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Original Research: Chest Infections |

Antipsychotic Use and Risk of Hospitalization or Death Due to Pneumonia in Persons With and Those Without Alzheimer Disease

Anna-Maija Tolppanen, PhD; Marjaana Koponen, MSc (Pharm); Antti Tanskanen, Phil Lic; Piia Lavikainen, MSc; Reijo Sund, DSocSc; Jari Tiihonen, MD, PhD; Sirpa Hartikainen, MD, PhD; Heidi Taipale, PhD (Pharm)
Author and Funding Information

aSchool of Pharmacy, University of Eastern Finland, Kuopio, Finland

bResearch Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland

cKuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland

dDepartment of Psychiatry, Kuopio University Hospital, Kuopio, Finland

eDepartment of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland

fDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

gNational Institute for Health and Welfare, Helsinki, Finland

hDepartment of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland

iCentre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland

CORRESPONDENCE TO: Anna-Maija Tolppanen, PhD, School of Pharmacy, University of Eastern Finland, PL 1627, 70211 Kuopio, Finland


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1233-1241. doi:10.1016/j.chest.2016.06.004
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Background  The use of antipsychotic agents has been associated with increased pneumonia risk, but although people with dementia are particularly susceptible to pneumonia, only one small study has assessed the risk of pneumonia in relation to the use of antipsychotic agents among people with Alzheimer disease (AD).

Methods  We investigated whether the incident use of antipsychotic agents, or specific antipsychotic agents, are related to a higher risk of hospitalization or death due to pneumonia in the Medication and Alzheimer Disease (MEDALZ) cohort. The cohort includes all individuals with AD who received a clinically verified AD diagnosis in Finland in 2005 to 2011 (N = 60,584; incident pneumonia, n = 12,225). A matched comparison cohort without AD (N = 60,584; incident pneumonia, n = 6,195) was used to compare the magnitude of risk. Results were adjusted for a propensity score derived from comorbidities, concomitant medications, and sociodemographic characteristics. Sensitivity analyses with case-crossover design were conducted.

Results  The use of antipsychotic agents was associated with a higher risk of pneumonia (adjusted hazard ratio [HR], 2.01; 95% CI, 1.90-2.13) in the AD cohort and a somewhat higher risk in the non-AD cohort (adjusted HR, 3.43; 95% CI, 2.99-3.93). Similar results were observed with case-crossover analyses (OR, 2.02; 95% CI, 1.75-2.34 in the AD cohort and OR, 2.59; 95% CI, 1.77-3.79 in the non-AD cohort). The three most commonly used antipsychotic agents (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.

Conclusions  Regardless of applied study design, treatment duration, or the choice of drug, the use of antipsychotic agents was associated with a higher risk of pneumonia. With observational data, we cannot fully rule out a shared causality between pneumonia and the use of antipsychotic agents, but the risk to benefit balance should be considered when antipsychotic agents are prescribed.

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