- 學位論文
台灣抗鬱藥之藥物流行病學研究：新一代抗鬱藥之治療持續性與糖尿病風險
Pharmacoepidemiological Study of Antidepressants in Taiwan: The Treatment Persistence and the Diabetes Risk of New-Generation Antidepressants
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摘要
背景與目的：抗鬱藥為常用的藥物之一。過去的研究發現抗鬱藥的使用，有逐年增加的趨勢，其增加的原因可能為新一代抗鬱藥物上市，以及增加新的治療適應症。雖然新一代的藥物有較少的副作用，但臨床上服用抗鬱藥之持續性偏低，成為憂鬱症治療成效的影響因素。此外，抗鬱藥的長期安全性，尤其是代謝方面的副作用，仍然未有定論。本研究目的：為探討台灣新一代抗鬱藥之治療持續性與糖尿病之風險。本研究主要內容是利用健保資料庫的資料，針對下列三個議題加以研究：一、探討新一代抗鬱藥之盛行率與發生率之趨勢。二、憂鬱症病患使用新一代抗鬱藥之治療持續性，以及相關影響因素。三、長期使用新一代抗鬱藥與糖尿病之關連。 方法：本研究將以健保資料庫2005年百萬人抽樣檔，分析台灣使用抗鬱藥的盛行率與發生率之趨勢。 憂鬱症患者使用抗鬱藥之治療持續性，將以回溯性世代研究，進行新一代抗鬱藥與傳統藥物之比較分析，並探討可能相關的因素。 評估長期使用新一代抗鬱藥是否增加第二型糖尿病之風險，本研究將以新診斷之第二型糖尿病的患者，進行巢狀病例對照研究，選出2倍的對照個案。統計分析將以條件式羅吉斯迴歸來估算使用長期使用新一代抗鬱藥之糖尿病風險，並控制相關的干擾因素。 結果：台灣使用抗鬱藥的盛行率從2000年的37.6‰ 增加到2011年的54.0‰。而抗鬱藥的發生率則是從2000年的20.2‰，逐年增加到2004年23.7‰，但之後又始逐年下降至2011年18.7‰。 憂鬱症患者使用抗鬱藥之藥物持續性的研究發現，只有17.4%的憂鬱症患者，持續使用抗鬱藥治療超過180天。新一代抗鬱藥之使用者，有較佳之治療持續性。此外，男性、年長者、有焦慮症或睡眠疾患共病之患者，亦有較佳之治療持續性。 使用新一代抗鬱藥之選擇性血清抑制劑超過兩年以上者，會增加41%的糖尿病風險。而使用傳統三環抗鬱藥兩年以上者，其糖尿病風險並無顯著增加。 結論：台灣抗鬱藥之使用盛行率逐年增加，但其發生率逐年下降。整體而言，台灣使用抗鬱藥之盛行率略低於其他國家。新一代抗鬱藥之使用者，有較佳之治療持續性。然而累積使用新一代抗鬱藥超過兩年，將會增加之糖尿病風險。本研究使用台灣健保資料庫，其資料樣本數大，且有全國代表性，因此研究結果有高度的可類推性。臨床上，使用新一代抗鬱藥時，需仔細評估其可能之利弊，如治療持續性與代謝副作用。
並列摘要
Background Antidepressants are one of the most frequently prescribed medications. Studies have shown that antidepressant use has increased over time. The introduction of new-generation antidepressants, and an expansion of the conditions they treat, might be responsible for the increased trend in antidepressant use. Although new-generation antidepressants have fewer adverse effects, the medication persistence is still low and affects the treatment outcome. In addition, the long-term safety and metabolic effects of new-generation antidepressants remains unclear. Therefore, the aim of this study is to explore the treatment persistence and diabetes risk of new-generation antidepressants in Taiwan. We used the National Health Insurance Research Database to examine the following three issues: 1) the prevalence and incidence of antidepressant use in Taiwan; 2) the treatment persistence of new-generation antidepressants among patients with depressive disorders and potential determinants; and 3) the association between long-term new-generation antidepressant use and diabetes risk. Methods To address these issues, we conducted several studies. First, we used the Longitudinal Health Insurance Database 2005, a subset of National Health Insurance Research Database, to explore the prevalence and incidence of antidepressant use. Next, we conducted a retrospective cohort study to compare the treatment persistence of new-generation antidepressants with that of tricyclic antidepressants and explored the potential determinants. Finally, to investigate the relationship between long-term antidepressant use and diabetes risk, we conducted a nested case-control study with newly-diagnosed patients with type 2 diabetes mellitus and used a conditional logistic regression model to estimate the effect of new-generation antidepressants on diabetes risk with adjustment for potential confounders. Results Overall, the prevalence of antidepressant use increased from 37.6‰ in 2000 to 54.0‰ in 2011; however, the age-adjusted incidence increased from 20.2‰ in 2000 to 23.7‰ in 2004, but then declined to 18.7‰ in 2011. In terms of the persistence of antidepressant treatment among patients with depressive disorder, only 17.4% of patients continued antidepressant treatment over 180 days. Depressive patients treated with new-generation antidepressants showed better treatment persistence. Male gender, older age, comorbidity with anxiety or sleep disorders, and concomitant use of sedatives/hypnotics were associated with better treatment persistence. Patients treated with new-generation antidepressants more than 2 years had an increased risk of diabetes (adjusted odds ratio 1.41, 95% CI 1.03–1.93). However, use of tricyclic antidepressants more than 2 years was not associated with diabetes risk. Conclusion We found the prevalence of antidepressant use in Taiwan increased; however, the incidence declined. Patients taking new-generation antidepressants were associated with better treatment persistence. However, cumulative use of new-generation antidepressants for more than 2 years increased the risk of diabetes. Because this study used the National Health Insurance Research Database, which has a large sample size that is representative of the national population, its results have good generalizability. In clinical implications, use of a new-generation antidepressant should be considered against its risk and benefits, such as medication persistence and adverse effects.
參考文獻
110. Lin CC, Lai MS, Syu CY, Chang SC, Tseng FY. Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. Journal of the Formosan Medical Association = Taiwan yi zhi 2005; 104: 157-63.
I. References
1. Hartzema AG, Tilson HH, Chan KA. Pharmacoepidemiology and Therapeutic Risk Management2008.
2. Schneeweiss S, Avorn J. A review of uses of health care utilization databases for epidemiologic research on therapeutics. Journal of clinical epidemiology 2005; 58: 323-37.
3. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009; 66: 848-56.