Association of Aripiprazole With the Risk for Psychiatric Hospitalization, Self-harm, or Suicide

Abstract

IMPORTANCE Some reports have raised concerns regarding a potential psychiatric worsening associated with first-time use of aripiprazole in patients already treated with other antipsychotic medications. Whether aripiprazole use, particularly in the long term, increases the risk for serious psychiatric events is unclear. OBJECTIVE To assess whether switching to or adding aripiprazole is associated with serious psychiatric treatment failure compared with switching to or adding another antipsychotic drug in patients previously exposed to antipsychotic medications. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted from January 1, 2005, to March 31, 2015. Data were obtained from the United Kingdom Clinical Practice Research Datalink, one of the world's largest computerized databases linked to the Hospital Episodes Statistics repository and the Office for National Statistics (ONS) mortality database. Within a base cohort of new users of antipsychotic drugs, patients switching or adding aripiprazole (n = 1643) were propensity matched 1:1 to patients switching to or adding another antipsychotic medication (n = 1643). All patients were followed up until psychiatric treatment failure, for 365 days (1 year) after cohort entry, until death from any cause other than suicide, until end of registration or linkage with the databases, or end of the study period (March 31, 2016). MAIN OUTCOMES AND MEASURES Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% CIs of serious events of psychiatric treatment failure (psychiatric hospitalizations, self-harm, or suicide) associated with switching to or adding aripiprazole compared with other antipsychotic drugs. In addition to propensity score matching, all models were adjusted for age, number of psychiatric hospitalizations or self-harm events in the 6 months before cohort entry, number of different antipsychotic drugs before cohort entry, and quintiles of the Index of Multiple Deprivation. RESULTS The study cohort included 1643 patients (949 [57.8%] were women with a mean [SD] age of 42.1 [16.8] years) starting aripiprazole use; they were matched 1:1 to 1643 patients (871 [53.0%] were women with a mean [SD] age of 42.4 [17.1] years) starting use of another antipsychotic drug. During 2692 person-years of follow-up, 391 incident serious psychiatric treatment failures occurred, with a crude incidence rate of 14.52 (95% CI, 13.16-16.04) per 100 person-years. First-time use of aripiprazole was not associated with an increased rate of psychiatric treatment failure (HR, 0.87; 95% CI, 0.71-1.06), psychiatric hospitalizations (HR, 0.85; 95% CI, 0.69-1.06), or self-harm or suicide (HR, 0.96; 95% CI, 0.68-1.36) compared with starting use of another antipsychotic drug. Results were consistent across several sensitivity analyses. CONCLUSIONS AND RELEVANCE Initiating aripiprazole use, compared with another antipsychotic medication, after a previous antipsychotic exposure did not appear to be associated with psychiatric hospital...

Suicidality and psychotic episodes after starting aripiprazole: two case reports

“…Although reassuring data have recently been provided on the switch to or the addition of aripiprazole (Takeuchi et al , 2018; Montastruc et al , 2019), the cases that we report, associated with others, encourage at least careful monitoring of switches to aripiprazole from a strong D 2 blocker antipsychotic, particularly in patients with a history of suicide or ongoing depressive symptoms. Among these two cases, Case 2 is, to our knowledge, the first case of suicidal attempt and suicide following an overdose directly related to an aripiprazole switch.…”

Brand-Name Antidepressants Outperform Their Generic Counterparts in Preventing Hospitalization for Depression: The Real-World Evidence from Taiwan

“…The occurrence of hospitalization is an important outcome for evaluating treatment effectiveness in psychiatric research using a database ( Desai et al, 2019 ; Montastruc et al, 2019 ). Our results demonstrate that most brand-name antidepressants have an advantage in preventing psychiatric hospitalization: a finding supported by previous studies ( Wu et al, 2011 ; Desai et al, 2019 ).…”

Catatonia and Schizophrenia in a Young Man with Autism Spectrum Disorder and Clozapine-Induced Myocarditis

“…55 In a population-based cohort study from the United Kingdom that involved 1643 people starting aripiprazole who had previously been taking another antipsychotic, the treatment failure incident rate was 13.1 per 100 person-years, which did not differ significantly from those who were switched to a different antipsychotic. 56 Taken together, these studies suggest that transition to aripiprazole is possible but that clinical vigilance is necessary. Furthermore, in a patient with a recent history of catatonia, aripiprazole may be a reasonable option and may be less likely than other high-potency antipsychotic agents to worsen catatonia.…”

“…In a meta-analysis looking at 22 randomized, controlled trials, no difference in psychotic worsening was found when switching to aripiprazole versus switching to another antipsychotic, although switching to aripiprazole was associated with greater risk of study discontinuation because of the lack of efficacy 55 . In a population-based cohort study from the United Kingdom that involved 1643 people starting aripiprazole who had previously been taking another antipsychotic, the treatment failure incident rate was 13.1 per 100 person-years, which did not differ significantly from those who were switched to a different antipsychotic 56 . Taken together, these studies suggest that transition to aripiprazole is possible but that clinical vigilance is necessary.…”