Antidepressant Use and Mortality Among Patients With Hepatocellular Carcinoma.

Importance: Liver cancer, primarily hepatocellular carcinoma (HCC), is the third leading cause of cancer deaths worldwide. Although some studies have proposed that antidepressants may have apoptotic effects on cancer, no study has examined the association between antidepressant use and HCC prognosis. Objective: To investigate the association between antidepressant use and mortality risk in patients with HCC. Design, Setting, and Participants: This population-based cohort study analyzed Taiwan's National Health Insurance Research Database, which covers 99% of Taiwan's population and includes comprehensive medical information. Patients with a new diagnosis of HCC between 1999 and 2017 were identified. Analysis took place in June 2023. Main Outcomes and Measures: All patients with HCC were followed up until 2018 to measure overall and cancer-specific mortality. To examine whether the timing of antidepressant use influenced the association with mortality, antidepressant use was examined before and after HCC diagnosis. Cox proportional hazards regression was performed to estimate hazard ratios (HRs) and the 95% CIs for the association between antidepressant use and overall mortality and cancer-specific mortality. Results: The study cohort comprised 308 938 participants, primarily consisting of older individuals (131 991 [42.7%] were aged ≥65 years) with a higher proportion of male individuals (202 589 [65.6%]). Antidepressant use before the diagnosis of HCC was not associated with lower risks of overall mortality (adjusted HR, 1.10; 95% CI, 1.08-1.12) and cancer-specific mortality (adjusted HR, 1.06; 95% CI, 0.96-1.17). However, antidepressant use after a diagnosis of HCC was associated with a lower risk of overall mortality (adjusted HR, 0.69; 95% CI, 0.68-0.70) and cancer-specific mortality (adjusted HR, 0.63; 95% CI, 0.59-0.68). The observed associations were consistent across subgroups with different antidepressant classes and comorbidities, including hepatitis B virus or hepatitis C virus infection, liver cirrhosis, and alcohol use disorders. Conclusions and Relevance: Based on this nationwide cohort study, postdiagnosis antidepressant use may be associated with lower mortality in patients with HCC. Further randomized clinical trial evaluation should be considered.

Antidepressants and the risk of myocardial infarction among patients with diabetes: A population-based cohort study.

OBJECTIVE: To investigate the impact of antidepressants (ATDs) on the risk of myocardial infarction (MI) among patients with diabetes mellitus (DM). METHODS: This was a retrospective population-based cohort study that used data obtained from the National Health Insurance Research Database in Taiwan. The study cohort included diabetic patients who were older than 50 years from 1997 to 2010. We then randomly assigned individuals to the matched cohort at a 1:1 ratio according to their demographic data. Both study and matched cohorts were followed up to compare the risk of MI between patients with and without ATD use from 2000 until the end of 2013. Multivariate Cox proportional hazards models were used to evaluate the relationship between ATD treatment and the occurrence of MI. RESULTS: After adjustment for confounders, patients with ATD use of more than 180 days had a lower risk of MI than those without ATD use in the matched cohort (adjusted hazard ratio [HR] = 0.68, 95% confidence interval [CI], 0.66-0.71). The adjusted HRs of MI were 0.77 (95% CI, 0.73-0.81) and 0.56 (95% CI, 052.-0.60) in patients with DM and ATD use of 180 > cDDD ≥ 28 and cDDD ≥ 180, respectively. When the duration of ATD treatment was 180 days or longer, MI risk was significantly reduced (after adjustment) for all classes of ATD except bupropion. CONCLUSIONS: Most ATDs, but not bupropion, were associated with significantly reduced risk of MI among the DM population.

Risk of Dementia Among Individuals With Psoriasis: A Nationwide Population-Based Cohort Study in Taiwan.

