目的:在90年代对特非那定和阿司咪唑进行监管限制后,只有很少的证据表明抗组胺药可能导致心律失常.我们评估与使用单独抗组胺药相关的室性快速性心律失常(VA)的风险。
方法:在欧盟资助的ARITMO项目中,在一组新的抗组胺药使用者中进行了匹配的病例对照研究。1997-2010年的数据来自七个医疗保健数据库:AARHUS(丹麦),GEPARD(德国),HSD和ERD(意大利),PHARMO和IPCI(荷兰)和THIN(英国)。选择VA病例,每个病例匹配多达100个对照。使用条件逻辑回归估计当前使用的个体抗组胺药(AHs)的比值比(OR)。
结果:对于主要用于预防过敏症状的药物,如西替利嗪,左西替利嗪,氯雷他定,地氯雷他定和非索非那定,我们没有发现VA风险.具有统计学意义的,仅在汇总分析中发现当前使用环嗪的VA风险增加(ORadj,5.3;3.6-7.6)和薄(ORadj,5.3;95%CI,3.7-7.6),对于GEPARD中的二甲双胍(ORadj,3.9;1.1-14.7)和GEPARD中的ebastine(ORadj,3.3;1.1-10.8)和PHARMO(ORadj,4.6;1.3-16.2)。
结论:与一些特异性抗组胺药相关的VA风险可归因于使用模式或受体结合谱的异质性。
OBJECTIVE: After regulatory restrictions for terfenadine and astemizole in \'90s, only scarce evidence on proarrhythmic potential of antihistamines has been published. We evaluate the risk of ventricular tachyarrhythmia (VA) related to the use of individual
antihistamines.
METHODS: A matched
case-control study nested in a cohort of new users of
antihistamines was conducted within the EU-funded ARITMO project. Data on 1997-2010 were retrieved from seven healthcare databases: AARHUS (Denmark), GEPARD (Germany), HSD and ERD (Italy), PHARMO and IPCI (Netherlands) and THIN (UK). Cases of VA were selected and up to 100 controls were matched to each
case. The odds ratio (OR) of current use for individual
antihistamines (AHs) was estimated using conditional logistic regression.
RESULTS: For agents largely used to prevent allergic symptoms, such as cetirizine, levocetirizine, loratadine, desloratadine and fexofenadine, we found no VA risk. A statistically significant, increased risk of VA was found only for current use of cyclizine in the pooled analysis (ORadj, 5.3; 3.6-7.6) and in THIN (ORadj, 5.3; 95% CI, 3.7-7.6), for dimetindene in GEPARD (ORadj, 3.9; 1.1-14.7) and for ebastine in GEPARD (ORadj, 3.3; 1.1-10.8) and PHARMO (ORadj, 4.6; 1.3-16.2).
CONCLUSIONS: The risk of VA associated with a few specific
antihistamines could be ascribable to heterogeneity in pattern of use or in receptor binding profile.