Open AccessAdverse Outcomes Associated With Off-Label Agents Used to Treat Dementia Patients With Psychosis: A Case-Control Medicare Database Study
Author(s) -
Nazia Rashid,
James B. Wetmore,
Muna Irfan,
Victor Abler
Publication year - 2022
Publication title -
american journal of alzheimer's disease and other dementias
Language(s) - English
Resource type - Journals
eISSN - 1938-2731
pISSN - 1533-3175
DOI - 10.1177/15333175221081374
Subject(s) - medicine , divalproex , dementia , antipsychotic , odds ratio , extrapyramidal symptoms , adverse effect , psychosis , atypical antipsychotic , bipolar disorder , psychiatry , pediatrics , schizophrenia (object oriented programming) , disease , mood , mania
Currently, there are no Food and Drug Administration-approved therapies to treat dementia-related psychosis (DRP). This study investigated the association between using antipsychotics and the anticonvulsant divalproex (sodium valproate) to manage DRP and adverse outcomes.Methods A retrospective case/control matching study evaluated the risk of mortality, extrapyramidal symptoms (EPS), ischemic stroke, and cardiac arrest/ventricular arrhythmia (CA/VA) with ever-use of antipsychotics/divalproex in patients with DRP vs never-use.Results 49 509 patients were included; 76.8% used an antipsychotic/divalproex. Treatment ever-use was associated with an increased risk of all-cause mortality (odds ratio, 1.14; 95% CI, 1.10-1.18) and a smaller increase in the risk of EPS (1.10; 1.00-1.19) relative to never-use (adjusted for matching demographic variables, comorbid conditions, and disability) .Conclusions Current agents used for DRP were associated with increased risk of death and adverse outcomes. An increased risk of death was evident within 3 months of antipsychotic/divalproex initiation and persisted with long-term use.