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Some Antipsychotics Linked To Elevated Pneumonia Risk
Pneumonia in patients with schizophrenia is associated with the use of specific antipsychotics, according to study findings published in JAMA Psychiatry.
“Significantly higher risks were detected for clozapine (≥180 mg/d), quetiapine (≥440 mg/d), and olanzapine (≥11 mg/d),” wrote first author Jurjen J. Luykx, MD, PhD, of Amsterdam University Medical Center, Amsterdam, the Netherlands, and study coauthors.
The cohort study included 61,889 patients with schizophrenia or schizoaffective disorder identified in Finnish registers between 1972 and 2014. Researchers investigated whether hospitalization for incident pneumonia was associated with specific antipsychotics, antipsychotic polytherapy, antipsychotic dosing, or antipsychotic receptor binding properties.
Over 22 years of follow-up, 14.4% of patients were hospitalized for pneumonia, and 12.8% died within 30 days of admission, the study found.
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Antipsychotic monotherapy, but not polytherapy, was associated with an increased risk of pneumonia hospitalization in a dose-dependent manner compared with no antipsychotic use, according to the study.
Anticholinergic burden, too, was associated with increased risk of pneumonia. Researchers reported a 1.26 adjusted hazard ratio for pneumonia with the use of antipsychotics with a high anticholinergic burden.
For specific antipsychotic drugs, adjusted hazard ratios for pneumonia were 1.78 for high-dose quetiapine, 1.44 for high-dose clozapine, 1.43 for medium-dose clozapine, and 1.29 for high-dose olanzapine, the study found.
“Results of this cohort study suggest that in patients with schizophrenia, antipsychotic agents associated with pneumonia include not only clozapine (at dosages ≥180 mg/d) but also quetiapine (≥440 mg/d) and olanzapine (≥11 mg/d). Moreover, monotherapy antipsychotics and antipsychotics with high anticholinergic burden are associated with increased pneumonia risk in a dose-dependent manner,” researchers wrote. “These findings call for prevention strategies aimed at patients with schizophrenia requiring high-risk antipsychotics.”
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