El-Saifi N, Moyle W, Jones C, Tuffaha H
Menzies Health Institute Queensland, Griffith University, QLD, Australia.
J Clin Pharm Ther. 2016 Feb;41(1):7-18. doi: 10.1111/jcpt.12357.
Quetiapine is a second-generation antipsychotic that is commonly prescribed for a range of approved and off-label indications in older adults. However, little is known about its safety in this population. The available evidence on quetiapine safety is based on studies on second-generation antipsychotics as a group, often in the general population and for approved indications. There are no systematic reviews on the safety of quetiapine in older adults, and therefore, there is a need for systematically assessing quetiapine safety in this group of patients to establish an appropriate safety profile for this vulnerable population. The aim of this paper was to review and describe adverse drug events associated with quetiapine use in older adults.
A systematic literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched were CINAHL, PubMed, Medline, PsycInfo and the Cochrane Library.
Sixty-nine papers met the inclusion criteria. The majority of the studies (n = 36, 52%) were observational, and 11 (16%) were randomized controlled trials (RCTs). Most of the reported indications (75%) were off-label. The most commonly reported adverse events were somnolence (25-39%), dizziness (15-27%), headache (10-23%), postural hypotension (6-18%) and weight gain (11-30%). From the included RCTs, comparing quetiapine with placebo, quetiapine resulted in significantly greater cognitive impairment, higher rates of falls and injury and increased mortality in patients with parkinsonism, but not in patients with dementia. Compared with risperidone and olanzapine, quetiapine had significantly lower risk of mortality, reduced rate of cerebrovascular events, increased rate of falls and injury and less metabolic disorders compared with olanzapine, but higher metabolic disorders compared with risperidone.
This work provides full characterization of quetiapine safety in older people, which may help healthcare providers better anticipate, prevent and manage ADEs in this population.
喹硫平是一种第二代抗精神病药物，常用于老年人一系列已获批和未获批的适应症。然而，对于其在该人群中的安全性知之甚少。现有的关于喹硫平安全性的证据基于对第二代抗精神病药物作为一个整体的研究，这些研究通常在普通人群中进行，且针对已获批的适应症。目前尚无关于喹硫平在老年人中安全性的系统评价，因此，有必要系统评估该药物在这组患者中的安全性，以便为这一脆弱人群建立合适的安全性概况。本文的目的是回顾和描述与老年人使用喹硫平相关的药物不良事件。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统的文献检索。检索的数据库包括CINAHL、PubMed、Medline、PsycInfo和Cochrane图书馆。
69篇论文符合纳入标准。大多数研究（n = 36，52%）为观察性研究，11篇（16%）为随机对照试验（RCT）。报告的大多数适应症（75%）为未获批适应症。最常报告的不良事件为嗜睡（25 - 39%）、头晕（15 - 27%）、头痛（10 - 23%）、体位性低血压（6 - 18%）和体重增加（11 - 30%）。在纳入的RCT中，将喹硫平与安慰剂进行比较，喹硫平导致认知障碍显著更严重、帕金森病患者跌倒和受伤率更高以及死亡率增加，但在痴呆患者中并非如此。与利培酮和奥氮平相比，喹硫平的死亡率风险显著更低，脑血管事件发生率降低，跌倒和受伤率增加，与奥氮平相比代谢紊乱更少，但与利培酮相比代谢紊乱更多。
本研究全面描述了喹硫平在老年人中的安全性，这可能有助于医疗保健提供者更好地预测、预防和管理该人群中的药物不良事件。
