Diagnoses Associated With Use of Atypical Antipsychotics in a Commercial Health Plan: A Claims Database Analysis

Citrome, Leslie; Kalsekar, Iftekhar; Guo, Zhenchao; Laubmeier, Kimberly K.; Hebden, Tony

doi:10.1016/j.clinthera.2013.09.006

Cited by 28 publications

(29 citation statements)

References 4 publications

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“…Quetiapine was first approved for mania in all three Scandinavian countries during 2008 and 2009, and later for further indications, such as bipolar depression, maintenance treatment in bipolar disorder, and for major depressive disorder during 2009 and 2010. However, this might not be the only cause of the observed increase, as a significant proportion of quetiapine users, ranging from 57–70%, did not have diagnoses of severe mental illness (schizophrenia or bipolar disorder) . Data have suggested that low‐dose quetiapine is frequently used for anxiety and sleep disorders .…”

Section: Discussionmentioning

confidence: 99%

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Pottegård

Johnsen

Kroken

et al. 2019

Brit J Clinical Pharma

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Aims: The aim of this study was to investigate time trends in dosing and prevalence of antipsychotic prescriptions in Scandinavia.Methods: We retrieved data on antipsychotic use between 2006 and 2016 from Danish, Norwegian and Swedish national prescription registers. For each antipsychotic, we calculated prevalence of use and mean doses, overall and for specific age groups (young, adults and elderly). Results: Antipsychotic use in Scandinavia increased from 16.5 to 17.2 users/1000 inhabitants between 2006 and 2016 (+2.4%, annual change: 0.07 users/1000 inhabitants/year, 95% CI: 0.02-0.20, P = 0.02). In 2006, chlorprothixene and levomepromazine were the most commonly used antipsychotics. By 2016, quetiapine was the most used antipsychotic in all three countries and across all age groups, with an overall 1-year prevalence of 4.05-9.97 users/1000 inhabitants (annual change: 0.57 users/1000 inhabitants/year, 95% CI: 0.54-0.60, P < 0.001). Quetiapine showed a marked decrease in mean doses during the 11-year study period (0.46-0.28 defined daily doses (DDD)/user/day: 39.1%, −0.02 DDD/user/day/year, 95% CI: −0.020 to −0.015, P < 0.001). In 2016, the highest mean doses were seen for clozapine (0.90-1.07 DDD/user/day) and olanzapine (0.66-0.88 DDD/user/day).Conclusions: There is an increased prevalence of antipsychotic prescriptions that coincides with low and/or decreasing mean doses of the majority of commonly used antipsychotics in Scandinavia. Of all antipsychotics, this development was most pronounced for quetiapine. Reasons for and consequences of increased antipsychotic use that lasts shorter periods of time requires further study.

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Section: Discussionmentioning

confidence: 99%

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Pottegård

Johnsen

Kroken

et al. 2019

Brit J Clinical Pharma

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“…Interestingly, patients initiated on olanzapine and quetiapine, both multi-receptor targeted antipsychotics 35 , were more likely to have a history of drug abuse (6.8% for lurasidone versus 13.9% for olanzapine and 13.6% for quetiapine) than patients initiated on lurasidone. Previous research has also reported that quetiapine was more likely to be used by patients with comorbid substance use 36 and anecdotal evidence suggests that quetiapine may be used off-label to treat substance abuse 37 . Finally, patients treated with lurasidone in this study had a lower prior risk of hospitalization, an important potential marker of a more debilitating condition 30 .…”

Section: Discussionmentioning

confidence: 99%

Hospitalization risk in bipolar disorder patients treated with lurasidone versus other atypical antipsychotics

Ng-Mak

Halpern

Rajagopalan

et al. 2018

Current Medical Research and Opinion

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“…A high rate of offlabel paliperidone use would not necessarily be of concern if there were scientific evidence supporting the effectiveness of this medication for conditions other than schizophrenia. Since 2003, antipsychotic medications have been approved by the FDA for the treatment of other disorders in addition to schizophrenia and BPD: risperidone and aripiprazole for irritability in autism, aripiprazole, olanzapine, and quetiapine for adjunctive use with antidepressants in patients with treatment-resistant depression [18]. Hence, such uses of these drugs would not be considered off-label today, although they were at the time these data were collected.…”

