Association of Risk of Suicide Attempts With Methylphenidate Treatment

Man, Kenneth K C; Coghill, David; Chan, Esther W.; Lau, Wallis C.Y.; Hollis, Chris; Liddle, Elizabeth B.; Banaschewski, Tobias; McCarthy, Suzanne; Neubert, Antje; Sayal, Kapil; Ip, Patrick; Schuemie, Martijn J.; Sturkenboom, Miriam; Sonuga‐Barke, Edmund; Buitelaar, Jan K.; Carucci, Sara; Zuddas, Alessandro; Kovshoff, Hanna; Garas, Peter; Nagy, Péter; Inglis, Sarah K.; Konrad, Kerstin; Häge, Alexander; Rosenthal, Éric; Wong, Ian C. K.

doi:10.1001/jamapsychiatry.2017.2183

Cited by 109 publications

(115 citation statements)

References 44 publications

(111 reference statements)

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“…To the best of our knowledge, this is the first large contemporary analysis of real‐world clinical practice to compare the risk of CVE among hip fracture patients with and without antiosteoporosis treatment, and complements results from RCTs. All records in the CDARS were validated with high accuracy, and is a powerful platform from which to conduct large‐scale, postmarketing, drug surveillance studies . This study was also carefully designed.…”

Section: Discussionmentioning

confidence: 99%

Association of Alendronate and Risk of Cardiovascular Events in Patients With Hip Fracture

Sing

Wong

Kiel

et al. 2018

Journal of Bone and Mineral Research

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The risk of cardiovascular events (CVEs) with alendronate use in real-world hip fracture patients is unknown. This study aimed to investigate the risk of CVE with and without use of alendronate in patients with hip fracture. We conducted a retrospective cohort study using a population-wide database managed by the Hong Kong Hospital Authority. Patients newly diagnosed with hip fracture from 2005 through 2013 were followed until November 6, 2016. Alendronate and other antiosteoporosis medications use during the study period were examined. We matched treated and nontreated patients based on time-dependent propensity score. The risks of cardiovascular mortality, myocardial infarction, and stroke between treatment groups were evaluated using conditional Cox regression stratified by match pairs. To examine the associations over time, outcomes were assessed at 1 year, 3 years, 5 years, and 10 years. Among 34,991 patients with newly diagnosed hip fracture, 4602 (13.2%) received antiosteoporosis treatment during follow-up. Physical functioning or survival prospect was not significantly different between treated and nontreated patients. A total of 4594 treated patients were matched with 13,568 nontreated patients. Results of Cox regression analysis revealed that alendronate was associated with a significantly lower risk of 1-year cardiovascular mortality (HR 0.33; 95% CI, 0.17 to 0.65) and incident myocardial infarction (HR 0.55; 95% CI, 0.34 to 0.89), whereas marginally significant reduction in risk of stroke was observed at 5 years and 10 years (HR at 5 years: 0.82; 95% CI, 0.67 to 1.00; p = 0.049; HR at 10 years: 0.83; 95% CI, 0.69 to 1.01; p = 0.065). The strength of the association declined over time but remained significant. Similar results were observed when all nitrogen-containing bisphosphonates (N-BPs) were analyzed together. These findings were robust in multiple sensitivity analyses. Additional studies in other population samples and randomized clinical trials may be warranted to further understand the relationship between use of various antiosteoporosis medication and risk of CVE in patients with hip fracture. © 2018 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Association of Alendronate and Risk of Cardiovascular Events in Patients With Hip Fracture

Sing

Wong

Kiel

et al. 2018

Journal of Bone and Mineral Research

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“…Adverse outcomes in adolescence and adulthood include academic and vocational underachievement [11], obesity [12], unemployment, low economic status [13], emotional dysregulation [14], and pregnancy in adolescence [15]. It has been shown that ADHD patients present higher suicide attempts when compared to the general population [16]. To sum up, ADHD has an important impact in the quality of life of those affected, comparable to other severe psychiatry disorders [17].…”

