近日，牛津大学Seena Fazel研究组报道了一项基于瑞典人口的队列研究，分析加巴喷丁类药物与自杀行为、意外服药过量、受伤、道路交通事故和暴力犯罪之间的关系。相关论文发表在2019年6月出版的《英国医学杂志》上。

加巴喷丁类药物具有抗惊厥、镇痛和抗焦虑的功能，主要分为加巴喷丁（gabapentin）和普瑞巴林（pregabalin）两类，目前在欧洲（包括瑞典）已被批准用于治疗癫痫和神经性疼痛。

在2006年至2013年间，191973名参与者在瑞典处方药登记处获取了加巴喷丁类药物的处方。在研究期间，10026人(5.2%)因自杀行为接受治疗或死于自杀，17144人(8.9%)发生意外服药过量，12070人(6.3%)发生道路交通意外或违规，70522人(36.7%)头部/身体受伤，7984人(4.1%)因暴力犯罪被捕。在个体分析中, 加巴喷丁类药物治疗与上述前4类事件的风险增加相关，而与暴力犯罪无明显相关性。当把两类加巴喷丁类药物单独分析时，普瑞巴林与上述所有事件的风险增加都相关，而加巴喷丁则与某些风险呈负相关或无显著相关性。当按年龄分层时，上述所有事件的风险增加都15-24岁人群相关。

因此，这项研究表明，服用加巴喷丁类药物与自杀行为、意外服药过量、头部/身体伤害、道路交通事故和犯罪的风险增加相关。与加巴喷丁相比，普瑞巴林与这些事件风险的增加存在更高的相关性。

附：英文原文

Title: Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: population based cohort study in Sweden

Author: Yasmina Molero, Henrik Larsson, Brian M D’Onofrio, David J Sharp, Seena Fazel

Issue&Volume:vol 365, issue 8203,2019

Abstract

Objective To examine associations between gabapentinoids and adverse outcomes related to coordination disturbances (head or body injuries, or both and road traffic incidents or offences), mental health (suicidal behaviour, unintentional overdoses), and criminality.

Design Population based cohort study.

Setting High quality prescription, patient, death, and crime registers, Sweden.

Participants 191 973 people from the Swedish Prescribed Drug Register who collected prescriptions for gabapentinoids (pregabalin or gabapentin) during 2006 to 2013.

Main outcome measures Primary outcomes were suicidal behaviour, unintentional overdoses, head/body injuries, road traffic incidents and offences, and arrests for violent crime. Stratified Cox proportional hazards regression was conducted comparing treatment periods with non-treatment periods within an individual. Participants served as their own control, thus accounting for time invariant factors (eg, genetic and historical factors), and reducing confounding by indication. Additional adjustments were made by age, sex, comorbidities, substance use, and use of other antiepileptics.

Results During the study period, 10 026 (5.2%) participants were treated for suicidal behaviour or died from suicide, 17 144 (8.9%) experienced an unintentional overdose, 12 070 (6.3%) had a road traffic incident or offence, 70 522 (36.7%) presented with head/body injuries, and 7984 (4.1%) were arrested for a violent crime. In within-individual analyses, gabapentinoid treatment was associated with increased hazards of suicidal behaviour and deaths from suicide (age adjusted hazard ratio 1.26, 95% confidence interval 1.20 to 1.32), unintentional overdoses (1.24, 1.19 to 1.28), head/body injuries (1.22, 1.19 to 1.25), and road traffic incidents and offences (1.13, 1.06 to 1.20). Associations with arrests for violent crime were less clear (1.04, 0.98 to 1.11). When the drugs were examined separately, pregabalin was associated with increased hazards of all outcomes, whereas gabapentin was associated with decreased or no statistically significant hazards. When stratifying on age, increased hazards of all outcomes were associated with participants aged 15 to 24 years.

Conclusions This study suggests that gabapentinoids are associated with an increased risk of suicidal behaviour, unintentional overdoses, head/body injuries, and road traffic incidents and offences. Pregabalin was associated with higher hazards of these outcomes than gabapentin.

DOI: https://doi.org/10.1136/bmj.l2147

Source: https://www.bmj.com/content/365/bmj.l2147