Section: Off-label Usementioning

confidence: 99%

“…Risperidone has shown evidence for efficacy in disruptive behaviours [23]. Aripiprazole and risperidone are also FDA-approved medications for behavioural disturbances (irritability and aggression) associated with autism and/or intellectual disabilities in children and adolescents (age 6-17 years) [24,18,25].…”

Section: Off-label Usementioning

confidence: 99%

The prescribing pattern of paliperidone in a pediatric population

Yektaş

Paşabeyoğlu

Mutlu

et al. 2017

Psychiatry and Clinical Psychopharmacology

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OBJECTIVES: Paliperidone is a relatively new atypical antipsychotic, offers a potential new treatment option for adolescents, with several advantages including single dosage per day and availability in hepatic problems. However, there is a lack of efficacy and safety data for the use of this medication in various psychiatric disorders among children and adolescents. In this study, we retrospectively investigated the use of paliperidone in various psychiatric disorders among a youth population. METHODS: The children and adolescents treated with paliperidone for any psychiatric problem at the outpatient and inpatient Child and Adolescent Psychiatry clinics of Düzce University Medical Faculty Hospital and Bakırkoy Mental Health Hospital were evaluated for the study. Data were collected retrospectively from the patient records. Patients' charts were reviewed to retrieve additional data on indications of the medications, adverse drug reactions (ADRs) and changes in the clinical condition. The clinical status of individual patients was assessed using the Clinical Global Index (CGI) score for severity and improvement. RESULTS: The mean age of patients was 15.8 ± 1.3 years, and 59.6% (n = 31) of the group was male and 40.4% (n = 21) was female. Paliperidone was prescribed for median 150 days (quartiles 60 and 487 days). The median average daily dose was 7.6 mg/day (range 3-12 mg/day). The main indications for paliperidone prescription were psychotic disorders and bipolar disorders (BPDs) (17 patients, 32.6%; 16 patients, 30.7%, respectively). The other most common diagnostic group was disruptive behavior disorders (DBDs) associated with attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, intellectual disability, conduct disorders, or oppositional defiant disorders (15 patients; 28.8%) tic/neurological disorder (4 patients; 7.9%). Thirty-five patients (67.4%) did not have a diagnosis of schizophrenia and were considered to have received these drugs off-label. Dosing was notably lower in the group of DBDs patients than for patients with BPD or psychotic disorders. Of the 52 patients receiving paliperidone, 53.9% of patients were concurrently treated at some point with one or more than one of a psychostimulant/ADHD medication, an other antipsychotics, an antidepressant, a mood stabilizer, and any other class of psychotropic drug (such as a sleep medication). Totally, ADRs were recorded in 26 (50%) patients: weight gain (n = 24); extra pyramidal symptoms (n = 8); gastrointestinal system symptoms (n = 4); insomnia (n = 2); hyperprolactinemia (n = 4); sedation (n = 2); and skin affection (n = 1). CONCLUSIONS: In this study group, paliperidone has been commonly used for schizophrenia, but it has also been used for mood disorders, DBDs, and Tourette's disorder in children and adolescents. Results showed clinically meaningful improvements in symptom measurements of different disorders. The drug is generally well tolerated and the most frequent adverse events include rigidity, akathisia, sedation, and incre...

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Diagnoses Associated With Use of Atypical Antipsychotics in a Commercial Health Plan: A Claims Database Analysis

Abstract: Nearly a fifth of commercially insured patients were prescribed atypical antipsychotics, in particular, olanzapine, quetiapine, or risperidone, for diagnoses that were not aligned with US Food and Drug Administration-approved indications.

Cited by 28 publications

References 4 publications

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Hospitalization risk in bipolar disorder patients treated with lurasidone versus other atypical antipsychotics

The prescribing pattern of paliperidone in a pediatric population

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