• Silvia Perez-Vilar, Andrew D Mosholder, Elizabeth R Smith, Hye Seung Lee, An-Chi Lo, Marc Stone, Amy Brehm, Yueqin Zhao, Armen Avagyan, Kira Leishear, Michael Wernecke, Thomas E MaCurdy, Jeffrey A Kelman, and David J Graham.
• Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD, USA. silvia.perezvilar@fda.hhs.gov.
• J Gen Intern Med. 2024 Nov 25.

ImportanceAcute respiratory failure (ARF) associated with antipsychotic use has been documented through case reports and population-based studies.ObjectiveTo assess whether the recent use of antipsychotics is associated with an increased risk of ARF in U.S. Medicare beneficiaries with chronic obstructive pulmonary disease.Design, Setting, And ParticipantsCase-crossover study conducted among U.S. Fee-for-Service Medicare beneficiaries with chronic obstructive pulmonary disease hospitalized with ARF, from January 1, 2007, through December 31, 2019.ExposureOral antipsychotics.Main Outcome(S) And Measure(S)Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for ARF requiring invasive mechanical ventilation associated with the use of antipsychotics in the case period (days -14 to -1) compared to the control period (days -75 to -88).ResultsWe identified 145,018 cases (mean age 69.4 years, 57.2% female). Of these, 2,003 had antipsychotic use only during the case period and 1,728 only during the control period. The aOR of ARF within 14 days after antipsychotic use was 1.13 (95% CI, 1.06, 1.20). The risk increased with increasing age, being statistically significant in patients ages 75-84 years (aOR: 1.37 [95% CI, 1.17, 1.60]) and 85 + years (aOR: 1.50 [95% CI, 1.20, 1.89]), but not in beneficiaries under 75 years of age (aOR 18-49 years: 1.01 [95% CI, 0.85, 1.20]; 50-64 years: 1.03 [95% CI, 0.92, 1.15]; 65-74 years: 1.12 [95% CI, 0.98, 1.27]).Conclusions And RelevanceRecent antipsychotic use by Medicare beneficiaries with chronic obstructive pulmonary disease was associated with an increased risk of ARF in those aged 75 years and older.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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