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Table 4 Studies on the risk of pneumonia associated with antipsychotic medicines

From: Choice of observational study design impacts on measurement of antipsychotic risks in the elderly: a systematic review

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