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Quetiapine for the treatment of bipolar mania in older adults


  • MS has received research grant funding from Abbott Laboratories, Bristol-Myers Squibb, and GlaxoSmithKline; has been a consultant or on advisory boards for AstraZeneca and GlaxoSmithKline; and is on the speakers bureau for AstraZeneca. JRC has received grant funding from Abbott Laboratories, AstraZeneca, GlaxoSmithKline, Janssen, and Eli Lilly & Co.; and has been a consultant or on advisory boards for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen, Johnson & Johnson, and Solvay/Wyeth. JM is an employee of AstraZeneca Pharmaceuticals LP.

Martha Sajatovic, MD, Department of Psychiatry, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA. Fax: +1 440 423 1863; e-mail:


Objectives:  A post hoc analysis of pooled data from two quetiapine monotherapy clinical trials was conducted to evaluate the efficacy and tolerability of quetiapine therapy (twice daily, 400–800 mg/day) among bipolar manic adults aged 55 years and older. The primary efficacy endpoint was the change from baseline in Young Mania Rating Scale (YMRS) total score at Day 21. A secondary endpoint was change from baseline in YMRS score at Day 84.

Methods:  A total of 407 patients made up the safety population, consisting of 59 older adults (aged ≥55 years) and 348 younger adults. A total of 403 patients made up the efficacy population, consisting of 59 older adults and 344 younger adults. Efficacy outcomes were analyzed using covariance models (ANCOVA); descriptive statistics are presented for safety outcomes.

Results:  Both older and younger individuals treated with quetiapine had significant improvement from baseline on YMRS scores compared with placebo-treated patients. The older adult group demonstrated a sustained reduction in YMRS score compared with placebo that was apparent by Day 4 of treatment. For the quetiapine treatment groups, the most common adverse effects (at a frequency ≥10%) were dry mouth, somnolence, postural hypotension, insomnia, weight gain, and dizziness in older adults, and dry mouth, somnolence, and insomnia in younger adults. For the placebo treatment groups, insomnia was the most common adverse event in both older and younger adults.

Conclusions:  This secondary analysis suggests that quetiapine represents a potentially useful treatment option among older adults with bipolar I mania. Studies with a primary focus of geriatric bipolar mania, and including larger patient numbers, are needed to confirm these findings.

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