Oral antipsychotic medication use in children and adolescents in Japan between 2013 and 2021

Abstract

Objective Many antipsychotics have been marketed for adults, whereas they are often used off-label for children and adolescents. Some antipsychotics became newly available in the past decade, but no recent study has investigated prescription patterns, including beyond 2020. Here, we aimed to evaluate prescription patterns of antipsychotics in children and adolescents from 2013 to 2021. Methods The study was designed as a descriptive epidemiology study using a large-scale nationwide claims database. Patients aged 0–17 years with first-time prescriptions for antipsychotics between 2013 and 2021 were included. Incidence rate and prescribing patterns of antipsychotics were described for all patients and by calendar year, age, and sex. Results Of 30,054 patients, 8.4% were aged 0–5 years, 36.4% were 6–11 years, and 55.2% were 12–17 years. 41.6% were girls. The incidence rate of antipsychotic prescription increased from 2.46 per 1,000 person-years in 2013 to 3.90 in 2021. Atypical drugs (98.3%) were more frequently prescribed than typical drugs or their combination. First-time prescriptions were most frequently monotherapy (90.3%) and low-dose (< 50 mg/day chlorpromazine equivalent) (53.2%). Aripiprazole and risperidone were more likely to be prescribed in all age groups. In the latter period, adolescents aged ≥ 13 years often received newly marketed drugs. Conclusion This real-world database study for antipsychotics in Japan for 2013–2021 showed that the number of patients initiating antipsychotics has increased. Prescription of antipsychotics was initiated cautiously, such as with atypical monotherapy and low doses. Most drugs remain off-label for children and adolescents, suggesting the ongoing need for clinical caution in antipsychotic use.