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Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.

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Title: Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.
Authors: Poulos, Jason (AUTHOR), Normand, Sharon-Lise T. (AUTHOR), Zelevinsky, Katya (AUTHOR), Newcomer, John W. (AUTHOR), Agniel, Denis (AUTHOR), Abing, Haley K. (AUTHOR), Horvitz-Lennon, Marcela (AUTHOR)
Source: Psychological Medicine. Dec2023, Vol. 53 Issue 16, p7677-7684. 8p.
Subjects: Mortality risk factors, Drug therapy for schizophrenia, Confidence intervals, Race, Retrospective studies, Type 2 diabetes, Risk assessment, Research funding, Sensitivity & specificity (Statistics), Antipsychotic agents, Longitudinal method, Disease risk factors, Adults
Geographic Terms: United States
Abstract: Background: Individuals with schizophrenia exposed to second-generation antipsychotics (SGA) have an increased risk for diabetes, with aripiprazole purportedly a safer drug. Less is known about the drugs' mortality risk or whether serious mental illness (SMI) diagnosis or race/ethnicity modify these effects. Methods: Authors created a retrospective cohort of non-elderly adults with SMI initiating monotherapy with an SGA (olanzapine, quetiapine, risperidone, and ziprasidone, aripiprazole) or haloperidol during 2008–2013. Three-year diabetes incidence or all-cause death risk differences were estimated between each drug and aripiprazole, the comparator, as well as effects within SMI diagnosis and race/ethnicity. Sensitivity analyses evaluated potential confounding by indication. Results: 38 762 adults, 65% White and 55% with schizophrenia, initiated monotherapy, with haloperidol least (6%) and quetiapine most (26·5%) frequent. Three-year mortality was 5% and diabetes incidence 9.3%. Compared with aripiprazole, haloperidol and olanzapine reduced diabetes risk by 1.9 (95% CI 1.2–2.6) percentage points, or a 18.6 percentage point reduction relative to aripiprazole users' unadjusted risk (10.2%), with risperidone having a smaller advantage. Relative to aripiprazole users' unadjusted risk (3.4%), all antipsychotics increased mortality risk by 1.1–2.2 percentage points, representing 32.4–64.7 percentage point increases. Findings within diagnosis and race/ethnicity were generally consistent with overall findings. Only quetiapine's higher mortality risk held in sensitivity analyses. Conclusions: Haloperidol's, olanzapine's, and risperidone's lower diabetes risks relative to aripiprazole were not robust in sensitivity analyses but quetiapine's higher mortality risk proved robust. Findings expand the evidence on antipsychotics' risks, suggesting a need for caution in the use of quetiapine among individuals with SMI. [ABSTRACT FROM AUTHOR]
Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.
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  Data: <searchLink fieldCode="AR" term="%22Poulos%2C+Jason%22">Poulos, Jason</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Normand%2C+Sharon-Lise+T%2E%22">Normand, Sharon-Lise T.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zelevinsky%2C+Katya%22">Zelevinsky, Katya</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Newcomer%2C+John+W%2E%22">Newcomer, John W.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Agniel%2C+Denis%22">Agniel, Denis</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Abing%2C+Haley+K%2E%22">Abing, Haley K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Horvitz-Lennon%2C+Marcela%22">Horvitz-Lennon, Marcela</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Psychological+Medicine%22">Psychological Medicine</searchLink>. Dec2023, Vol. 53 Issue 16, p7677-7684. 8p.
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  Data: Background: Individuals with schizophrenia exposed to second-generation antipsychotics (SGA) have an increased risk for diabetes, with aripiprazole purportedly a safer drug. Less is known about the drugs' mortality risk or whether serious mental illness (SMI) diagnosis or race/ethnicity modify these effects. Methods: Authors created a retrospective cohort of non-elderly adults with SMI initiating monotherapy with an SGA (olanzapine, quetiapine, risperidone, and ziprasidone, aripiprazole) or haloperidol during 2008–2013. Three-year diabetes incidence or all-cause death risk differences were estimated between each drug and aripiprazole, the comparator, as well as effects within SMI diagnosis and race/ethnicity. Sensitivity analyses evaluated potential confounding by indication. Results: 38 762 adults, 65% White and 55% with schizophrenia, initiated monotherapy, with haloperidol least (6%) and quetiapine most (26·5%) frequent. Three-year mortality was 5% and diabetes incidence 9.3%. Compared with aripiprazole, haloperidol and olanzapine reduced diabetes risk by 1.9 (95% CI 1.2–2.6) percentage points, or a 18.6 percentage point reduction relative to aripiprazole users' unadjusted risk (10.2%), with risperidone having a smaller advantage. Relative to aripiprazole users' unadjusted risk (3.4%), all antipsychotics increased mortality risk by 1.1–2.2 percentage points, representing 32.4–64.7 percentage point increases. Findings within diagnosis and race/ethnicity were generally consistent with overall findings. Only quetiapine's higher mortality risk held in sensitivity analyses. Conclusions: Haloperidol's, olanzapine's, and risperidone's lower diabetes risks relative to aripiprazole were not robust in sensitivity analyses but quetiapine's higher mortality risk proved robust. Findings expand the evidence on antipsychotics' risks, suggesting a need for caution in the use of quetiapine among individuals with SMI. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1017/S0033291723001502
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      – Code: eng
        Text: English
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    Subjects:
      – SubjectFull: Mortality risk factors
        Type: general
      – SubjectFull: Drug therapy for schizophrenia
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Race
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      – SubjectFull: Type 2 diabetes
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      – SubjectFull: Sensitivity & specificity (Statistics)
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      – SubjectFull: Antipsychotic agents
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      – SubjectFull: Adults
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      – SubjectFull: United States
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      – TitleFull: Antipsychotics and the risk of diabetes and death among adults with serious mental illnesses.
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              Text: Dec2023
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              Y: 2023
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