Glucose and Prolactin Monitoring in Children and Adolescents Initiating Antipsychotic Therapy

Abstract

Objective: We aimed to evaluate glucose and prolactin monitoring in children and adolescents initiating antipsychotic therapy using a nationwide claims database.Methods: A retrospective 15-month cohort study was conducted using the National Database of Health Insurance Claim Information and Specified Medical Checkups in Japan. Patients aged ≤18 years, who were newly prescribed antipsychotics between April 2014 and March 2015, were followed up for 450 days. Outcomes were the use of glucose and prolactin testing through 15 months after drug initiation (index date) with consideration of persistence with antipsychotic therapy. The incidence proportion of patients monitored was assessed within the following four time windows: baseline (between 30 days before the index date and the index date), at 1–3 months (between 1 and 90 days after the index date), at 4–9 months (between 91 and 270 days after the index date), and at 10–15 months (between 271 and 450 days after the index date).Results: Of 43,608 new users in 6620 medical institutions, the percentage of persistent antipsychotic users was 46.4% at 90 days, 29.7% at 270 days, and 23.8% at 450 days after the index date. The proportion of patients who received monitoring within the baseline period was 13.5% (95% confidence interval [CI], 13.2–13.8) for glucose and 0.6% (95% CI, 0.5–0.6) for prolactin, respectively. The proportion of patients who received glucose monitoring at all time windows decreased to 0.9%. The proportion of patients who received prolactin monitoring by the second time window decreased to 0.1%.Conclusions: Our study shows that monitoring for glucose and prolactin is infrequent in children and adolescents initiating antipsychotic therapy. Strategies for physicians, patients, and guardians are needed to overcome the barriers in glucose and prolactin monitoring.

Current follow‐up practices often fail to detect metabolic and neurological adverse reactions in children treated with second‐generation antipsychotics

“…Our study findings were in line with previous studies that suggested that SGA treatment poses major metabolic risks for children (6,7,26). Despite these findings, and the existing guidelines, monitoring practices have often remained irregular (16)(17)(18)(19)(20). In our study, the baseline information necessary for detecting changes in growth and the laboratory test values were seldom complete.…”

“…These findings highlight the need for proper monitoring practices for children treated with SGAs. There are guidelines on follow-up practices, but there has been limited systematic monitoring, despite the evidence of SGA-related adverse reactions (16)(17)(18)(19)(20).…”

Monitoring of Adverse Drug Reaction-Related Parameters in Children and Adolescents Treated With Antipsychotic Drugs in Psychiatric Outpatient Clinics

“…Although previous studies have shown differences in monitoring frequencies in children treated with antipsychotic drugs, it is clear that the monitoring frequencies were suboptimal ( 13 , 15 , 16 , 18 ). Overall, it has been shown that the physical parameter weight was monitored more frequently in children treated with antipsychotic drugs compared to the laboratory parameters glucose and lipids, and waist circumference was monitored much less, which is in line with the results of this current study ( 14 , 15 , 19 ).…”

“…Monitoring instructions of these parameters are available in clinical guidelines, and in regulatory drug product information such as the information leaflet (9)(10)(11)(12). Despite the existing guidelines and instructions, previous studies have shown a large variability in the monitoring frequencies of ADR-related parameters, and that the overall monitoring frequencies were suboptimal (13)(14)(15)(16). The majority of these studies used administrative databases from various settings, such as insurance companies or databases of general practitioners, but questionnaires about monitoring among prescribers have also been assessed (14,16).…”

Current situation and challenges for mental health focused on treatment and care in Japan and the Philippines - highlights of the training program by the National Center for Global Health and Medicine

“…The off-label use of antipsychotics is not associated with patient refusal of the prescription; rather, the most common factor for patient refusal of medications was the belief that antidepressant use causes more harm than good. Glucose and prolactin monitoring are infrequent in children initiated with antipsychotic therapy [21]. Concern in the use of antipsychotics in pediatric patients in Japan is also limited but there is a need for psychiatrists to routinely monitor the metabolic condition of patients.…”