Mast Gavin, Fernandes Kimberly, Tadrous Mina, Martins Diana, Herrmann Nathan, Gomes Tara
St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8 Canada.
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON Canada.
Drugs Real World Outcomes. 2016 May 13;3(2):175-182. doi: 10.1007/s40801-016-0073-6. eCollection 2016 Jun.
Antipsychotics are commonly used to manage behavioral and psychological symptoms of dementia. Concerns over their safety and efficacy in this role have resulted in antipsychotics typically being recommended for short-term usage only when used among dementia patients. However, there is little work examining the duration of antipsychotic treatment in the elderly dementia patient population.
To determine the persistence of use of antipsychotics in elderly dementia patients and the role of dose on therapy duration.
A retrospective, population-based cohort study using administrative data, including dispensing records from a provincial public drug program, from Ontario, Canada between 2009 and 2012. Elderly dementia patients newly initiated onto antipsychotics were followed until drug discontinuation, death, 2-year follow-up, or end of study. Competing risk analysis was performed to determine time to discontinuation, stratified by categories of initial dose.
After 2 years 49.1 % of the cohort ( = 22,927 of 46,695) had discontinued treatment. When stratified by dose, the high-dose group (51.1 % discontinued) discontinued more frequently than the medium- (48.7 % discontinued) and low- (47.5 % discontinued) dose groups ( < 0.0001).
Approximately half of elderly dementia patients treated with antipsychotics discontinue within 2 years, with those on higher doses more likely to discontinue. However, the number of patients remaining on therapy represents a serious public health concern.
抗精神病药物常用于治疗痴呆的行为和心理症状。对其在该用途中的安全性和有效性的担忧导致抗精神病药物通常仅在痴呆患者中短期使用时才被推荐。然而，很少有研究考察老年痴呆患者群体中抗精神病药物治疗的持续时间。
确定老年痴呆患者使用抗精神病药物的持续时间以及剂量对治疗持续时间的影响。
一项基于人群的回顾性队列研究，使用行政数据，包括2009年至2012年加拿大安大略省省级公共药物计划的配药记录。对新开始使用抗精神病药物的老年痴呆患者进行随访，直至停药、死亡、随访2年或研究结束。进行竞争风险分析以确定停药时间，并按初始剂量类别分层。
2年后，队列中的49.1%（46,695人中的22,927人）停止了治疗。按剂量分层时，高剂量组（51.1%停药）比中剂量组（48.7%停药）和低剂量组（47.5%停药）停药更频繁（P<0.0001）。
接受抗精神病药物治疗的老年痴呆患者中约有一半在2年内停药，高剂量患者更有可能停药。然而，继续接受治疗的患者数量仍是一个严重的公共卫生问题。
