Prescription of second-generation, lower metabolic risk antipsychotics increases

SAN DIEGO — Findings presented here indicated that prescription of second-generation antipsychotics with lower metabolic risk have increased from 2006 to 2011, particularly for individuals with several metabolic disorders, but not those with cardiovascular disease.

“We know that patients with severe mental illness have a higher mortality rate than those without, estimates are between 13 and 30 years shorter life expectancy. That mortality gap has been widening in recent years,” Alisa Busch, MD, of McLean Hospital, said during a presentation. “Much of this excess mortality is due to medical comorbidity. We’ve known for a while now that second-generation antipsychotics can increase the risk for metabolic syndrome, which is a combination of different medical conditions —hypertension, hypercholesterolemia, diabetes and obesity — which in turn lead to increased risk for cardiovascular disease.”

To determine if patient characteristics were associated with differences in higher vs. lower risk second-generation antipsychotic prescribing patterns, researchers conducted an observational study of claims data from a 20% national sample of Medicare fee-for-service beneficiaries diagnosed with schizophrenia, bipolar I disorder, or major depression with psychotic features. Study participants filled at least one prescription for an oral second-generation antipsychotic within at least 1 year from 2006 to 2011. Analysis included 351,141 person-years.

Odds for filling a higher-risk antipsychotic decreased from 2006 (OR = 0.94; 95% CI, 0.91-0.98) to 2011 (OR = 0.66; 95% CI, 0.64-0.68).

Male gender (OR = 1.65; 95% CI, 1.62-1.68) and older age (OR = 2.36; 95% CI, 2.03-2.74) were associated with increased risk for using a higher-risk antipsychotic.

Past-year mental health admission or ED visit was associated with increased risk for using a higher-risk antipsychotic (OR = 1.38; 95% CI, 1.36-1.41).

Participants with cardiovascular disease were more likely to fill a higher-risk antipsychotic (OR = 1.03; 95% CI, 1-1.05). However, participants with metabolic syndrome disorders were less likely to fill a higher-risk prescription, with odds ratios of 1.06 (95% CI, 1.03-1.09) for one metabolic disorder to 0.76 (95% CI, 0.73-0.79) for four disorders.

“There does clearly seem to be a trend towards prescribing decreased metabolic-risk antipsychotics over time, and that’s despite the increased entry of generic medications, which are a higher metabolic risk option. Associated with higher metabolic risk prescribing was having an older age, having a mental health hospitalization or ED visit in the past year and being male,” Busch said. “At first I thought perhaps the association with older age is that maybe these are individuals that are already stabilized on the earlier entry second-generation antipsychotics, but that explanation wouldn’t really hold up with mental health hospitalization or ED visits in the prior year, because that would suggest individuals who are less stable. Looking forward to any insight on these findings.” – by Amanda Oldt

Reference:

Busch A, et al. Prescribing second-generation antipsychotic medications of higher vs. lower metabolic risk: The role of patient characteristics. Presented at: American Psychiatric Association Annual Meeting; May 20-24, 2017; San Diego.

Disclosure: The researchers report no relevant financial disclosures.