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Some Psych Drugs Pose Bigger Risk in Dementia (CME/CE)

MedPageToday, 2012

on the so-called atypical antipsychotics in 2005 and followed suit three years later with a similar warning on the others.
But the comparative safety of individual drugs remains unclear, although the issue is important because off-label use seems likely to climb, Huybrechts and colleagues noted.
To help clarify the issue, they studied all-cause mortality (except for cancer deaths) among the 75,445 nursing home residents who were 65 or older, eligible for Medicaid, and who were new users of antipsychotic drugs from 2001 through 2005.
Database analysis showed that risperidone (Risperdal) was the most commonly used, so it served as the comparator for the other five drugs studied – haloperidol, quetiapine, aripiprazole (Abilify), olanzapine (Zyprexa), and ziprasidone (Geodon, Zeldox).
Other antipsychotics, such as chlorpromazine (Thorazine), were excluded because they collectively formed less than 1% of prescriptions, the researchers noted.
Compared with risperidone, they found: Risk of death associated with haloperidol was doubled (HR 2.07, 95% CI, 1.89 to 2.26) Quetiapine was associated with a decreased risk (HR 0.81, 95% CI, 0.75 to 0.88) The other three drugs were associated with risks that were not significantly different from risperidone
The mortality rate per 100 person-years during the first 180 days after the start of treatment was 37.1 overall, ranging from 26.2 for aripiprazole to 109.1 for haloperidol.
The researchers found that the risks were highest early in treatment, were still present regardless of dose, and were seen for all of the causes of death that were studied, such as circulatory or respiratory.
They cautioned that unmeasured confounders might have affected the results, although sensitivity analyses suggested it was unlikely.
They also noted that – although the study population consisted of people in a nursing home – the findings should apply to other groups, as long as socioeconomic status doesn't modify the effect of the drugs themselves.
Although the risks of antipsychotics have been known for years, the drugs are still used in elderly demented patients, largely because physicians may not see good alternative choices, according to Jenny McCleery, MRCPsych, of the Oxford Health NHS Foundation Trust in Oxford, England, and Robin Fox, MBBS, of the Health Centre in Bicester, England.