Opioid Use and the Risk of Ventricular Arrhythmias: A Systematic Review and Meta-Analysis.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-08-01 DOI:10.1002/pds.5854

Shahrzad Salmasi, Samuel Igweokpala, Antonios Douros, Nehal Islam, Jason G Andrade, Kristian B Filion

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Abstract

Background: The association between opioid use and the risk of ventricular arrhythmias (VA) is poorly understood.

Aims: The objective of this study was to synthesize the evidence on the risk of VA associated with opioid use.

Materials & methods: We systematically searched the Cochrane Library, Embase, MEDLINE, and CINAHL databases in July 2022. Risk of bias was assessed using the Cochrane risk for bias tool for randomized controlled trials (RCTs) and ROBINS-I for observational studies. Certainty of evidence was assessed using GRADE.

Results: We included 15 studies (12 observational, 2 post hoc analyses of RCTs, 1 RCT). Most studies focused on opioid use for maintenance therapy (n = 9), comparing methadone to buprenorphine (n = 13), and reported QTc prolongation (n = 13). Six observational studies had a critical risk of bias, and one RCT was at high risk of bias. Two studies could not be included in the meta-analysis as they reported a different outcome and studied an opioid antagonist. Meta-analysis of 13 studies indicated that the use of methadone was associated with an increased risk of VA compared to the use of buprenorphine, morphine, placebo, or levacetylmethadol (risk ratio [RR], 2.39; 95% CI, 1.31-4.35; I² = 60%). The pooled estimate varied greatly between observational studies (RR, 2.12; 95% CI, 1.15-3.91; I² = 62%) and RCTs (RR, 14.09; 95% CI, 1.52-130.61; I² = 0%), but both indicated an increased risk.

Conclusion: In this systematic review and meta-analysis, we found that methadone use is associated with more than twice the risk of VA compared to comparators. However, our findings should be interpreted cautiously given the limited quality of the available evidence.

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阿片类药物的使用与室性心律失常的风险：系统回顾与元分析》。

背景：目的：本研究旨在综合阿片类药物使用与室性心律失常（VA）风险相关的证据：我们于 2022 年 7 月系统检索了 Cochrane Library、Embase、MEDLINE 和 CINAHL 数据库。对随机对照试验（RCT）使用 Cochrane 偏倚风险工具评估偏倚风险，对观察性研究使用 ROBINS-I 评估偏倚风险。证据的确定性采用 GRADE 进行评估：我们纳入了 15 项研究（12 项观察性研究、2 项 RCT 后期分析、1 项 RCT）。大多数研究侧重于阿片类药物的维持治疗（9 项），比较了美沙酮和丁丙诺啡（13 项），并报告了 QTc 延长（13 项）。六项观察性研究存在严重偏倚风险，一项研究性试验存在高度偏倚风险。两项研究未能纳入荟萃分析，因为它们报告了不同的结果并研究了一种阿片类拮抗剂。对 13 项研究的荟萃分析表明，与使用丁丙诺啡、吗啡、安慰剂或左乙酰美沙酮相比，使用美沙酮与 VA 风险增加有关（风险比 [RR]，2.39；95% CI，1.31-4.35；I2 = 60%）。观察性研究（RR，2.12；95% CI，1.15-3.91；I2 = 62%）和研究性试验（RR，14.09；95% CI，1.52-130.61；I2 = 0%）的汇总估计值差异很大，但都表明风险增加：在这项系统综述和荟萃分析中，我们发现与对比研究相比，美沙酮的使用与两倍以上的VA风险相关。然而，鉴于现有证据的质量有限，我们应谨慎解释我们的研究结果。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.