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Antipsychotics have greater mortality risk than previously thought

Recent data suggest that elderly patients with dementia being treated with antipsychotics may have a greater increased risk for mortality than previously expected, according to researchers.

“The present analyses provide critical information that can help physicians minimize potential harms at multiple decision points,” the researchers wrote.

The retrospective study included data from the Veterans Health Administration, including 90,786 patients aged 65 years or older with a dementia diagnosis.

They examined absolute change in mortality risk and the number needed to harm over 180 days of follow-up. Specifically, they looked at new prescriptions for antipsychotics: haloperidol, olanzapine, quetiapine and risperidone; or valproic acid and derivatives or an antidepressant among 46,008 patients.

Patients who were prescribed haloperidol had a 3.8% increased risk for mortality and a number needed to harm of 26. Those prescribed risperidone exhibited a 3.7% mortality risk, with a number needed to harm of 27; and patients prescribed olanzapine had a 2.5% increased mortality risk, with a number needed to harm of 40; and quetiapine users had a 2% increased mortality risk, with a number needed to harm of 50, according to data.

However, the mortality risk for those prescribed antidepressants ranged from 12.3% with a number needed to harm of 8 for haloperidol; to 3.2% with a number needed to harm of 31 for quetiapine, the researchers wrote.

The researchers also observed a dose-response increase in mortality risk for the atypical antipsychotics of 3.5% in the high-dose subgroup compared with the low-dose subgroup.

There was an increased dose-adjusted mortality risk for risperidone and olanzapine, compared with quetiapine, they added.

“These new data can help physicians minimize the potential harm associated with antipsychotic treatment,” they wrote. – by Samantha Costa

Disclosure: Schneider reports grants from the National Institute on Aging, the State of California, the Alzheimer’s Association, and grants or research support from Johnson & Johnson, Eli Lilly, Novartis, and Pfizer. He has served as a consultant for and received consulting fees from Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Johnson & Johnson, Lundbeck, Merck, Novartis, Pfizer, Takeda, and the State of California Department of Justice. Kim reports grants from the National Institute of Mental Health, National Institute of Nursing Research, and the Department of Veterans Affairs. Kales reports receipt of grants from the National Institute of Nursing Research and the Department of Veterans Affairs.