The Effect of Use of Tricyclic Antidepressants or Serotonin-Norepinephrine Reuptake Inhibitors Versus Selective Serotonin Reuptake Inhibitors on the Risk of Urinary Tract Infection Among People With Multiple Sclerosis: A Nested Case–Control Study

Abstract

Purpose: To study the effect of tricyclic antidepressant (TCA)/selective serotonin-norepinephrine reuptake inhibitor (SNRI) versus selective serotonin reuptake inhibitor (SSRI) on the risk of urinary tract infection (UTI) among people with multiple sclerosis (MS). Methods: A case–control study was conducted using data from the UK Clinical Practice Research Datalink Aurum, nested within a cohort of people with MS. Each person with a UTI was matched to ≤ 4 controls on sex, region, age (±2 years), and time since MS diagnosis (±20%). Conditional logistic regression analyses were conducted to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) to compare TCA/SNRI to SSRI use and each antidepressant group to no antidepressant use. ORs were adjusted for smoking status, BMI, comorbidities, and recent drug prescriptions. Results: Two thousand six hundred and sixty-four cases were matched to 3722 controls. TCA/SNRI versus SSRI use did not increase the risk of UTI (conditional aOR 1.21 [95% CI: 0.84–1.75]). TCA/SNRI use versus no antidepressant use did show an increased risk (conditional aOR [95% CI: 1.43 [1.21–1.69]), but SSRI versus no use did not (conditional aOR 1.15 [0.96–1.37]). Conclusions: This study showed no increased risk of UTI for TCA/SNRI versus SSRI use among people with MS. However, effect estimates were imprecise due to small sample sizes.