阿片类相关死亡几率增加约60%相关。如预期,同时使用阿片类药物和NSAID,与阿片类药物相关死亡之间无显着的相关性(OR,1.11;0.98~1.27;P=0.113;aOR,1.14;0.98~1.32;P=0.083)。处于阿片类药物与加巴喷丁联合使用风险的患者的探索性分析中,研究人员发现,在2013年时,48.0%的加巴喷丁使用者(45173/98288)接受了至少一个同时使用阿片类药物的处方。本研究局限于安大略有资格享受公共药物覆盖的个人,因此研究人员仅能鉴别出被政府报销的处方和零售药店的配药情况,而加巴喷丁使用的适应症信息无法获得。此外,由于所有都是观察性研究,因此源于不可测量变量的混杂是偏倚的潜在来源。

结论:接受阿片类药物处方的患者中,同时使用加巴喷丁与阿片类药物相关死亡风险的大幅增加相关。医生应仔细考虑是否继续开具此两种药物联合使用的处方,当认为联合使用是必要的时,应该密切监测患者,并相应调整阿片类药物的剂量。将来的研究应该调查普瑞巴林和阿片类药物之间是否也存在相似的相互作用。

原始出处:

Gomes T, Juurlink DN, Antoniou T,et al. Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. PLoS Med. 2017 Oct 3;14(10):e1002396. doi: 10.1371/journal.pmed.1002396. eCollection 2017 Oct.

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    2020-10-29 lovetcm

    同时使用#加巴喷丁##**类#药物相关死亡风险的大幅增加相关,一般建议还是单用加巴喷丁

    0

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    2017-11-23 lhlxtx
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