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Original Research |

Antipsychotic use and risk of hospitalisation or death due to pneumonia in persons with and without Alzheimer’s 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

Summary of conflict of interest statements: JT has served as a consultant to Lundbeck, Organon, Janssen-Cilag, Eli Lilly, AstraZeneca, F. Hoffman-La Roche, and Bristol-Myers Squibb. He has received fees for giving expert opinions to Bristol-Myers Squibb and GlaxoSmithKline, lecture fees from Janssen-Cilag, Bristol-Myers Squibb, Eli Lilly, Pfizer, Lundbeck, GlaxoSmithKline, AstraZeneca and Novartis; and grant from Stanley Foundation. JT is a member of advisory board in AstraZeneca, Janssen-Cilag, and Otsuka. MK has received personal research grant from Oy H. Lundbeck Ab foundation outside the submitted work. SH has received a lecturing fee from MSD. Other authors declare no conflicts of interest.

Search terms: Alzheimer’s disease, antipsychotics, pneumonia, observational studies, register-based studies, cohort study, case-crossover, risperidone, quetiapine, haloperidol

Funding information: None

No prior abstract publication/presentation

1School of Pharmacy, University of Eastern Finland, Kuopio, Finland

2Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, Kuopio, Finland

3Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland

4Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland

5Department of Forensic Psychiatry, Niuvanniemi Hospital, Kuopio, Finland

6Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden

7National Institute for Health and Welfare, Helsinki, Finland

8Department of Pharmacology, Drug Development and Therapeutics, University of Turku, Turku, Finland

9Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland

Correspondence to: Anna-Maija Tolppanen, School of Pharmacy, University of Eastern Finland, PL 1627, 70211 Kuopio, Finland.


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


Chest. 2016. doi:10.1016/j.chest.2016.06.004
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Abstract

Background  Antipsychotics have been associated with increased pneumonia risk, but although persons with dementia are particularly susceptible to pneumonia, only one small study assessed the risk of pneumonia in relation to antipsychotic use among persons with Alzheimer’s disease (AD).

Methods  We investigated whether incident antipsychotic use, or specific antipsychotics are related to higher risk of hospitalisation or death due to pneumonia in the MEDALZ cohort. The cohort includes all persons with AD who received a clinically verified AD diagnosis in Finland in 2005-2011 (N=60,584, n with incident pneumonia 12,225). A matched comparison cohort without AD (N=60,584, n with incident pneumonia 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  Antipsychotic use was associated with higher pneumonia risk (adjusted hazard ratio, 95% confidence interval (CI) 2.01, 1.90-2.13) in the AD cohort and somewhat higher risk in the non-AD cohort (3.43, 2.99-3.93). Similar results were observed with case-crossover analyses (odds ratio 2.02, 95% CI 1.75-2.34 in the AD cohort, 2.59, 1.77-3.79 in the non-AD cohort). The three most commonly used antipsychotics (quetiapine, risperidone, haloperidol) had similar associations with pneumonia risk.

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


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