Off-Label Use of Atypical Antipsychotics: An Update
Adverse Effects in Elderly Patients: Placebo Comparisons (1 of 3)
A previously published meta-analysis combined the results from 15 placebo comparisons of aripiprazole, olanzapine, quetiapine, and risperidone comprising a total of 5,204 patients. The investigators found that, when compared with placebo, the risk of death in elderly patients (65 and older) with dementia was elevated during treatment with atypical antipsychotics. For every 100 patients, over a 10- to 12-week course of treatment, 1 death is attributable to the atypical antipsychotic. The strength of evidence for this finding is high.
Typical antipsychotics are also associated with an increased risk of death among dementia patients, as revealed in a review of the literature reporting observational studies that was performed as part of the comparative effectiveness review. Twelve studies with a total of 310,752 patients were reviewed and found to demonstrate that there is an elevated risk of death with both atypical and typical antipsychotics when used to treat patients with dementia. The strength of evidence for this finding is moderate.
Keywords: antipsychotics | atypical antipsychotics | off-label | second generation | dementia | mortality rate
- Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934-43. PMID: 16234500.
- Maglione M, Ruelaz Maher A, Hu J, et al. Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Review No. 43 (Prepared by the Southern California RAND Evidence-based Practice Center under Contract No. HHSA 290-2007-10062-I). Rockville, MD: Agency for Healthcare Research and Quality; September 2011. AHRQ Publication No. 11(12)-EHC087-EF. Available at www.effectivehealthcare.ahrq.gov/offlabelantipsych.cfm.
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