Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory

Authors

  • Stacie B. Dusetzina,

    Corresponding author
    • Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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  • Alisa B. Busch,

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
    2. McLean Hospital, Belmont, MA, USA
    3. Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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  • Rena M. Conti,

    1. Section of Pediatrics Hematology/Oncology, Department of Pediatrics, University of Chicago Hospitals, Chicago, IL, USA
    2. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
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  • Julie M. Donohue,

    1. Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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  • G. Caleb Alexander,

    1. Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA
    2. Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
    3. Johns Hopkins University School of Medicine, Department of General Internal Medicine, Baltimore, MD, USA
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  • Haiden A. Huskamp

    1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Stacie B. Dusetzina, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. E-mail: Dusetzina@hcp.med.harvard.edu

ABSTRACT

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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