D Papola1, G Ostuzzi1, C Gastaldon1, G P Morgano2, E Dragioti3, A F Carvalho4,5, P Fusar-Poli6,7,8,9, C U Correll10,11,12,13, M Solmi6,14,15, C Barbui1. 1. WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, University of Verona, Verona, Italy. 2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. 3. Pain and Rehabilitation centre and Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, University of Linköping, Linköping, SE, Sweden. 4. Department of Psychiatry, University of Toronto, Toronto, ON, Canada. 5. Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. 6. Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 7. OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK. 8. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 9. National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK. 10. Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, NY, USA. 11. Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. 12. Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY, USA. 13. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany. 14. Neuroscience Centre, University of Padua, Padua, Italy. 15. Department of Neuroscience, University of Padua, Padua, Italy.
Abstract
OBJECTIVE: To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics. METHODS: Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC). RESULTS: Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 ± 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 ± 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 ± 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 ± 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 ± 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 ± 9.3 years). CONCLUSION: The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.
OBJECTIVE: To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics. METHODS: Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC). RESULTS: Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 ± 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 ± 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 ± 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 ± 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 ± 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 ± 9.3 years). CONCLUSION: The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.
Authors: Heidi Taipale; Antti Tanskanen; Juha Mehtälä; Pia Vattulainen; Christoph U Correll; Jari Tiihonen Journal: World Psychiatry Date: 2020-02 Impact factor: 49.548
Authors: Giovanni Ostuzzi; Davide Papola; Chiara Gastaldon; Georgios Schoretsanitis; Federico Bertolini; Francesco Amaddeo; Alessandro Cuomo; Robin Emsley; Andrea Fagiolini; Giuseppe Imperadore; Taishiro Kishimoto; Giulia Michencigh; Michela Nosé; Marianna Purgato; Serdar Dursun; Brendon Stubbs; David Taylor; Graham Thornicroft; Philip B Ward; Christoph Hiemke; Christoph U Correll; Corrado Barbui Journal: BMC Med Date: 2020-07-15 Impact factor: 8.775
Authors: Francisco T T Lai; Bruce Guthrie; Stewart W Mercer; Daniel J Smith; Benjamin H K Yip; Gary K K Chung; Kam-Pui Lee; Roger Y Chung; Patsy Y K Chau; Eliza L Y Wong; Eng-Kiong Yeoh; Samuel Y S Wong Journal: BMC Med Date: 2020-11-02 Impact factor: 8.775
Authors: Perrine Janiaud; Arnav Agarwal; Ioanna Tzoulaki; Evropi Theodoratou; Konstantinos K Tsilidis; Evangelos Evangelou; John P A Ioannidis Journal: BMC Med Date: 2021-07-06 Impact factor: 11.150
Authors: Jose de Leon; Can-Jun Ruan; Georgios Schoretsanitis; Carlos De Las Cuevas Journal: Psychother Psychosom Date: 2020-04-14 Impact factor: 17.659