Tags

Type your tag names separated by a space and hit enter

Risk of Mortality Associated With Atypical Antipsychotic use: A National Cohort Study of Older Adults With Depression and Parkinson's Disease.
Am J Geriatr Psychiatry. 2020 Feb 07 [Online ahead of print]AJ

Abstract

OBJECTIVES

This study examined the risk of all-cause-mortality in patients with Parkinson's Disease (PD) and comorbid depression using inappropriate atypical antipsychotics (AAPs), based on the 2015 American Geriatrics Society Beers criteria.

METHODS

A retrospective analysis of 2007-2010 Minimum Data Set linked Medicare data was conducted using a propensity-matched approach. The cohort included PD patients aged 65 years or older without schizophrenia or bipolar disorder who started AAPs. All patients had a diagnosis of comorbid depression. Risk of 6-month all-cause-mortality was compared across appropriate AAPs (aripiprazole, clozapine, or quetiapine) and inappropriate AAPs (olanzapine, asenapine, brexpiprazole, iloperidone, lurasidone, paliperidone, risperidone, or ziprasidone) using robust Cox regression models involving the matched cohort.

RESULTS

All-cause mortality rate was 15.65% in appropriate AAP group (n = 6,038) and 16.91% in inappropriate AAP group (n = 6,038) over 6-month follow-up in the matched cohort. The robust Cox proportional hazards models revealed increased risk of all-cause mortality (hazard ratio [HR] 1.13 [95% confidence interval {CI}: 1.01-1.28)] for patients who used inappropriate compared to appropriate AAPs. Risk of death was also higher for risperidone compared to quetiapine (HR: 1.20 [95% CI: 1.03-1.40]) in sensitivity analysis. However, there was a significant relationship between pneumonia and death in all analyses. The impact of inappropriate AAP use on mortality was not significant when pneumonia was modeled as a mediator.

CONCLUSIONS

Inappropriate AAP use is associated with a higher risk of all-cause-mortality in older patients with PD which is mainly mediated by pneumonia. Therefore, inappropriate AAP use should be avoided to improve quality of care in PD.

Authors+Show Affiliations

Department of Pharmaceutical Health Outcomes and Policy (FC, MLJ, HC, RRA), College of Pharmacy, University of Houston, Houston, TX.The University of Texas Health Science Center (HMH), Houston, TX; Division of Geriatric and Palliative Medicine (HMH), McGovern Medical School, Houston, TX.Department of Pharmaceutical Health Outcomes and Policy (FC, MLJ, HC, RRA), College of Pharmacy, University of Houston, Houston, TX.Department of Pharmaceutical Health Outcomes and Policy (FC, MLJ, HC, RRA), College of Pharmacy, University of Houston, Houston, TX.Department of Pharmaceutical Health Outcomes and Policy (FC, MLJ, HC, RRA), College of Pharmacy, University of Houston, Houston, TX.Department of Pharmaceutical Health Outcomes and Policy (FC, MLJ, HC, RRA), College of Pharmacy, University of Houston, Houston, TX. Electronic address: rraparasu@uh.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32147383

Citation

Chekani, Farid, et al. "Risk of Mortality Associated With Atypical Antipsychotic Use: a National Cohort Study of Older Adults With Depression and Parkinson's Disease." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 2020.
Chekani F, Holmes HM, Johnson ML, et al. Risk of Mortality Associated With Atypical Antipsychotic use: A National Cohort Study of Older Adults With Depression and Parkinson's Disease. Am J Geriatr Psychiatry. 2020.
Chekani, F., Holmes, H. M., Johnson, M. L., Chen, H., Sherer, J. T., & Aparasu, R. R. (2020). Risk of Mortality Associated With Atypical Antipsychotic use: A National Cohort Study of Older Adults With Depression and Parkinson's Disease. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry. https://doi.org/10.1016/j.jagp.2020.01.193
Chekani F, et al. Risk of Mortality Associated With Atypical Antipsychotic Use: a National Cohort Study of Older Adults With Depression and Parkinson's Disease. Am J Geriatr Psychiatry. 2020 Feb 7; PubMed PMID: 32147383.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of Mortality Associated With Atypical Antipsychotic use: A National Cohort Study of Older Adults With Depression and Parkinson's Disease. AU - Chekani,Farid, AU - Holmes,Holly M, AU - Johnson,Michael L, AU - Chen,Hua, AU - Sherer,Jeffrey T, AU - Aparasu,Rajender R, Y1 - 2020/02/07/ PY - 2019/11/11/received PY - 2020/01/28/revised PY - 2020/01/29/accepted PY - 2020/3/10/entrez KW - Parkinson's disease KW - antipsychotics KW - mortality KW - pneumonia JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry N2 - OBJECTIVES: This study examined the risk of all-cause-mortality in patients with Parkinson's Disease (PD) and comorbid depression using inappropriate atypical antipsychotics (AAPs), based on the 2015 American Geriatrics Society Beers criteria. METHODS: A retrospective analysis of 2007-2010 Minimum Data Set linked Medicare data was conducted using a propensity-matched approach. The cohort included PD patients aged 65 years or older without schizophrenia or bipolar disorder who started AAPs. All patients had a diagnosis of comorbid depression. Risk of 6-month all-cause-mortality was compared across appropriate AAPs (aripiprazole, clozapine, or quetiapine) and inappropriate AAPs (olanzapine, asenapine, brexpiprazole, iloperidone, lurasidone, paliperidone, risperidone, or ziprasidone) using robust Cox regression models involving the matched cohort. RESULTS: All-cause mortality rate was 15.65% in appropriate AAP group (n = 6,038) and 16.91% in inappropriate AAP group (n = 6,038) over 6-month follow-up in the matched cohort. The robust Cox proportional hazards models revealed increased risk of all-cause mortality (hazard ratio [HR] 1.13 [95% confidence interval {CI}: 1.01-1.28)] for patients who used inappropriate compared to appropriate AAPs. Risk of death was also higher for risperidone compared to quetiapine (HR: 1.20 [95% CI: 1.03-1.40]) in sensitivity analysis. However, there was a significant relationship between pneumonia and death in all analyses. The impact of inappropriate AAP use on mortality was not significant when pneumonia was modeled as a mediator. CONCLUSIONS: Inappropriate AAP use is associated with a higher risk of all-cause-mortality in older patients with PD which is mainly mediated by pneumonia. Therefore, inappropriate AAP use should be avoided to improve quality of care in PD. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/32147383/Risk_of_Mortality_Associated_With_Atypical_Antipsychotic_use:_A_National_Cohort_Study_of_Older_Adults_With_Depression_and_Parkinson's_Disease L2 - https://linkinghub.elsevier.com/retrieve/pii/S1064-7481(20)30216-5 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.