Mortality in patients with dementia treateds with atypical antipsychotics (olanzapine, quetiapine, and ziprasidone)

Martínez Martínez, L.; Olivera Fernández, M.R.; Piñeiro Corrales, G.

doi:10.1016/S2173-5085(09)70088-7

Farmacia Hospitalaria

ISSN: 1130-6343

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The atypical antipsychotics (AA) quetiapine, olanzapine, and ziprasidone are used to treat behavioural disorders associated with dementia. This indication does not appear on their technical sheet. The object of this study is to analyse the relationship of these treatments with mortality and other factors.

Method

Retrospective study from March 2005 to July 2007 of AA treatments requested as compassionate use. We collected information on mortality, age, history of heart disease or cerebrovascular disease, and duration and number of concomitant treatments per patient.

Results

Two hundred eighty-nine patients were studied. Mortality was 31.1%. A higher mortality rate was shown for patients with a history of heart disease and in those who used olanzapine. Quetiapine was the most commonly prescribed antipsychotic drug.

Conclusions

The use of AA in the elderly could have risks that outweigh the benefits. When prescribing these drugs for at-risk patients, one should consider their safety warnings and the individual case of each patient. According to our data, olanzapine seems to be associated with a higher risk than quetiapine and ziprasidone.

Keywords:

Atypical antipsychotic agents

Quetiapine

Olanzapine

Ziprasidone

Cardiovascular risk

Cognitive defect dementia

Mortality

Adverse drug reaction

Resumen

Introducción

Los antipsicóticos atípicos (AA) quetiapina, olanzapina y ziprasidona se utilizan para el tratamiento de trastornos conductuales asociados a demencia. Esta indicación no figura en su ficha técnica. El objetivo de este estudio es analizar la relación de estos tratamientos con la mortalidad y otros factores.

Método

Estudio retrospectivo desde marzo de 2005 hasta julio de 2007 de los tratamientos de AA solicitados como uso compasivo. Se registraron datos de mortalidad, edad, antecedentes de cardiopatía o de enfermedad cerebrovascular (ECV), duración y tratamiento por paciente.

Resultados

Los pacientes estudiados fueron 289. La mortalidad fue del 31,1%. Se constató mayor mortalidad en los pacientes con antecedentes de enfermedad cardiovascular y en los que usaron olanzapina. La quetiapina fue el antipsicótico más prescrito.

Conclusiones

La utilización de AA en ancianos puede tener riesgos que superen los beneficios. Cuando se prescriben en pacientes de riesgo deben considerarse las alertas sobre su seguridad y la individualidad de cada paciente. De acuerdo con nuestros datos, la olanzapina parece entrañar un mayor riesgo que la quetiapina y la ziprasidona.

Palabras clave:

Agentes antipsicóticos atípicos

Quetiapina

Olanzapina

Ziprasidona

Riesgo cardiovascular

Demencia

Mortalidad

Reacciones adversas a medicamentos

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