1. Sudden cardiac and sudden unexpected death related to antipsychotics: A meta-analysis of observational studies
- Author
-
Salvo, F., Pariente, A., Shakir, S., Robinson, P., Arnaud, M., Thomas, S. H. L., RASCHI, EMANUEL, Fourrier Reglat, A., Moore, N., Sturkenboom, M., Hazell, L., Salvo, F., Pariente, A., Shakir, S., Robinson, P., Arnaud, M., Thomas, S.H.L., Raschi, E., Fourrier-Reglat, A., Moore, N., Sturkenboom, M., Hazell, L., and Medical Informatics
- Subjects
Olanzapine ,ERG1 Potassium Channel ,medicine.medical_specialty ,hERG ,Sudden cardiac death ,Inhibitory Concentration 50 ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Clozapine ,Pharmacology ,Risperidone ,biology ,business.industry ,Ether-A-Go-Go Potassium Channel ,Odds ratio ,medicine.disease ,Ether-A-Go-Go Potassium Channels ,Confidence interval ,3. Good health ,Observational Studies as Topic ,Antipsychotic Agent ,Death, Sudden, Cardiac ,Anesthesia ,biology.protein ,Quetiapine ,business ,030217 neurology & neurosurgery ,Antipsychotic Agents ,Human ,medicine.drug - Abstract
To estimate the risk of sudden cardiac death (SCD) or sudden unexpected death (SUD) related to individual antipsychotics, a meta-analysis of observational studies was performed. Adjusted odds ratio (OR) of SCD/SUD with 95% confidence intervals (CI) were extracted and pooled; heterogeneity was studied using Q statistic and I(2) index, and its potential causes (e.g., hERG blockade potency) explored using meta-regression. Two cohort (740,306 person-years) and four case-control (2,557 cases; 17,670 controls) studies, investigating nine antipsychotics, were included. Compared with nonusers, the risk was increased for quetiapine (OR = 1.72, 95% CI: 1.33-2.23), olanzapine (OR = 2.04, 1.52-2.74), risperidone (OR = 3.04, 2.39-3.86), haloperidol (OR = 2.97, 1.59-5.54), clozapine (OR = 3.67, 1.94-6.94), and thioridazine (OR = 4.58, 2.09-10.05). Heterogeneity was found (Q = 20.0, P = 0.01; I(2) = 60.0%), and the increasing mean hERG blockade potency (P = 0.01) accounted for 43% of this. The SCD/SUD risk differed between individual antipsychotics, and mean hERG blockade potency could be an explanatory factor. This should be considered when initiating antipsychotic treatment.
- Published
- 2015
- Full Text
- View/download PDF