CMAJ：研究发现口服双膦酸盐者患巩膜炎发生风险高

4月2日，在线发表于《加拿大医学会杂志》（Canadian Medical Association Journal）的加拿大一项研究显示，与未使用双膦酸盐的患者相比，首次口服该药者发生巩膜炎和葡萄膜炎的风险较高。使用该药者须熟悉上述炎症的症状和体征，以及时就诊于眼科医师。

该项研究纳入2000-2007年间于眼科就诊患者约93.4万例。

结果为，首次使用口服双膦酸盐的患者发生葡萄膜炎[校正后相对风险比（RR）为1.45，95% CI为1.25~1.68]和巩膜炎（校正RR为1.51，95%CI为1.34~1.68）的风险升高。经倾向分数校正分析后，上述风险比的结果不变（葡萄膜炎的RR为1.50，95% CI为1.29~1.73；巩膜炎的RR为1.53，95% CI为1.39~1.70）。

doi:10.1503/cmaj.111752
Inflammatory ocular adverse events with the use of oral bisphosphonates: a retrospective cohort study

Mahyar Etminan, Farzin Forooghian, David Maberley

Background: There have been several published reports of inflammatory ocular adverse events, mainly uveitis and scleritis, among patients taking oral bisphosphonates. We examined the risk of these adverse events in a pharmacoepidemiologic cohort study.

Methods: We conducted a retrospective cohort study involving residents of British Columbia who had visited an ophthalmologist from 2000 to 2007. Within the cohort, we identified all people who were first-time users of oral bisphosphonates and who were followed to the first inflammatory ocular adverse event, death, termination of insurance or the end of the study period. We defined an inflammatory ocular adverse event as scleritis or uveitis. We used a Cox proportional hazard model to determine the adjusted rate ratios. As a sensitivity analysis, we performed a propensity-score–adjusted analysis.

Results: The cohort comprised 934 147 people, including 10 827 first-time users of bisphosphonates and 923 320 nonusers. The incidence rate among first-time users was 29/10 000 person-years for uveitis and 63/10 000 person-years for scleritis. In contrast, the incidence among people who did not use oral bisphosphonates was 20/10 000 person-years for uveitis and 36/10 000 for scleritis (number needed to harm: 1100 and 370, respectively). First-time users had an elevated risk of uveitis (adjusted relative risk [RR] 1.45, 95% confidence interval [CI] 1.25–1.68) and scleritis (adjusted RR 1.51, 95% CI 1.34–1.68). The rate ratio for the propensity-score–adjusted analysis did not change the results (uveitis: RR 1.50, 95% CI 1.29–1.73; scleritis: RR 1.53, 95% CI 1.39–1.70).

Interpretation: People using oral bisphosphonates for the first time may be at a higher risk of scleritis and uveitis compared to people with no bisphosphonate use. Patients taking bisphosphonates must be familiar with the signs and symptoms of these conditions, so that they can immediately seek assessment by an ophthalmologist.