OBJECTIVE: Psoriasis is a chronic inflammatory disease putatively associated with dementia. However, the epidemiologic evidence of the relationship between psoriasis and dementia has been limited. We used a large national sample to investigate this relationship as well as the association between systemic therapy for psoriasis and incident dementia. METHODS: The cases were identified as a first recorded diagnosis of psoriasis (ICD-9-CM codes: 696.0, 696.1, or 696.8) between 1996 and 2013 from Taiwan's National Health Insurance Research Database (NHIRD). Each selected case of psoriasis was compared with 4 sex-, age-, and urbanization-matched comparison subjects. The first diagnosis of dementia (ICD-9-CM codes: 290.0-290.4, 294.1-294.2, 331.0-331.2, or 331.82) that covered vascular and nonvascular subtypes until the end of 2013 was tracked in both groups. Cox regression analyses and a competing risk model were applied to evaluate the risk, adjusting for sex, urbanization, age, hypertension, diabetes, heart disease, hyperlipidemia, stroke, and depression. The association between systemic therapy and incidence of dementia in the psoriasis group was examined in further stratified analyses. RESULTS: Overall, 3,820 patients with psoriasis and 15,280 comparisons were identified. After adjustment, a significantly higher risk of dementia was identified in the psoriasis group than in the comparison group (adjusted hazard ratio [aHR] = 1.23; 95% CI, 1.06-1.42). A significant association between psoriasis and dementia was identified for nonvascular dementia (aHR = 1.25, 95% CI, 1.07-1.45) but not for vascular dementia (aHR = 1.27, 95% CI, 0.83-1.93). Receiving systemic therapy for psoriasis for more than 90 days significantly reduced the risk of developing dementia compared with no systemic therapy (aHR = 0.66; 95% CI, 0.45-0.97). Compared with those who received no systemic therapy, the patients who received disease-modifying antirheumatic drugs and/or biologics had a significantly lower risk of dementia incidence (aHR = 0.69; 95% CI, 0.50-0.97), which was not the case in patients who received only phototherapy. CONCLUSIONS: Individuals with psoriasis have a significantly higher incidence of dementia, particularly the nonvascular type. Systemic therapy might be protective in preventing dementia in patients with psoriasis.

The use of antipsychotics is associated with lower mortality in patients with Alzheimer's disease: A nationwide population-based nested case-control study in Taiwan.

OBJECTIVE: The purpose of this study was to identify the association between antipsychotics and mortality in Alzheimer's disease patients. METHODS: Using the Taiwan National Health Insurance Research Database, 735 newly diagnosed Alzheimer's disease patients aged over 65 years and receiving antipsychotic treatments, and 735 age, sex, physical comorbidity, and entry year with propensity scores, matched control subjects were enrolled and followed for a 10-year period until the end of 2011. Multivariate Cox proportional hazards regression models were used for analysis. RESULTS: The mortality rate was 56% in Alzheimer's disease patients treated with antipsychotics, and 65% in Alzheimer's disease patients not treated with antipsychotics during an average of 5.2 years of follow-up. The use of antipsychotics, typical antipsychotics, and atypical antipsychotics was found to be associated with lower mortality (adjusted hazard ratio=0.66, 95% confidence interval 0.58-0.75; 0.69, 0.60-0.79; 0.56, 0.44-0.71, respectively, all p<0.001). In addition, Alzheimer's disease patients with higher cumulative dose and longer duration of exposure to antipsychotics showed a significantly reduced risk of mortality. Other variables associated with higher risk of mortality included age (adjusted hazard ratio=1.08, 95% confidence interval 1.07-1.09, p<0.001), male gender (1.27, 1.11-1.45, p<0.001), diabetes mellitus (1.30, 1.10-1.54, p<0.01), congestive heart failure (1.54, 1.11-2.12, p<0.01), and stroke (1.23, 1.05-1.44, p<0.01). CONCLUSION: The use of antipsychotics was found to be associated with lower mortality in Alzheimer's disease patients. Moreover, dose and duration response effects were also identified.

Herpes Zoster and Dementia: A Nationwide Population-Based Cohort Study.

OBJECTIVE: Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. METHODS: Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. RESULTS: A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). CONCLUSIONS: Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster.