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Comparative cardiometabolic risk of antipsychotics in children, adolescents and young adults.
Eur Child Adolesc Psychiatry. 2020 May 29 [Online ahead of print]EC

Abstract

Understanding different cardiometabolic safety profiles of antipsychotics helps avoid unintended outcomes among young patients. We conducted a population-based study to compare cardiometabolic risk among different antipsychotics in children, adolescents and young adults. From Taiwan's National Health Insurance Database, 2001-2013, we identified two patient cohorts aged 5-18 (children and adolescents) and 19-30 (young adults), diagnosed with psychiatric disorders and newly receiving antipsychotics, including haloperidol and sulpiride, and second generation antipsychotics (SGA, including olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, paliperidone, and ziprasidone). Risperidone users were considered the reference group. We analyzed electronic medical records from seven hospitals in Taiwan and confirmed findings with validation analyses of identical design. Primary outcomes were composite cardiometabolic events, including type 2 diabetes mellitus, hypertension, dyslipidemia, and major adverse cardiovascular events. Multivariable Cox proportional hazards regression models compared cardiometabolic risk among antipsychotics. Among 29,030 patients aged 5-18 and 50,359 patients aged 19-30 years, we found 1200 cardiometabolic event cases during the total follow-up time of 37,420 person-years with an incidence of 32.1 per 1000 person-years. Compared to risperidone, olanzapine was associated with a significantly higher risk of cardiometabolic events in young adults (adjusted hazard ratio, 1.57; 95% CIs 1.13-2.18) but not in children and adolescents (1.85; 0.79-4.32). Specifically, we found young adult patients receiving haloperidol (1.52; 1.06-2.20) or olanzapine (1.75; 1.18-2.61) had higher risk of hypertension compared with risperidone users. Results from validation analyses concurred with main analyses. Antipsychotics' various risk profiles for cardiometabolic events merit consideration when selecting appropriate regimes. Due to cardiometabolic risk, we suggest clinicians may consider to select alternative antipsychotics to olanzapine in children, adolescents and young adults.

Authors+Show Affiliations

School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan. Department of Pharmacy, Chang Gung Memorial Hospital, Chiayi, Taiwan.School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan. Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan.Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan.Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan.School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan.Department of Psychiatry, National Cheng Kung University and Hospital, Tainan and Dou-Liu, Taiwan.School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, No.1, University Road, 701, Tainan, Taiwan. edward_lai@mail.ncku.edu.tw. Department of Pharmacy, National Cheng Kung University Hospital, Tainan, Taiwan. edward_lai@mail.ncku.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32472205

Citation

Chung, Ying-Shan, et al. "Comparative Cardiometabolic Risk of Antipsychotics in Children, Adolescents and Young Adults." European Child & Adolescent Psychiatry, 2020.
Chung YS, Shao SC, Chi MH, et al. Comparative cardiometabolic risk of antipsychotics in children, adolescents and young adults. Eur Child Adolesc Psychiatry. 2020.
Chung, Y. S., Shao, S. C., Chi, M. H., Lin, S. J., Su, C. C., Kao Yang, Y. H., Yang, Y. K., & Lai, E. C. (2020). Comparative cardiometabolic risk of antipsychotics in children, adolescents and young adults. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-020-01560-1
Chung YS, et al. Comparative Cardiometabolic Risk of Antipsychotics in Children, Adolescents and Young Adults. Eur Child Adolesc Psychiatry. 2020 May 29; PubMed PMID: 32472205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative cardiometabolic risk of antipsychotics in children, adolescents and young adults. AU - Chung,Ying-Shan, AU - Shao,Shih-Chieh, AU - Chi,Mei-Hong, AU - Lin,Swu-Jane, AU - Su,Chien-Chou, AU - Kao Yang,Yea-Huei, AU - Yang,Yen-Kuang, AU - Lai,Edward Chia-Cheng, Y1 - 2020/05/29/ PY - 2019/11/10/received PY - 2020/05/13/accepted PY - 2020/5/31/entrez KW - Adolescents KW - Antipsychotics KW - Cardiometabolic risk KW - Children KW - Comparative risk JF - European child & adolescent psychiatry JO - Eur Child Adolesc Psychiatry N2 - Understanding different cardiometabolic safety profiles of antipsychotics helps avoid unintended outcomes among young patients. We conducted a population-based study to compare cardiometabolic risk among different antipsychotics in children, adolescents and young adults. From Taiwan's National Health Insurance Database, 2001-2013, we identified two patient cohorts aged 5-18 (children and adolescents) and 19-30 (young adults), diagnosed with psychiatric disorders and newly receiving antipsychotics, including haloperidol and sulpiride, and second generation antipsychotics (SGA, including olanzapine, quetiapine, risperidone, amisulpride, aripiprazole, paliperidone, and ziprasidone). Risperidone users were considered the reference group. We analyzed electronic medical records from seven hospitals in Taiwan and confirmed findings with validation analyses of identical design. Primary outcomes were composite cardiometabolic events, including type 2 diabetes mellitus, hypertension, dyslipidemia, and major adverse cardiovascular events. Multivariable Cox proportional hazards regression models compared cardiometabolic risk among antipsychotics. Among 29,030 patients aged 5-18 and 50,359 patients aged 19-30 years, we found 1200 cardiometabolic event cases during the total follow-up time of 37,420 person-years with an incidence of 32.1 per 1000 person-years. Compared to risperidone, olanzapine was associated with a significantly higher risk of cardiometabolic events in young adults (adjusted hazard ratio, 1.57; 95% CIs 1.13-2.18) but not in children and adolescents (1.85; 0.79-4.32). Specifically, we found young adult patients receiving haloperidol (1.52; 1.06-2.20) or olanzapine (1.75; 1.18-2.61) had higher risk of hypertension compared with risperidone users. Results from validation analyses concurred with main analyses. Antipsychotics' various risk profiles for cardiometabolic events merit consideration when selecting appropriate regimes. Due to cardiometabolic risk, we suggest clinicians may consider to select alternative antipsychotics to olanzapine in children, adolescents and young adults. SN - 1435-165X UR - https://www.unboundmedicine.com/medline/citation/32472205/Comparative_cardiometabolic_risk_of_antipsychotics_in_children,_adolescents_and_young_adults L2 - https://dx.doi.org/10.1007/s00787-020-01560-1 DB - PRIME DP - Unbound Medicine ER -
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