LATEBREAKER
Aging
Comparative safety of antidepressants on motor-vehicle crash risk among older adults with depression: a sequential target trial emulation Marzan A. Khan* Marzan Khan Nina R. Joyce Melissa R. Pfeiffer Seth A. Margolis Brian R. Ott Allison E. Curry Melissa R. Riester Andrew R. Zullo
Background: Selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants (AAs), and tricyclic antidepressants (TCAs) are often prescribed for depression, but might increase the risk of motor-vehicle crash (MVC) in older adults through sedation, dizziness, and blurred vision.
Objective: Estimate the effect of initiating AAs and TCAs versus SSRIs on 1-year risk of MVC.
Methods: We emulated a sequence of 470 target trials each consecutive week from January 6, 2008 through January 1, 2017 using a novel linkage of Medicare fee-for-service health insurance claims and New Jersey police-reported MVCs and drivers’ licensing data. Eligible patients aged ≥ 66 years with depression were included in one or more target trials; thus person-trials were the unit of analysis. Using stabilized inverse probability of treatment and censoring weighted estimators to account for potential confounding and selection bias, we estimated cumulative incidence curves and risk ratios (RRs). We computed weights using pooled logistic regression models involving up to 67 demographic, comorbidity, medication, and healthcare utilization covariates. Percentile bootstrapped 95% confidence limits (CLs) were estimated.
Results: In the intention-to-treat (ITT) estimand, there were 31 MVCs among 644 TCA-treated person-trials, 65 among 2,130 AA-treated person-trials, and 380 among 10,260 SSRI-treated person-trials. In the per-protocol (PP) estimand there were 28 and 199 MVCs among AA and SSRI-treated person-trials, respectively. The adjusted ITT and PP RRs comparing 1) AA to SSRI were 0.97 (95% CLs 0.68, 1.46) and 0.94 (95% CLs 0.49, 1.35) respectively and 2) TCA to SSRI were 1.02 (95% CLs 0.57, 1.86) and 0.93 (95% CLs 0.29, 1.89) respectively.
Conclusion: We observed similar risks of MVC between the TCA, AA, and SSRI treatment strategies. MVC risk should not be a major concern when clinicians select between these antidepressants to treat depression among older adults.