Wei Yu-Jung, Liu Xinyue, Rao Nikhil, McPherson Marie, Jones Mary Beth, Bussing Regina, Winterstein Almut G
1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy , Gainesville, Florida.
2 Department of Psychiatry, University of Florida College of Medicine , Gainesville, Florida.
J Child Adolesc Psychopharmacol. 2017 Nov;27(9):833-839. doi: 10.1089/cap.2017.0006. Epub 2017 Jul 14.
To examine incidence of adverse health outcomes and associated factors among preschoolers (under age 6) who received antipsychotic treatment through the Florida Medicaid Prior Authorization (PA) program.
Using Florida's PA registry linked to the state's Medicaid claims data, we ascertained incident outcomes during PA-approved antipsychotic use between April 2008 and September 2015 (7.5 years). Six outcomes associated with use of antipsychotics included: diabetes, obesity, hyperlipidemia, hyperprolactinemia, cardiovascular disease (CVD) (including hypertension, ventricular arrhythmia, and other CVDs), and extrapyramidal symptoms (EPS) (including dystonia, akathisia, parkinsonism, and tardive dyskinesia). Outcome-specific incidences were stratified by short-term (≤1 year) and long-term (>1-7 years) antipsychotic use. We used multivariate modified Poisson regressions to determine factors associated with these outcomes among preschoolers.
The overall crude incidence during PA-approved antipsychotic use was highest for EPS and obesity (57 and 19 cases/1000 children-years, respectively). The rate of these two outcomes differed by duration of antipsychotic use. We observed a higher obesity (23.8 vs. 9.6, p < 0.001) and dystonia incidence (7.2 vs. 2.5, p < 0.05), but lower akathisia incidence (44.4 vs. 60.6, p < 0.05) among long-term antipsychotic users compared with short-term users. Five outcomes-ventricular arrhythmia, other cardiovascular side effects, hyperprolactinemia, parkinsonism, and tardive dyskinesia-occurred rarely (<2.0/1000 children-years). Preschoolers who were younger at baseline (≤2 years old vs. 4-5 years old) and Black (vs. White) were at a higher risk of EPS.
Risk for EPS and obesity deserves clinical attention during antipsychotic treatment among preschoolers. Controlled studies that allow interpretation of these incidence rates in the context of background risk and that formally quantify the incremental risk associated with antipsychotic initiation during early childhood are needed.
研究通过佛罗里达医疗补助事先授权（PA）计划接受抗精神病药物治疗的学龄前儿童（6岁以下）不良健康结局的发生率及相关因素。
利用与该州医疗补助索赔数据相关联的佛罗里达PA登记系统，我们确定了2008年4月至2015年9月（7.5年）期间PA批准使用抗精神病药物期间的发病结局。与使用抗精神病药物相关的六种结局包括：糖尿病、肥胖、高脂血症、高泌乳素血症、心血管疾病（CVD）（包括高血压、室性心律失常和其他心血管疾病）以及锥体外系症状（EPS）（包括肌张力障碍、静坐不能、帕金森症和迟发性运动障碍）。特定结局的发生率按短期（≤1年）和长期（>1 - 7年）使用抗精神病药物进行分层。我们使用多变量修正泊松回归来确定学龄前儿童中与这些结局相关的因素。
在PA批准使用抗精神病药物期间，总体粗发病率最高的是EPS和肥胖（分别为每1000儿童年57例和19例）。这两种结局的发生率因抗精神病药物使用时长而异。我们观察到，与短期使用者相比，长期抗精神病药物使用者的肥胖发生率更高（23.8对9.6，p < 0.001），肌张力障碍发生率更高（7.2对2.5，p < 0.05），但静坐不能发生率更低（44.4对60.6，p < 0.05）。五种结局——室性心律失常、其他心血管副作用、高泌乳素血症、帕金森症和迟发性运动障碍——很少发生（<每1000儿童年2.0例）。基线时年龄较小（≤2岁对4 - 5岁）和黑人（与白人相比）的学龄前儿童发生EPS的风险更高。
在学龄前儿童抗精神病药物治疗期间，EPS和肥胖风险值得临床关注。需要进行对照研究，以便在背景风险的背景下解释这些发生率，并正式量化幼儿期开始使用抗精神病药物相关的增量风险。
