Table 4

Studies on the risk of pneumonia associated with antipsychotic medicines
Study Population Outcome Propensity for bias/Study quality Procedures to minimize bias Follow-up Outcome Rate in reference group Result
LEVEL III Evidence: Observational Studies
Studies that compared atypical antipsychotic (ATYP) treatment to non-use (NU)
CASE-CONTROL STUDIES
Knol [52] 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) hospital diagnosis of pneumonia ICD9 480-486, 507 Moderate/Low Yes (unmatched covariate adjustment) 6 months NR OR (ATYP v NU); 3.1 95% CI; 1.9-5.1
Trifiro [53] 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) Fatal or non-fatal diagnosis of pneumonia Moderate/Low Yes (matched; `age/sex) 11 years NA Current use: OR (ATYP v PU); 2.6 95% CI; 1.5-4.6 Recent use: OR (ATYP v PU); 1.4 95% CI; 0.5-4.1
Gau [54] 194 cases, 952 controls Patients admitted to community hospital, Ontario (Canada) (age>=65) Hospitalisation for pneumonia Moderate/Low Yes (matched; hospitalization for another diagnosis) 12 months NA OR (ATYP v NU); 2.3 95% CI; 1.2-4.2
SELF-CONTROLLED CASE SERIES STUDIES
Pratt [50] 13932, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for pneumonia (Australia) (age>=65) Hospitalisation for pneumonia ICD10 J12–J18 Moderate/Moderate Yes (within patient design) 4 years NA 1 week:IRR (ATYP V UEXP); 1.73 95% CI; 1.31-2.29 2-8 weeks: IRR (ATYP V UEXP); 1.70 95% CI; 1.48-1.95 9-12 weeks: IRR (ATYP V UEXP); 1.67 95% CI; 1.37-2.04 >12 weeks: IRR (ATYP V UEXP); 1.70 95% CI; 1.51-1.93
Studies that compared conventional antipsychotic (CONV) treatment to non-use (NU)
CASE-CONTROL STUDIES
Knol [52] 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) hospital diagnosis of pneumonia ICD9 480-486, 507 Moderate/Low Yes (matched) 6 months NA OR (CONV v NU); 1.5 95% CI; 1.2-1.9
Trifiro[53] 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) Fatal or non-fatal diagnosis of pneumonia Moderate/Low Yes (matched) 11 years NA Current use: OR (CONV v PU); 1.8 95% CI; 1.2-2.5 Recent use: OR (CONV v PU); 1.3 95% CI; 0.8-2.0
SELF-CONTROLLED CASE SERIES STUDIES
Pratt [50] 13932, Australian Department of Veterans Affairs Veterans/spouses with hospitalization for pneumonia (Australia) (age>=65) Hospitalisation for pneumonia ICD10 J12–J18 Moderate/Moderate Yes (within patient design) 4 years NA 1 week: IRR (CONV V UEXP); 1.51 95% CI; 1.07, 2.14 2-8 weeks: IRR (CONV V UEXP); 1.62 95% CI; 1.37, 1.92 9-12 weeks: IRR (CONV V UEXP); 1.69 95% CI; 1.32, 2.16 >12 weeks: IRR (CONV V UEXP); 1.63 95% CI; 1.36, 1.96
Studies that compared antipsychotic (ANTIP) treatment to non-use (NU)
CASE-CONTROL STUDIES
Knol [52] 543 cases, 2163 controls All patients; no prior pneumonia, PHARMO Database (Netherlands) (age>=65) hospital diagnosis of pneumonia ICD9 480-486, 507 Moderate/Low Yes (matched) 6 months NA 0-8 days: OR (ANTIP v NU); 4.4 95% CI; 2.9-7.2 8-14 days: OR (ANTIP v NU); 2.3 95% CI; 1.1-4.9 15-30 days: OR (ANTIP v NU); 1.9 95% CI; 1.0-3.1 31-90 days: OR (ANTIP v NU); 2.0 95% CI; 1.1-3.0 >90 days: OR (ANTIP v NU); 1.1 95% CI; 0.9-0.6
Wada [55] 121, Alzheimers patients in psychiatric hospital patients; (mean age 78.2) pneumonia High/Low No (unmatched) Not reported Not reported OR (ANTIP v NU); 3.13 95% CI; 1.46-6.69
Studies that compared conventional antipsychotic (CONV) and atypical antipsychotic (ATYP) treatment
COHORT STUDIES
Wang [45] 22890 Patients in Pharmacy Assistance Contract for Elderly Program (age>=65) Hospital Admission for pneumonia plus prescription for an antibiotic medication Moderate/Moderate Yes (Propensity score adjustment, instrumental variable analysis) 180 days NR 30 days: HR (CONV v ATYP); 1.11 95% CI; 0.76-1.63 60 days: HR (CONV v ATYP); 1.03 95% CI; 0.76-1.38 180 days: HR (CONV v ATYP); 0.84 95% CI; 0.66-1.05 IV analyses not reported
Trifiro [53] 258 cases, 1686 controls Elderly patients from Dutch General Practice database (IPCI) patients (age>=65) Fatal or non-fatal diagnosis of pneumonia Moderate/Low Yes (matched) 11 years NA Current use: OR (ATYP V CONV); 1.48 95% CI; 0.84-2.60 Current use: OR (ATY/PHENO v BUTY); 1.86 95% CI; 1.09-3.17

Pratt et al.

Pratt et al. BMC Medical Research Methodology 2012 12:72   doi:10.1186/1471-2288-12-72

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