Section: Impairmentsmentioning

confidence: 99%

A Review on the Role of Inflammation in Attention-Deficit/Hyperactivity Disorder

Leffa

Torres

Rohde

2018

Neuroimmunomodulation

111

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Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition that impairs quality of life in social, academic, and occupational contexts for both children and adults. Although a strong neurobiological basis has been demonstrated, the pathophysiology of ADHD is still poorly understood. Among the proposed mechanisms are glial activation, neuronal damage and degeneration, increased oxidative stress, reduced neurotrophic support, altered neurotransmitter metabolism, and blood-brain barrier disruption. In this way, a potential role of inflammation has been increasingly researched. However, evidence for the involvement of inflammation in ADHD is still scarce and comes mainly from (1) observational studies showing a strong comorbidity of ADHD with inflammatory and autoimmune disorders; (2) studies evaluating serum inflammatory markers; and (3) genetic studies. A co-occurrence of ADHD with inflammatory disorders has been demonstrated in a large number of subjects, suggesting a range of underlying mechanisms such as an altered immune response, common genetics, and environmental links. The evaluation of serum inflammatory markers has provided mixed results, likely due to the small sample sizes and high heterogeneity between biomarkers. However, there is evidence that increased inflammation during the early development may be a risk factor for ADHD symptoms. Although genetic studies have demonstrated a potential role for inflammation in this disorder, there is no clear evidence. To sum up, inflammation may be an important mechanism in ADHD pathophysiology, but more studies are still needed for a more precise conclusion.

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“…Patients with a seizure history may be more likely to be prescribed ADHD medication during periods of low seizure risk, thus possibly inducing a false protective effect. In addition, several recent studies have reported the risk of adverse events, including seizures, to be elevated immediately before medication initiation, which could influence the estimated relative risk associated with starting medication treatment . It is therefore important to further investigate the safety of ADHD medication in samples with more detailed information on seizure history and concurrent antiepileptic drug (AED) treatment, comorbid NDDs, and timing of ADHD medication initiation.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, several recent studies have reported the risk of adverse events, including seizures, to be elevated immediately before medication initiation, which could influence the estimated relative risk associated with starting medication treatment. 25,26 It is therefore important to further investigate the safety of ADHD medication in samples with more detailed information on seizure history and concurrent antiepileptic drug (AED) treatment, comorbid NDDs, and timing of ADHD medication initiation. To address this, we used nationwide Swedish register data and within-individual comparisons to assess the risk of acute seizures associated with both ADHD medication initiation and repeated ADHD medication periods among individuals with epilepsy, with and without comorbid NDDs.…”

Section: Introductionmentioning

confidence: 99%

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

et al. 2019

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Summary Objective Attention‐deficit/hyperactivity disorder (ADHD) affects 10%‐30% of individuals with epilepsy, yet concerns remain regarding the safety of ADHD medication in this group. The objective of this study was to examine the risk of acute seizures associated with ADHD medication in individuals with epilepsy. Methods A total of 21 557 individuals with a seizure history born between 1987 and 2003 were identified from Swedish population registers. Within this study population, we also identified 6773 youth (<19 years of age) who meet criteria for epilepsy, and 1605 youth with continuous antiepileptic drug (AED) treatment. ADHD medication initiation and repeated medication periods were identified from the Swedish Prescribed Drug Register between January 1, 2006 and December 31, 2013. Acute seizures were identified via unplanned visits to hospital or specialist care with a primary seizure discharge diagnosis in the Swedish National Patient Register during the same period. Conditional Poisson regression was used to compare the seizure rate during the 24 weeks before and after initiation of ADHD medication with the rate during the same 48 weeks in the previous year. Cox regression was used to compare the seizure rate during ADHD medication periods with the rate during nonmedication periods. Comparisons were made within‐individual to adjust for unmeasured, time?constant confounding. Results Among 995 individuals who initiated ADHD medication during follow‐up, within‐individual analyses showed no statistically significant difference in the rate of seizures during the 24 weeks before and after medication initiation, compared to the same period in the previous year. In the full study population 11 754 seizure events occurred during 136 846 person‐years and 1855 individuals had at least one ADHD medication period. ADHD medication periods were associated with a reduced rate of acute seizures (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.57‐0.94), compared to nonmedication periods within the same individual. Similar associations were found in youth with epilepsy and continuous AED treatment, when adjusting for AEDs, and across sex, age, and comorbid neurodevelopmental disorders. Significance We found no evidence for an overall increased rate of acute seizures associated with ADHD medication treatment among individuals with epilepsy. These results suggest that epilepsy should not automatically preclude patients from receiving ADHD medications.

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Association of Risk of Suicide Attempts With Methylphenidate Treatment

Cited by 109 publications

References 44 publications

Association of Alendronate and Risk of Cardiovascular Events in Patients With Hip Fracture

Association of Alendronate and Risk of Cardiovascular Events in Patients With Hip Fracture

A Review on the Role of Inflammation in Attention-Deficit/Hyperactivity Disorder

Medication treatment for attention‐deficit/hyperactivity disorder and the risk of acute seizures in individuals with epilepsy

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