Study | Population | Outcome | Propensity for bias/Study quality | Procedures to minimize bias | Follow-up | Outcome Rate in reference group | Result |
---|---|---|---|---|---|---|---|
LEVEL III Evidence: Observational Studies | |||||||
Studies that compared atypical antipsychotic (ATYP) treatment to non-use (NU) | |||||||
CASE-CONTROL STUDIES | |||||||
Knol [52] | 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) | hospital diagnosis of pneumonia ICD9 480-486, 507 | Moderate/Low | Yes (unmatched covariate adjustment) | 6 months | NR | OR (ATYP v NU); 3.1 95% CI; 1.9-5.1 |
Trifiro [53] | 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) | Fatal or non-fatal diagnosis of pneumonia | Moderate/Low | Yes (matched; `age/sex) | 11 years | NA | Current use: OR (ATYP v PU); 2.6 95% CI; 1.5-4.6 Recent use: OR (ATYP v PU); 1.4 95% CI; 0.5-4.1 |
Gau [54] | 194 cases, 952 controls Patients admitted to community hospital, Ontario (Canada) (age>=65) | Hospitalisation for pneumonia | Moderate/Low | Yes (matched; hospitalization for another diagnosis) | 12 months | NA | OR (ATYP v NU); 2.3 95% CI; 1.2-4.2 |
SELF-CONTROLLED CASE SERIES STUDIES | |||||||
Pratt [50] | 13932, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for pneumonia (Australia) (age>=65) | Hospitalisation for pneumonia ICD10 J12–J18 | Moderate/Moderate | Yes (within patient design) | 4 years | NA | 1 week:IRR (ATYP V UEXP); 1.73 95% CI; 1.31-2.29 2-8 weeks: IRR (ATYP V UEXP); 1.70 95% CI; 1.48-1.95 9-12 weeks: IRR (ATYP V UEXP); 1.67 95% CI; 1.37-2.04 >12 weeks: IRR (ATYP V UEXP); 1.70 95% CI; 1.51-1.93 |
Studies that compared conventional antipsychotic (CONV) treatment to non-use (NU) | |||||||
CASE-CONTROL STUDIES | |||||||
Knol [52] | 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) | hospital diagnosis of pneumonia ICD9 480-486, 507 | Moderate/Low | Yes (matched) | 6 months | NA | OR (CONV v NU); 1.5 95% CI; 1.2-1.9 |
Trifiro[53] | 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) | Fatal or non-fatal diagnosis of pneumonia | Moderate/Low | Yes (matched) | 11 years | NA | Current use: OR (CONV v PU); 1.8 95% CI; 1.2-2.5 Recent use: OR (CONV v PU); 1.3 95% CI; 0.8-2.0 |
SELF-CONTROLLED CASE SERIES STUDIES | |||||||
Pratt [50] | 13932, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for pneumonia (Australia) (age>=65) | Hospitalisation for pneumonia ICD10 J12–J18 | Moderate/Moderate | Yes (within patient design) | 4 years | NA | 1 week: IRR (CONV V UEXP); 1.51 95% CI; 1.07, 2.14 2-8 weeks: IRR (CONV V UEXP); 1.62 95% CI; 1.37, 1.92 9-12 weeks: IRR (CONV V UEXP); 1.69 95% CI; 1.32, 2.16 >12 weeks: IRR (CONV V UEXP); 1.63 95% CI; 1.36, 1.96 |
Studies that compared antipsychotic (ANTIP) treatment to non-use (NU) | |||||||
CASE-CONTROL STUDIES | |||||||
Knol [52] | 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) | hospital diagnosis of pneumonia ICD9 480-486, 507 | Moderate/Low | Yes (matched) | 6 months | NA | 0-8 days: OR (ANTIP v NU); 4.4 95% CI; 2.9-7.2 8-14 days: OR (ANTIP v NU); 2.3 95% CI; 1.1-4.9 15-30 days: OR (ANTIP v NU); 1.9 95% CI; 1.0-3.1 31-90 days: OR (ANTIP v NU); 2.0 95% CI; 1.1-3.0 >90 days: OR (ANTIP v NU); 1.1 95% CI; 0.9-0.6 |
Wada [55] | 121, Alzheimers patients in psychiatric hospital patients; (mean age 78.2) | pneumonia | High/Low | No (unmatched) | Not reported | Not reported | OR (ANTIP v NU); 3.13 95% CI; 1.46-6.69 |
Studies that compared conventional antipsychotic (CONV) and atypical antipsychotic (ATYP) treatment | |||||||
COHORT STUDIES | |||||||
Wang [45] | 22890 Patients in Pharmacy Assistance Contract for Elderly Program (age>=65) | Hospital Admission for pneumonia plus prescription for an antibiotic medication | Moderate/Moderate | Yes (Propensity score adjustment, instrumental variable analysis) | 180 days | NR | 30 days: HR (CONV v ATYP); 1.11 95% CI; 0.76-1.63 60 days: HR (CONV v ATYP); 1.03 95% CI; 0.76-1.38 180 days: HR (CONV v ATYP); 0.84 95% CI; 0.66-1.05 IV analyses not reported |
Trifiro [53] | 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) | Fatal or non-fatal diagnosis of pneumonia | Moderate/Low | Yes (matched) | 11 years | NA | Current use: OR (ATYP V CONV); 1.48 95% CI; 0.84-2.60 Current use: OR (ATY/PHENO v BUTY); 1.86 95% CI; 1.09-3.17 |