Abstract：
OBJECTIVE: The aim of this retrospective study was to analyze the incidence of lower urinary tract infections (LUTI) and antibiotic prescriptions within 12 months after initial prescription of anti-seizure medication (ASM) between January and December 2020 (index date) and to investigate the association between a broad spectrum of ASMs and the risk of LUTI in patients with epilepsy.
METHODS: This retrospective cohort study included a total of 9186 adult patients (≥18 years) with an initial diagnosis of epilepsy and a prescription of an ASM treated in 1284 general practices in Germany between January 2010 and December 2020 (index date). Six frequently prescribed ASMs with at least 1000 available patients were analyzed. Patients treated with one of six ASMs were matched to each other by propensity scores based on sex, age, and secondary diagnoses. Cox regression models were used to analyze the association between the use of ASM and LUTI risk.
RESULTS: The cumulative LUTI incidence 12 months after the start of therapy was highest in patients treated with pregabalin (16.7%), followed by valproate (11.6%) and gabapentin (10.2%). A similar trend was observed for LUTI with antibiotic prescription (9.2% pregabalin, 6.8% valproate, 6.8% gabapentin). Conditional regression analyses revealed that pregabalin therapy was significantly positively associated with LUTI (HR: 1.76; 95% CI 1.29-2.39) and LUTI-based antibiotic prescription (HR: 2.16; 95% CI 1.43-3.27). Carbamazepine was associated with a significantly lower incidence of LUTI in women (HR: 0.47; 95% CI: 0.30-0.75), but not in men. No significant associations were observed for other ASMs.
CONCLUSIONS: The present study identifies a significant positive association between ASM and LUTI incidence and antibiotic prescriptions in patients with epilepsy treated with pregabalin, whereas a protective effect was found for carbamazepine in women only. No significant associations were observed for the four remaining ASMs.
METHODS: This retrospective cohort study included a total of 9186 adult patients (≥18 years) with an initial diagnosis of epilepsy and a prescription of an ASM treated in 1284 general practices in Germany between January 2010 and December 2020 (index date). Six frequently prescribed ASMs with at least 1000 available patients were analyzed. Patients treated with one of six ASMs were matched to each other by propensity scores based on sex, age, and secondary diagnoses. Cox regression models were used to analyze the association between the use of ASM and LUTI risk.
RESULTS: The cumulative LUTI incidence 12 months after the start of therapy was highest in patients treated with pregabalin (16.7%), followed by valproate (11.6%) and gabapentin (10.2%). A similar trend was observed for LUTI with antibiotic prescription (9.2% pregabalin, 6.8% valproate, 6.8% gabapentin). Conditional regression analyses revealed that pregabalin therapy was significantly positively associated with LUTI (HR: 1.76; 95% CI 1.29-2.39) and LUTI-based antibiotic prescription (HR: 2.16; 95% CI 1.43-3.27). Carbamazepine was associated with a significantly lower incidence of LUTI in women (HR: 0.47; 95% CI: 0.30-0.75), but not in men. No significant associations were observed for other ASMs.
CONCLUSIONS: The present study identifies a significant positive association between ASM and LUTI incidence and antibiotic prescriptions in patients with epilepsy treated with pregabalin, whereas a protective effect was found for carbamazepine in women only. No significant associations were observed for the four remaining ASMs.
摘要：
目的：这项回顾性研究的目的是分析2020年1月至12月（指标日期）首次服用抗癫痫药物（ASM）后12个月内下尿路感染（LUTI）和抗生素处方的发生率，并研究广泛的ASM与癫痫患者LUTI风险之间的关系。
方法：这项回顾性队列研究纳入了2010年1月至2020年12月（指标日期）在德国的1284个一般诊所中，总共9186例（≥18岁）的初步诊断为癫痫和处方ASM的成年患者。分析了六个经常处方的ASM，其中至少有1000名可用患者。接受六种ASM之一治疗的患者通过基于性别的倾向评分相互匹配，年龄,和二级诊断。Cox回归模型用于分析ASM使用与LUTI风险之间的关联。
结果：普瑞巴林治疗后12个月的累积LUTI发生率最高（16.7%），其次是丙戊酸钠(11.6%)和加巴喷丁(10.2%)。使用抗生素处方的LUTI也观察到了类似的趋势(9.2%的普瑞巴林，6.8%丙戊酸盐，6.8%加巴喷丁)。条件回归分析显示，普瑞巴林治疗与LUTI（HR：1.76；95％CI1.29-2.39）和基于LUTI的抗生素处方（HR：2.16；95％CI1.43-3.27）显着正相关。卡马西平与女性LUTI的发病率显着降低相关（HR：0.47;95％CI：0.30-0.75），但不是男人。
结论：本研究发现，在普瑞巴林治疗的癫痫患者中，ASM与LUTI发病率和抗生素处方之间存在显著正相关，而卡马西平仅对女性有保护作用。
方法：这项回顾性队列研究纳入了2010年1月至2020年12月（指标日期）在德国的1284个一般诊所中，总共9186例（≥18岁）的初步诊断为癫痫和处方ASM的成年患者。分析了六个经常处方的ASM，其中至少有1000名可用患者。接受六种ASM之一治疗的患者通过基于性别的倾向评分相互匹配，年龄,和二级诊断。Cox回归模型用于分析ASM使用与LUTI风险之间的关联。
结果：普瑞巴林治疗后12个月的累积LUTI发生率最高（16.7%），其次是丙戊酸钠(11.6%)和加巴喷丁(10.2%)。使用抗生素处方的LUTI也观察到了类似的趋势(9.2%的普瑞巴林，6.8%丙戊酸盐，6.8%加巴喷丁)。条件回归分析显示，普瑞巴林治疗与LUTI（HR：1.76；95％CI1.29-2.39）和基于LUTI的抗生素处方（HR：2.16；95％CI1.43-3.27）显着正相关。卡马西平与女性LUTI的发病率显着降低相关（HR：0.47;95％CI：0.30-0.75），但不是男人。
结论：本研究发现，在普瑞巴林治疗的癫痫患者中，ASM与LUTI发病率和抗生素处方之间存在显著正相关，而卡马西平仅对女性有保护作用。
