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Antipsychotics may elevate risk of short-term somatic serious adverse events

Dr Margaret Shi
10 Sep 2019

Antipsychotic causes short-term somatic serious adverse events, especially in the older patients, according to results in a recent study.

In this study, antipsychotic use was associated with an increased risk of developing somatic serious AEs (primary outcome) (odds ratio [OR], 1.24; 95 percent confidence interval [CI], 1.08 to 1.42 for minimum number of patients with at least one event and 1.10 to 1.41 for maximum, respectively). Psychiatric serious AEs, however, was not increased with antipsychotics (secondary outcome) (OR, 0.64; 95 CI, 0.61 to 0.73; OR, 0.64; 95 percent CI 0.58 to 0.71 for minimum and maximum, respectively). This led to an overall 17 percent risk reduction of serious AEs (OR 0.83, 095 percent CI 0.77 to 0.89) with antipsychotics. [Lancet Psychiatry 2019;6:753-765]

Further analysis demonstrated a higher risk of somatic serious AEs in older patients (secondary outcome) (OR, 1.56; 95 percent CI 1.22 to 1.98; OR, 1.58; 95 percent CI, 1.25 to 1.99 for minimum and maximum, respectively). Similar findings were also shown in children or adolescents (<18 years) though evidence less certain (OR 1.49, 95 percent CI; 0.81 to 2.75; OR 1.54, 95 percent CI, 0.85 to 2.77 for minimum and maximum, respectively).

The systematic review and meta-analysis analyzed 597 studies with 314 studies (mostly sponsored 3 months double blinded trials) of 67, 642 patients constituted the main dataset. Trials without limitations in population, dosing regimen, blinding status, duration, or publication year were included, with 5 percent of them rated at high risk of bias on serious AEs. Majority of the patients were adults (age, 18-65 years) with 8 percent older patients (>65 years) and mainly presented with schizophrenia (42 percent) and bipolar disorder (30 percent). Among all, olanzapine (17 percent) was the most frequently used drug. Serious AEs were classified according to the Medical Dictionary for Regulatory Activities and serious AEs of psychiatric disorders were considered based on the System Organ Class.

Observational studies in the past showed the association between antipsychotics and several serious physical disorders possibly arising from acutely occurring side-effects, whereby a serious AE is defined as any untoward medical occurrence at any dose that results in death, is life-threatening, and requires inpatient hospitalization or prolongation of existing hospitalization, resulting in persistent or significant disability [World Psychiatry 2015;14:119-36]. 

Clinicians should, therefore, be wary of the potential toxicity associated with antipsychotic, especially those who are vulnerable, particularly older patients, and possibly children and adolescents.

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Most Read Articles
Roshini Claire Anthony, 11 Sep 2019

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Elvira Manzano, 4 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 5 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
14 Sep 2019
In type 2 diabetes patients taking sulfonylureas, hypoglycaemia duration is longer at night and is inversely correlated with the level of glycated haemoglobin (HbA1c), a new study reports.