Risk of suicide attempt in asthmatic children and young adults prescribed leukotriene-modifying agents: a nested case-control study.
BACKGROUND
The US Food and Drug Administration has issued safety alerts about leukotriene receptor-modifying agents and suicidality/suicide, but because these were based on case reports, there is controversy about the association.


OBJECTIVE
We conducted a nested case-control study to determine the association between leukotriene-modifying agents (LTMAs) and attempted suicide among asthmatic children and young adults.


METHODS
Cases and control subjects were from a cohort of asthmatic patients aged 5 to 24 years who were new users of LTMAs or other asthma medications. Data were from an insurance claims database. Cases were defined as those with a suicide attempt (SA) occurring after exposure to asthma medication. Control subjects were persons at risk and were selected by using incidence density sampling in a 10:1 match. Conditional logistic regression was used to determine the association between LTMA exposure and the risk of attempted suicide adjusted for important covariates.


RESULTS
We identified 344 cases and 3438 matched control subjects. Cases were more likely than control subjects to have risk factors for suicide. We found that current use of any LTMA was not associated with increased risk of an SA; in fact, the direction of effect was the opposite (adjusted odd ratio, 0.70; 95% CI, 0.36-1.39).


CONCLUSIONS
In this analysis we found that use of LTMAs was not associated with an increased risk of SAs in children, adolescents, and young adults with asthma. Further research needs to be conducted to more fully understand the association between LTMAs and suicide, particularly in subpopulations.
Center for Pharmacoeconomic Research, Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA. schumock@uic.edu
Glen T
GT
Schumock
Leslie T
LT
Stayner
Robert J
RJ
Valuck
Min J
MJ
Joo
Robert D
RD
Gibbons
Todd A
TA
Lee
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology / Q000378:metabolism / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D020024:Leukotriene Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D018077:Receptors, Leukotriene / Q000378:metabolism; D012307:Risk Factors; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence; D055815:Young Adult
D018927:Anti-Asthmatic Agents; D020024:Leukotriene Antagonists; D018077:Receptors, Leukotriene