Trends in Prescribing Antipsychotics for Children and Adolescents in Japan: A Descriptive Epidemiological Study Using a Large-Scale Pharmacy Dataset

Nakane, Sayuri; Tanaka‐Mizuno, Sachiko; Nishiyama, Chika; Kochi, Kenji; Yamamoto-Sasaki, Madoka; Takeuchi, Masato; Ogawa, Yoshihide; Doi, Yuko; Arai, Masanobu; Fujii, Yosuke; Matsunaga, Toshiyuki; Furukawa, Toshi A; Kawakami, Koji

doi:10.1007/s10578-022-01330-x

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…For this age group, risperidone (5 years and older) in 2012 and aripiprazole (6 years and older) in 2016 were approved for children; these approvals may have contributed to the increasing trend. Our results of different patterns among gender and age groups agree with previous reports in Japan and other countries [6,15,27]. This heterogeneity in mental disorders and drug use by gender and age may be due to the onset mechanism of disorders in children or adolescents.…”

supporting

confidence: 91%

“…Against this background, a number of studies of clinical practice in antipsychotics prescription in children and adolescents have been reported from many countries -primarily Europe [6][7][8][9][10][11], with a few from other countries also, including Japan [12][13][14][15]. Of note, however, all these previous studies evaluated the period prior to 2018, and may not have fully covered the new antipsychotics released onto the market in recent decades, including brexpiprazole and lurasidone hydrochloride [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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

Tanaka‐Mizuno

Suga

Matsushita

et al. 2023

Preprint

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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.

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supporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Tanaka‐Mizuno

Suga

Matsushita

et al. 2023

Preprint

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“…Standard practice guidelines, such as those published by the United Kingdom’s National Institute for Health and Care Excellence, take a cautious approach to the prescription of antipsychotics for children and adolescents with DBDs, with their use confined to the short-term treatment of severe aggression resistant to psychosocial interventions [ 55 ]. Despite such recommendations, the use of atypical antipsychotics in children and adolescents with DBDs has increased markedly in the past two decades [ 32 , 33 , 34 , 44 , 56 ]. Most of the data on antipsychotic prescribing patterns comes from high-income countries, as there is a lack of published data on the use of these drugs among youth from low- and middle-income countries [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Rajkumar

2022

Biomedicines

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Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012–2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations using the search terms “disruptive behaviour disorder”, “oppositional defiant disorder”, “conduct disorder” and their variants, along with “antipsychotic”, “atypical antipsychotic” and the generic names of all currently approved atypical antipsychotics. Six relevant trials were identified during this period, including five randomized controlled trials and one naturalistic open-label trial. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that of all available antipsychotics, risperidone appears to be effective in the short-term management of DBDs. All available antipsychotics are associated with significant metabolic adverse effects in this population. These results are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.

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Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data

Radojčić

Pierce

Hope

et al. 2023

The Lancet Psychiatry

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Trends in Prescribing Antipsychotics for Children and Adolescents in Japan: A Descriptive Epidemiological Study Using a Large-Scale Pharmacy Dataset

Cited by 3 publications

References 33 publications

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

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

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review

Trends in antipsychotic prescribing to children and adolescents in England: cohort study using 2000–19 primary care data

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