title: Comparative risk of oral ulcerations among antipsychotics users - population-based retrospective cohort study.
abstract: OBJECTIVE
  The study aimed to evaluate the comparative risk of oral ulcerations among antipsychotic medications.
  
  
  METHODS
  We analyzed the National Health Insurance Research Database of Taiwan and included patients newly initiated with a single antipsychotic agent including haloperidol, sulpiride, olanzapine, quetiapine, risperidone, or amisulpride during 2002 to 2010. The outcome of interest was oral ulceration, defined by the presence diagnoses of stomatitis and mucositis, aphthous-like ulceration and oral burns, or dispensing of stomatological corticosteroids included triamcinolone, dexamethasone, hydrocortisone, and prednisolone. We conducted Cox proportional hazards regression to compare the risks of oral ulceration among antipsychotics.
  
  
  RESULTS
  The rate of oral ulcerations was highest in the amisulpride group (217.7 per 1000 person-year), followed by quetiapine (193.9 per 1000 person-year), olanzapine (161.9 per 1000 person-year), sulpiride (147.1 per 1000 person-year), risperidone (115.6 per 1000 person-year), haloperidol (107.5 per 1000 person-year) and aripiprazole (49.8 per 1000 person-year). Compared with haloperidol users, the adjusted hazard ratio (AHR) was 1.40 (95% CI, 1.12-1.73) in olanzapine, 1.48 (95% CI, 1.30-1.69) in quetiapine, 1.27 (95% CI, 1.19-1.44) in sulpiride, 1.68 (95% CI, 0.97-2.59) in amisulpride, 1.02 (95% CI, 0.83-1.45) in risperidone, and 0.41 (95% CI, 0.24-0.72) in aripiprazole users by Cox regression model.
  
  
  CONCLUSIONS
  Olanzapine, quetiapine, and sulpiride posed a higher risk, while aripiprazole posed a lower risk of oral ulcerations compared with haloperidol in subjects with newly initiated antipsychotic therapy. Risperidone and amisulpride tended to have higher risk of oral ulcerations, but this was not statistically significant.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.|Department of Medicine, Duke University School of Medicine, Durham, NC, USA.|School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan.|Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Edward Chia-Cheng
authors.initials: EC
authors.lastname: Lai
authors.affiliation: School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan.|Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan.
authors.forename: Cheng-Yang
authors.initials: CY
authors.lastname: Hsieh
authors.affiliation: Geriatric Medicine Unit, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Monera B
authors.initials: MB
authors.lastname: Wong
authors.affiliation: Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Swu-Jane
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan.|College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yang-Kuang
authors.initials: YK
authors.lastname: Yang
authors.affiliation: School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan.|Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Yea-Huei
authors.initials: YH
authors.lastname: Kao Yang
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.|Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Soko
authors.initials: S
authors.lastname: Setoguchi
mesh_terms: D000328:Adult; D000368:Aged; D000077582:Amisulpride; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D019226:Oral Ulcer / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods; D000069348:Quetiapine Fumarate / Q000009:adverse effects; D012189:Retrospective Studies; D013469:Sulpiride / Q000009:adverse effects / Q000031:analogs & derivatives; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; D013469:Sulpiride; D000077582:Amisulpride; D000077152:Olanzapine
keywords: antipsychotics; aripiprazole; olanzapine; oral health; pharmacoepidemiology; quetiapine; schizophrenia; sulpiride