Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory
Version of Record online: 3 MAY 2012
Copyright © 2012 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 21, Issue 12, pages 1251–1260, December 2012
How to Cite
Dusetzina, S. B., Busch, A. B., Conti, R. M., Donohue, J. M., Caleb Alexander, G. and Huskamp, H. A. (2012), Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory. Pharmacoepidem. Drug Safe., 21: 1251–1260. doi: 10.1002/pds.3272
- Issue online: 6 DEC 2012
- Version of Record online: 3 MAY 2012
- Manuscript Revised: 7 MAR 2012
- Manuscript Accepted: 7 MAR 2012
- Manuscript Received: 1 NOV 2011
- Agency for Healthcare Research and Quality. Grant Number: RO1 HS0189960
- drug utilization;
- FDA advisory;
- metabolic risk;
- second-generation antipsychotics
A 2003 Food and Drug Administration advisory warned of increased hyperlipidemia and diabetes risk for patients taking second-generation antipsychotics (SGAs). After the advisory, a professional society consensus statement provided treatment recommendations and stratified SGAs into high, intermediate, and low metabolic risk. We examine subsequent changes in incident and prevalent SGA use among individuals with severe mental illness.
We created a retrospective cohort using Florida Medicaid's claims from 2001 to 2006. We included non-Medicare eligible adults with bipolar disorder or schizophrenia who filled an SGA prescription. We assessed changes in overall and agent-specific use, discontinuations, interruptions, and therapeutic alternative use among prevalent users and agent-specific use among incident users. Pre-advisory utilization was compared with utilization initially after the advisory and two subsequent periods.
Among prevalent users, overall SGA use decreased slightly, and no increases in treatment interruptions or discontinuations were observed after the advisory and consensus statement publication. Compared with the pre-advisory period, in the months immediately after the advisory, the use of the highest metabolic-risk agent, olanzapine, decreased by 34% among prevalent users with bipolar disorder (adjusted risk ratio [aRR] = 0.66, 95%CI = 0.59–0.74) and 26% among prevalent users with schizophrenia (aRR = 0.74, 95%CI = 0.72–0.76). A greater decrease was estimated among incident users with bipolar disorder (aRR = 0.37, 95%CI = 0.29–0.47) and schizophrenia (aRR = 0.42, 95%CI = 0.35–0.51) during this period. During each subsequent post-advisory period, olanzapine use continued to decrease whereas quetiapine, ziprasidone, and aripiprazole use increased.
The metabolic risk advisory and the published consensus statement were associated with a selective reduction in olanzapine use without evidence of treatment disruptions among this population. Copyright © 2012 John Wiley & Sons, Ltd.