To review findings from pharmaco-epidemiological studies exploring antipsychotic (AP) drugs prescribing trends.
We retrieved original studies that explored AP prescribing trends in general population samples since 2000. For each study, we extracted information on sampling method, period, assessment of AP use and corresponding estimates (incidence rates, prevalence rates, pharmacy sales, prescription data) and diagnostic assessment.
Nearly all studies meeting the inclusion criteria (n = 17) showed an increase in AP prescriptions, mainly because of a dramatic rise in second-generation antipsychotics (SGAP) prescriptions. APs are often prescribed for non-psychotic disorders in adults as well as in children and adolescents.
Considering the growing number of persons from the general population exposed to APs, population studies assessing the risk/benefit ratio of SGAP use in disorders other than psychosis are necessary, particularly in children and adolescents.
"Second-generation antipsychotics (SGAs), clozapine, olanzapine and risperidone, have improved quality of life of billions psychiatric patients worldwide and became essential in the clinical guidelines for treatment of schizophrenia (SZ)  . Although the primary target of this drugs are SZ patients, estimated in 1% of world population  , leading experts have warned on the exponential increase of the " off-label " applications of SGAs, which include non- SZ adults , adolescents and children  suffering from a wide range of psychiatric conditions . Intriguingly, several of the increasing off-label indications in non-SZ patients still lack sufficient safety – and efficacy – evidence. "
"Over the last two decades, the risk of diabetes associated to antipsychotics attracted considerable clinical interest in psychiatry. The main reason for this emerging issue was a marked rise in second-generation antipsychotics' (SGAP) use, a class with less extrapyramidal Adverse Drug Reactions (ADRs) than first-generation antipsychotics (FGAP) (Geddes et al., 2000; Verdoux et al., 2010), but more likely to cause or exacerbate diabetes (Expert Group, 2004; Saddichha et al., 2008). Among SGAP, glycemic dysregulations and diabetes are more frequent with olanzapine or clozapine than with risperidone , quetiapine or aripiprazole (Starrenburg and Bogers, 2009; Reynolds and Kirk, 2010; Meyer et al., 2008). "
"The arrival of the second-generation antipsychotics (SGAPs) in the 1990s has undoubtedly favored this increase . SGAPs were believed to induce less neurological adverse drug reactions than first-generation antipsychotics (FGAPs) , even if extrapyramidal side effects may also occur with SGAPs . Moreover, some SGAPs have exhibited new pharmacological profiles, which may have contributed to the emergence of new off-label indications and OLP practices. "
[Show abstract][Hide abstract] ABSTRACT: New antipsychotics continuously arrive on the market, which thereby influences the approved and off-label prescribing (OLP) schemes. We aimed to identify the recent trends in the OLP of antipsychotics. We conducted a literature review based on three different populations: adult, pediatric, and elderly patients.
A literature search was performed in the PubMed and ScienceDirect databases using the following keyword algorithm: "off-label" AND ("antipsychotic*" OR "neuroleptic*"). The period investigated ranged from January 2000 to January 2015. Only English-written pharmacoepidemiological studies were included.
Seventy-seven relevant results were identified. Among adults, OLP consisted of 40 to 75% of all antipsychotic prescriptions. The main indications were mood disorders, anxiety disorders, insomnia and agitation. Quetiapine was the most frequently prescribed off-label antipsychotic, especially for anxiety and insomnia. Among children, OLP was estimated between 36 and 93.2% of all antipsychotic prescriptions. Risperidone and aripiprazole were primarily used and were most often prescribed for attention deficit hyperactivity disorder, anxiety, or mood disorders. Among elderly individuals, OLP consisted of 22 to 86% of all antipsychotic prescriptions. Antipsychotic OLP was particularly frequent for agitation; however, a recent decrease in this OLP was identified.
Antipsychotics have largely been prescribed off-label in recent years. The types of antipsychotic OLP practices differ according to the age category of patients. OLP is often used in cases of therapeutic dead-ends or for specific disorders with few or no currently approved medications. However, other OLP practices only reflect temporary prescription trends for mild symptoms, which may induce safety concerns.
Current pharmaceutical design 06/2015; 21(23). DOI:10.2174/1381612821666150619092903 · 3.45 Impact Factor
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