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Antipsychotics for Dementia Associated With More Adverse Outcomes Than Previously Thought
Antipsychotic use in patients with dementia is associated with an increased risk for a handful of serious adverse outcomes, including pneumonia, acute kidney injury, venous thromboembolism, and stroke, according to a study published in The BMJ.
“The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment,” wrote corresponding author Pearl LH Mok, PhD, of the University of Manchester in England, and study coauthors.
The study included 35,339 patients with dementia prescribed a new antipsychotic between January 1998 and May 2018. Each patient was matched with as many as 15 other patients with dementia who were not prescribed antipsychotics.
The average patient age at dementia diagnosis was 82 years. Risperidone, quetiapine, haloperidol, and olanzapine were the most frequently prescribed antipsychotics in the study population.
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Antipsychotic use, compared with non-use, was associated with an increased risk for pneumonia (researchers reported a hazard ratio of 2.19), acute kidney injury (1.72), venous thromboembolism (1.62), stroke (1.61), fracture (1.43), myocardial infarction (1.28), and heart failure (1.27), according to the study. No increased risk was found for ventricular arrhythmia.
In the 90 days after antipsychotic initiation, the cumulative incidence of pneumonia was 4.48% in patients prescribed antipsychotics compared with 1.49% in patients not prescribed antipsychotics, researchers reported. At 12 months, rates rose to 10.41% for antipsychotic users compared with 5.63% for nonusers.
Risks were highest over the first week of treatment for the majority of adverse outcomes, the study showed.
“Antipsychotic use is associated with a wide range of serious adverse outcomes in people with dementia, with relatively large absolute risks of harm for some outcomes. These risks should be considered in future regulatory decisions, alongside cerebrovascular events and mortality,” researchers wrote. “Any potential benefits of antipsychotic treatment need to be weighed against risk of serious harm, and treatment plans should be reviewed regularly.”
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