Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances

TY - JOUR

T1 - Impact of safety warnings on antipsychotic prescriptions in dementia: nothing has changed but the years and the substances

AU - Schulze, Jana

AU - van den Bussche, Hendrik

AU - Glaeske, Gerd

AU - Kaduszkiewicz, Hanna

AU - Wiese, Birgitt

AU - Hoffmann, Falk

N1 - Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.

AB - Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.

KW - Aged

KW - Aged, 80 and over

KW - Antipsychotic Agents

KW - Databases, Factual

KW - Dementia

KW - Drug Labeling

KW - Female

KW - Germany

KW - Humans

KW - Insurance, Health

KW - Male

U2 - 10.1016/j.euroneuro.2013.02.001

DO - 10.1016/j.euroneuro.2013.02.001

M3 - SCORING: Journal article

C2 - 23498307

VL - 23

SP - 1034

EP - 1042

JO - EUR NEUROPSYCHOPHARM

JF - EUR NEUROPSYCHOPHARM

SN - 0924-977X

IS - 9

ER -