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Starting aripiprazole may not increase risk for psychiatric treatment failure

Compared with initiation of another antipsychotic drug, starting aripiprazole after prior antipsychotic exposure was not associated with psychiatric hospitalization, self-harm or suicide in a population-based cohort study.

Only one prior study evaluated the risk for serious psychiatric worsening in those who switched to aripiprazole vs. those who switched to other antipsychotics; it found no increased risk from aripiprazole use during a max follow-up of 6 months, according to François Montastruc, MD, PhD, from the Lady Davis Research Institute, Jewish General Hospital, Montreal, and colleagues.

“There is a need to further examine, in a larger cohort and with longer follow-up, the risk for psychiatric worsening in patients who are taking a D₂ dopamine receptor partial agonist, such as aripiprazole, for the first time after a previous exposure to other antipsychotic drugs,” they wrote.

In their population-based cohort study, researchers evaluated whether switching to or adding aripiprazole was linked to serious psychiatric treatment failure compared with switching to or adding another oral antipsychotic in patients previously exposed to antipsychotic drugs using data from the U.K. Clinical Practice Research Datalink.

New users of antipsychotic drugs switching to or adding aripiprazole (n = 1,643) and those switching to or adding another antipsychotic medication (n = 1,643) were followed up until psychiatric treatment failure (psychiatric hospitalizations, self-harm or suicide), death from any other cause, 1 year post-cohort entry, end of registration or linkage with the databases or study period end.

Over the 2,692 person-years of follow-up, the results showed that 391 incident psychiatric treatment failures occurred, which yielded a crude incidence rate of 14.52 (95% CI, 13.16-16.04) per 100 person-years.

Analysis revealed that starting aripiprazole was not tied to an increased rate of psychiatric treatment failure compared with starting another antipsychotic (HR = 0.87; 95% CI, 0.71-1.06). When evaluated individually, analysis also showed no link to psychiatric hospitalization (HR = 0.85; 95% CI, 0.69-1.06) or with self-harm or suicide (HR = 0.96; 95% CI, 0.68-1.36).

Secondary analyses results showed that starting aripiprazole was not linked to a greater rate of psychiatric treatment failure in various subgroups, such as patients recently treated with antipsychotics (HR = 0.87; 95% CI, 0.67-1.15) and those with schizophrenia (HR = 0.82; 95% CI, 0.62-1.08). The researchers observed similar patterns when evaluating psychiatric hospitalization and self-harm or suicide separately.

‘These findings do not exclude a differential risk for nonserious psychiatric exacerbations that do not lead to psychiatric hospitalization. In addition, we could not eliminate a potential risk for psychiatric treatment failure in patients with prolonged antipsychotic treatment before initiation of aripiprazole use,” Montastruc and colleagues wrote. “Therefore, patients should still be monitored for psychiatric exacerbations when they switch to or add aripiprazole. These results warrant replication in larger population-based studies.” – by Savannah Demko

Disclosure: Montastruc reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.