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Fibromyalgia and Generalized Pain (Short)

Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland

Type
Disease or Syndrome
ID
PH866
Version ID
1811
Data Sources
Valid event data range
01/01/2005 - 30/11/2018
Sex
Female, Male
Agreement Date
2022-02-02
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Background:

Studies have reported an increased risk of mortality among people prescribed mirtazapine compared to other antidepressants. The study aimed to compare all-cause and cause-specific mortality between adults prescribed mirtazapine or other second-line antidepressants.

Methods:

This cohort study used English primary care electronic medical records, hospital admission records, and mortality data from the Clinical Practice Research Datalink (CPRD), for the period 01 January 2005 to 30 November 2018. It included people aged 18–99 years with depression first prescribed a selective serotonin reuptake inhibitor (SSRI) and then prescribed mirtazapine (5081), a different SSRI (15,032), amitriptyline (3905), or venlafaxine (1580). Follow-up was from starting to stopping the second antidepressant, with a 6-month wash-out window, censoring at the end of CPRD follow-up or 30 November 2018. Age-sex standardised rates of all-cause mortality and death due to circulatory system disease, cancer, or respiratory system disease were calculated. Survival analyses were performed, accounting for baseline characteristics using inverse probability of treatment weighting.

Results:

The cohort contained 25,598 people (median age 41 years). The mirtazapine group had the highest standardised mortality rate, with an additional 7.8 (95% confidence interval (CI) 5.9–9.7) deaths/1000 person-years compared to the SSRI group. Within 2 years of follow-up, the risk of all-cause mortality was statistically significantly higher in the mirtazapine group than in the SSRI group (weighted hazard ratio (HR) 1.62, 95% CI 1.28–2.06). No significant difference was found between the mirtazapine group and the amitriptyline (HR 1.18, 95% CI 0.85–1.63) or venlafaxine (HR 1.11, 95% CI 0.60–2.05) groups. After 2 years, the risk was significantly higher in the mirtazapine group compared to the SSRI (HR 1.51, 95% CI 1.04–2.19), amitriptyline (HR 2.59, 95% CI 1.38–4.86), and venlafaxine (HR 2.35, 95% CI 1.02–5.44) groups. The risks of death due to cancer (HR 1.74, 95% CI 1.06–2.85) and respiratory system disease (HR 1.72, 95% CI 1.07–2.77) were significantly higher in the mirtazapine than in the SSRI group.

Conclusions:

Mortality was higher in people prescribed mirtazapine than people prescribed a second SSRI, possibly reflecting residual differences in other risk factors between the groups. Identifying these potential health risks when prescribing mirtazapine may help reduce the risk of mortality.

Publications

  • Rebecca M Joseph, Ruth H Jack, Richard Morriss, Roger David Knaggs, Debbie Buttler, Chris Hollis, Julia Hippisley-Cox, Carrol Coupland, The risk of all-cause and cause-specific mortality in people prescribed mirtazapine an active comparator cohort study using electronic health records. BMC Medicine, 20(43), 2022.

Clinical Code List

Rows: 5
Code Description Entity type Category Coding System (Read)
1DC8.00 generalised pain [symptom] res176: Fibromyalgia and generalized pain (short) diagnostic Read
N239.00 fibromyalgia res176: Fibromyalgia and generalized pain (short) diagnostic Read
N248.00 fibromyalgia res176: Fibromyalgia and generalized pain (short) diagnostic Read
R00z200 [d]pain, generalized res176: Fibromyalgia and generalized pain (short) diagnostic Read
R00z211 [d]general aches and pains res176: Fibromyalgia and generalized pain (short) diagnostic Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH866/version/1811/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH866/version/1811/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH866', '1811', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH866/version/1811/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH866/version/1811/export/codes/?format=json
CSV site_root/phenotypes/PH866/version/1811/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH866', '1811', api_client=client)

Version History

Version
ID
Name Owner Publish date
1811 Fibromyalgia and Generalized Pain (Short) ieuan.scanlon 2022-04-04 currently shown

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