Trends in Antipsychotic Use in Dementia 1999-2007

Veterans Affairs Health Services Researchand Development Center for Clinical Management Research, Serious Mental Illness Treatment, Resource, and Evaluation Center, Ann Arbor, Michigan, USA.
Archives of general psychiatry (Impact Factor: 14.48). 02/2011; 68(2):190-7. DOI: 10.1001/archgenpsychiatry.2010.200
Source: PubMed


Use of atypical antipsychotics for neuropsychiatric symptoms of dementia increased markedly in the 1990s. Concerns about their use began to emerge in 2002, and in 2005, the US Food and Drug Administration warned that use of atypical antipsychotics in dementia was associated with increased mortality.
To examine changes in atypical and conventional antipsychotic use in outpatients with dementia from 1999 through 2007.
Time-series analyses estimated the effect of the various warnings on atypical and conventional antipsychotic usage using national Veterans Affairs data across 3 periods: no warning (1999-2003), early warning (2003-2005), and black box warning (2005-2007).
Patients aged 65 years or older with dementia (n = 254 564).
Outpatient antipsychotic use (percentage of patients, percentage of quarterly change, and difference between consecutive study periods).
In 1999, 17.7% (95% confidence interval [CI], 17.2-18.1) of patients with dementia were using atypical or conventional antipsychotics. Overall use began to decline during the no-warning period (rate per quarter, -0.12%; 95% CI, -0.16 to -0.07; P < .001). Following the black box warning, the decline continued (rate, -0.26%; 95% CI, -0.34 to -0.18; P < .001), with a significant difference between the early and black box warning periods (P = .006). Use of atypical antipsychotics as a group increased during the no-warning period (rate, 0.23; 95% CI, 0.17-0.30; P < .001), started to decline during the early-warning period (rate, -0.012; 95% CI, -0.14 to 0.11; P = .85), and more sharply declined during the black box warning period (rate, -0.27; 95% CI, -0.36 to -0.18; P < .001). Olanzapine and risperidone showed declining rates and quetiapine showed an increase during the early-warning period, but rates of use for all 3 antipsychotics declined during the black box warning period. In the black box warning period, there was a small but significant increase in anticonvulsant prescriptions (rate, 0.117; 95% CI, 0.08-0.16; P < .001).
Use of atypical antipsychotics began to decline significantly in 2003, and the Food and Drug Administration advisory was temporally associated with a significant acceleration in the decline.

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    • "Data on antipsychotic use can provide an additional perspective to regulators and clinicians in assessing the possible consequences of side effects of drugs by mapping the level of risk associated with antipsychotic exposure. Although several drug utilization studies have been conducted with different aims, especially in the US to assess the impact of regulatory warnings on the prescription pattern of antipsychotics [20-23], to the best of our knowledge, no detailed cross-national comparisons have been recently carried out in Europe. "
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    PLoS ONE 11/2013; 8(11):e81208. DOI:10.1371/journal.pone.0081208 · 3.23 Impact Factor
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    • "Even more worrisome, patients treated with divalproex in a substudy were found to experience accelerated brain volume loss and greater cognitive impairment compared with placebo-treated patients [80]. Finally, in a recently published administrative health database study, valproate appeared to have a similar risk of mortality in dementia patients compared with haloperidol, risperidone and olanzapine [81]. "
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    • "The highest prevalence was observed in the elderly population (age 65 and older), reaching values of 4.3% in males and 6.0% in females [38]. These values were consistent with data reported by other jurisdictions in Canada [39], Europe [40], [41] and the US [42]. "
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    PLoS ONE 05/2013; 8(5):e64217. DOI:10.1371/journal.pone.0064217 · 3.23 Impact Factor
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