Atypical Antipsychotics Increase Mortality in Older Adults With Dementia - The Diigo Meta page

• 04 Jun 08
  

  Dr Green
  • use of atypical antipsychotics to treat elderly patients with dementia was associated with an increased risk for death compared with placebo.... The mortality rate was approximately 1.6 to 1.7 times higher than with placebo and was greater with antipsychotics than with placebo in 15 of the 17 trials reviewed by the U.S. FDA
  • Compared with use of atypical antipsychotic drugs, use of conventional antipsychotic drugs was associated with a higher risk for death at all time points.
  • Unmeasured confounders increasing the risk for death could decrease or abolish the observed associations, according to the results of sensitivity analysis.
  • diagnosis of dementia and a new prescription for antipsychotic drugs
  • Excluded were those with other psychotic disorders
  • Mean age was 83 years,
  • • In the community-dwelling cohort, atypical antipsychotic drug users started treatment with risperidone (75%), olanzapine (20%), and quetiapine (5%).
      
    • Conventional antipsychotic drug users started treatment with haloperidol (60%), loxapine (18%), and thioridazine (10%).
  • New users of atypical antipsychotic drugs were significantly more likely to die at 30 days vs those who did not use antipsychotic drugs (community dwelling: adjusted HR, 1.31; absolute risk difference, 0.2 percentage point; long-term care: adjusted HR, 1.55; absolute risk difference, 1.2 percentage points)
  • Use of conventional antipsychotic drugs was associated with greater risk for death vs use of atypical antipsychotic drugs, and the risk was evident at 30 days (community dwelling: adjusted HR, 1.55; long-term care: adjusted HR, 1.26).
  • risk persisted to 180 days (community dwelling: absolute risk difference, 2.6 percentage points; long-term care: absolute risk difference, 2.2 percentage points).
  • unmeasured confounder may have overestimated the risk for mortality.

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