Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

Yunusa, Ismaeel; Alsumali, Adnan; Garba, Asabe E; Regestein, Quentin R.; Eguale, Tewodros

doi:10.1001/jamanetworkopen.2019.0828

Cited by 143 publications

(145 citation statements)

References 82 publications

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“…Similar to two published NMAs of pharmacologic interventions in persons with dementia, we found that antipsychotics were associated with an increased risk of cerebrovascular events [30,31]. Although one of these NMAs included cholinesterase inhibitors, authors did not conduct analyses to assess for an association with mortality risk [30].…”

Section: Discussionsupporting

confidence: 69%

Safety of pharmacologic interventions for neuropsychiatric symptoms in dementia: a systematic review and network meta-analysis

et al. 2020

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Background: Prescribing trends suggest that pharmacologic alternatives to antipsychotics are gaining in popularity, but randomized trial (RCT) data of their comparative safety is scarce. Our objective was to describe the comparative safety of pharmacologic interventions for treating neuropsychiatric symptoms in dementia. Methods: We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and PsycINFO, from inception to May 28, 2019, for studies of pharmacologic interventions used to treat neuropsychiatric symptoms in dementia. Dementia care partners selected fracture risk as our primary outcome. Pairs of reviewers, working independently, conducted all study screening, data abstraction, and risk of bias appraisal. We conducted Bayesian random-effects network metaanalyses (NMAs) using data from RCTs to derive odds ratios (ORs). In secondary analyses, we conducted frequentist random-effects NMAs using data from RCTs and Bayesian three-level hierarchical random-effects NMAs incorporating data from RCTs and non-randomized studies.

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Section: Discussionsupporting

confidence: 69%

Safety of pharmacologic interventions for neuropsychiatric symptoms in dementia: a systematic review and network meta-analysis

et al. 2020

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“…Although antidepressants, particularly selective serotonin reuptake inhibitors, have fewer and less severe adverse effects than antipsychotic medications, treatment may still be complicated by cardiac conduction-delaying effects and effects on reducing agitation (40% response rate) are not evident until after 6 to 9 weeks of treatment. 6 Yunusa and colleagues 7 Downloaded From: https://jamanetwork.com/ on 10/01/2020 risperidone, and quetiapine over placebo was small and consistent with previous findings, further highlighting the need for more-effective behavioral and pharmacotherapies for BPSD.…”

supporting

confidence: 81%

Behavioral and Psychological Symptoms—An Emerging Crisis of the Alzheimer Dementia Epidemic

Forester

Vahia²

2019

JAMA Netw Open

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“…Ultimately, 44 full texts of potentially relevant studies were independently assessed by two reviewers (GO, CB), and 10 were finally selected by agreement (see Supplemental material). [27][28][29][30][31][32][33][34][35][36] Medications showing evidence of benefit for the treatment of hyperactive delirium or other forms of agitation are reported in Table 1, along with other relevant clinical, pharmacological and regulatory data. Details on the search results, the study selection, the outcomes extracted from the selected reviews, the effect sizes and the strength of association are provided in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

Pharmacological treatment of hyperactive delirium in people with COVID-19: rethinking conventional approaches

Ostuzzi

Gastaldon

Papola

et al. 2020

Therapeutic Advances in Psychopharmacology

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People with coronavirus disease (COVID-19) might have several risk factors for delirium, which could in turn notably worsen the prognosis. Although pharmacological approaches for delirium are debated, haloperidol and other first-generation antipsychotics are frequently employed, particularly for hyperactive presentations. However, the use of these conventional treatments could be limited in people with COVID-19, due to the underlying medical condition and the risk of drug–drug interactions with anti-COVID treatments. On these premises, we carried out a rapid review in order to identify possible alternative medications for this particular population. By searching PubMed and the Cochrane Library, we selected the most updated systematic reviews of randomised trials on the pharmacological treatment of delirium in both intensive and non-intensive care settings, and on the treatment of agitation related to acute psychosis or dementia. We identified medications performing significantly better than placebo or haloperidol as the reference treatment in each population considered, and assessed the strength of association according to validated criteria. In addition, we collected data on other relevant clinical elements (i.e. common adverse events, drug-drug interactions with COVID-19 medications, daily doses) and regulatory elements (i.e. therapeutic indications, contra-indications, available formulations). A total of 10 systematic reviews were included. Overall, relatively few medications showed benefits over placebo in the four selected populations. As compared with placebo, significant benefits emerged for quetiapine and dexmedetomidine in intensive care unit (ICU) settings, and for none of the medications in non-ICU settings. Considering also data from indirect populations (agitation related to acute psychosis or dementia), aripiprazole, quetiapine and risperidone showed a potential benefit in two or three different populations. Despite limitations related to the rapid review methodology and the use of data from indirect populations, the evidence retrieved can pragmatically support treatment choices of frontline practitioners involved in the COVID-19 outbreak, and indicate future research directions for the treatment of delirium in particularly vulnerable populations.

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Assessment of Reported Comparative Effectiveness and Safety of Atypical Antipsychotics in the Treatment of Behavioral and Psychological Symptoms of Dementia

Cited by 143 publications

References 82 publications

Safety of pharmacologic interventions for neuropsychiatric symptoms in dementia: a systematic review and network meta-analysis

Safety of pharmacologic interventions for neuropsychiatric symptoms in dementia: a systematic review and network meta-analysis

Behavioral and Psychological Symptoms—An Emerging Crisis of the Alzheimer Dementia Epidemic

Pharmacological treatment of hyperactive delirium in people with COVID-19: rethinking conventional approaches

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