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Comprehensive comparison of monotherapies for psychiatric hospitalization risk in bipolar disorders
Author(s) -
Nestsiarovich Anastasiya,
Mazurie Aurélien J,
Hurwitz Nathaniel G,
Kerner Berit,
Nelson Stuart J,
Crisanti Annette S,
Tohen Mauricio,
Krall Ronald L,
Perkins Douglas J,
Lambert Christophe G
Publication year - 2018
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12665
Subject(s) - medicine , bupropion , aripiprazole , quetiapine , bipolar disorder , relative risk , psychiatry , schizoaffective disorder , lamotrigine , venlafaxine , ziprasidone , citalopram , lithium (medication) , fluoxetine , treatment of bipolar disorder , sertraline , clozapine , schizophrenia (object oriented programming) , mania , antidepressant , anxiety , psychosis , smoking cessation , epilepsy , confidence interval , receptor , pathology , serotonin
Objectives This study compared 29 drugs for risk of psychiatric hospitalization in bipolar disorders, addressing the evidence gap on the >50 drugs used by US patients for treatment. Methods The Truven Health Analytics MarketScan ® database was used to identify 190 894 individuals with bipolar or schizoaffective disorder who filled a prescription for one of 29 drugs of interest: lithium, first‐ or second‐generation antipsychotics, mood‐stabilizing anticonvulsants, and antidepressants. Competing risks regression survival analysis was used to compare drugs for risk of psychiatric hospitalization, adjusting for patient age, sex, comorbidities, and pretreatment medications. Other competing risks were ending monotherapy and non‐psychiatric hospitalization. Results Three drugs were associated with significantly lower risk of psychiatric hospitalization than lithium: valproate (relative risk [ RR ] = 0.80, P = 3.20 × 10 −4 ), aripiprazole ( RR = 0.80, P = 3.50 × 10 −4 ), and bupropion ( RR = 0.80, P = 2.80 × 10 −4 ). Eight drugs were associated with significantly higher risk of psychiatric hospitalization: haloperidol ( RR = 1.57, P = 9.40 × 10 −4 ), clozapine ( RR = 1.52, P = .017), fluoxetine ( RR = 1.17, P = 3.70 × 10 −3 ), sertraline ( RR = 1.17, P = 3.20 × 10 −3 ), citalopram ( RR = 1.14, P = .013), duloxetine ( RR = 1.24, P = 5.10 × 10 −4 ), venlafaxine ( RR = 1.33; P = 1.00 × 10 −6 ), and ziprasidone ( RR = 1.25; P = 6.20 × 10 −3 ). Conclusions This largest reported retrospective observational study on bipolar disorders pharmacotherapy to date demonstrates that the majority of patients end monotherapy within 2 months after treatment start. The risk of psychiatric hospitalization varied almost two‐fold across individual medications. The data add to the evidence favoring lithium and mood stabilizer use in short‐term bipolar disorder management. The findings that the dopaminergic drugs aripiprazole and bupropion had better outcomes than other members of their respective classes and that antidepressant outcomes may vary by baseline mood polarity merit further investigation.