使用 GLP-1 受体激动剂与自杀死亡风险

IF 22.5 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL JAMA Internal Medicine Pub Date : 2024-11-01 DOI:10.1001/jamainternmed.2024.4369
Peter Ueda, Jonas Söderling, Viktor Wintzell, Henrik Svanström, Laura Pazzagli, Björn Eliasson, Mads Melbye, Anders Hviid, Björn Pasternak
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引用次数: 0

摘要

重要性:胰高血糖素样肽-1(GLP-1)受体激动剂的使用与自杀和自残风险增加之间的联系引起了人们的关注:评估常规临床实践中使用 GLP-1 受体激动剂与自杀死亡风险之间的关联:这项主动比较新用户队列研究使用了瑞典和丹麦 2013 年至 2021 年的全国登记数据。研究纳入了开始接受 GLP-1 受体激动剂或钠-葡萄糖共转运体-2 (SGLT2) 抑制剂治疗的 18 至 84 岁成人。数据分析时间为 2024 年 3 月至 6 月。暴露:开始接受 GLP-1 受体激动剂或 SGLT2 抑制剂治疗:主要结果和测量指标:主要结果是死因登记中记录的自杀死亡。次要结果是自杀死亡和非致命性自残的综合结果,以及抑郁症和焦虑症的综合结果。利用倾向得分加权法,分别计算了两个国家的危险比(HRs)和 95% CIs,并将其汇总在一项荟萃分析中:共有124 517名成人开始使用GLP-1受体激动剂,174 036人开始使用SGLT2抑制剂;GLP-1受体激动剂使用者的平均(标清)年龄为60(13)岁,45%为女性。在平均(标清)2.5(1.7)年的随访期间,GLP-1 受体激动剂使用者中有 77 人自杀身亡,SGLT2 抑制剂使用者中有 71 人自杀身亡:加权发病率为每千人年 0.23 例 vs 0.18 例(HR,1.25;95% CI,0.83-1.88),绝对差异为每千人年 0.05 例(95% CI,-0.03-0.16)。自杀死亡和非致命性自残的HR为0.83(95% CI,0.70-0.97),抑郁和焦虑相关障碍事件的HR为1.01(95% CI,0.97-1.06):这项队列研究主要包括 2 型糖尿病患者,研究结果表明,使用 GLP-1 受体激动剂与自杀死亡、自残或抑郁和焦虑相关障碍的发生风险增加之间并无关联。GLP-1受体激动剂使用者自杀死亡的情况很少见,置信区间的上限与每1000人年不超过0.16起事件的绝对风险增加相符。
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GLP-1 Receptor Agonist Use and Risk of Suicide Death.

Importance: Concerns have been raised regarding a link between use of glucagon-like peptide-1 (GLP-1) receptor agonists and increased risk of suicidality and self-harm.

Objective: To assess the association between use of GLP-1 receptor agonists and the risk of suicide death in routine clinical practice.

Design, setting, and participants: This active-comparator new-user cohort study used nationwide register data from Sweden and Denmark from 2013 to 2021. Adults 18 to 84 years old who initiated treatment with GLP-1 receptor agonists or the comparator sodium-glucose cotransporter-2 (SGLT2) inhibitors were included. Data were analyzed from March to June 2024.

Exposure: Initiation of treatment with a GLP-1 receptor agonist or SGLT2 inhibitor.

Main outcomes and measures: The primary outcome was suicide death recorded in the cause of death registers. Secondary outcomes were the composite of suicide death and nonfatal self-harm and the composite of incident depression and anxiety-related disorders. Using propensity score weighting, hazard ratios (HRs) with 95% CIs were calculated separately in the 2 countries and pooled in a meta-analysis.

Results: In total, 124 517 adults initiated a GLP-1 receptor agonist and 174 036 initiated an SGLT2 inhibitor; among GLP-1 receptor agonist users, the mean (SD) age was 60 (13) years, and 45% were women. During a mean (SD) follow-up of 2.5 (1.7) years, 77 suicide deaths occurred among users of GLP-1 receptor agonists and 71 suicide deaths occurred among users of SGLT2 inhibitors: weighted incidences were 0.23 vs 0.18 events per 1000 person-years (HR, 1.25; 95% CI, 0.83-1.88), with an absolute difference of 0.05 (95% CI, -0.03 to 0.16) events per 1000 person-years. The HR was 0.83 (95% CI, 0.70-0.97) for suicide death and nonfatal self-harm, and the HR was 1.01 (95% CI, 0.97-1.06) for incident depression and anxiety-related disorders.

Conclusions and relevance: This cohort study, including mostly patients with type 2 diabetes, does not show an association between use of GLP-1 receptor agonists and an increased risk of suicide death, self-harm, or incident depression and anxiety-related disorders. Suicide death among GLP-1 receptor agonist users was rare, and the upper limit of the confidence interval was compatible with an absolute risk increase of no more than 0.16 events per 1000 person-years.

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来源期刊
JAMA Internal Medicine
JAMA Internal Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
43.50
自引率
1.30%
发文量
371
期刊介绍: JAMA Internal Medicine is an international, peer-reviewed journal committed to advancing the field of internal medicine worldwide. With a focus on four core priorities—clinical relevance, clinical practice change, credibility, and effective communication—the journal aims to provide indispensable and trustworthy peer-reviewed evidence. Catering to academics, clinicians, educators, researchers, and trainees across the entire spectrum of internal medicine, including general internal medicine and subspecialties, JAMA Internal Medicine publishes innovative and clinically relevant research. The journal strives to deliver stimulating articles that educate and inform readers with the latest research findings, driving positive change in healthcare systems and patient care delivery. As a member of the JAMA Network, a consortium of peer-reviewed medical publications, JAMA Internal Medicine plays a pivotal role in shaping the discourse and advancing patient care in internal medicine.
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