Chekani Farid, Holmes Holly M, Johnson Michael L, Chen Hua, Sherer Jeffrey T, Aparasu Rajender R
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX 77204-5047, USA.
Division of Geriatric and Palliative Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA.
Drug Healthc Patient Saf. 2020 Jan 31;12:23-30. doi: 10.2147/DHPS.S226486. eCollection 2020.
According to the 2015 American Geriatrics Society (AGS) Beers criteria, most antipsychotics are inappropriate in Parkinson's disease (PD) patients due to the risk of worsening Parkinsonian symptoms. This study examined the incidence and predictors of inappropriate antipsychotic use among long-term care residents with PD and comorbid depression.
This retrospective cohort study utilized 2007-2009 Minimum Data Set (MDS) linked to Chronic Condition Warehouse (CCW) Medicare data files involving patients with PD and comorbid depression. Using a 12-month baseline and a 24-month follow-up, the study examined incidence of inappropriate atypical antipsychotics, namely asenapine, brexpiprazole, iloperidone, lurasidone, olanzapine, paliperidone, risperidone, or ziprasidone as specified in the 2015 AGS Beers criteria. Appropriate atypical antipsychotic included aripiprazole, clozapine, or quetiapine. Multivariable logistic regression was used to examine various sociodemographic and clinical factors associated with inappropriate antipsychotic use in PD based on the Andersen Behavioral Model.
The incidence of atypical antipsychotic use was 17.50% (13,352/76,294) among PD patients over a 2-year follow-up. The percentage of inappropriate use among atypical antipsychotic users was 36.32%. The likelihood of inappropriate antipsychotic use was higher for patients who had dementia (OR=1.22, 95% CI: 1.12-1.33) or Chronic Obstructive Pulmonary Disease ((OR=1.13, 95% CI: 1.03-1.24). However, patients who were taking levodopa (OR=0.62, 95% CI: 0.57-0.67), dopamine agonists (OR=0.90, 95% CI: 0.82-0.98), Catechol-O-methyltransferase (COMT) inhibitors (OR=0.77, 95% CI: 0.68-0.86), Monoamine Oxidase (MAO) inhibitors type B (OR=0.72, 95% CI: 0.60-0.86), or amantadine (OR=0.84, 95% CI: 0.71-0.98) were less likely to receive inappropriate antipsychotics.
More than one-third of PD patients used inappropriate antipsychotics among those who were treated with atypical antipsychotic medications. Various socio-demographics and clinical factors were associated with inappropriate antipsychotic use in older patients with PD. Concerted efforts are needed to reduce inappropriate atypical antipsychotic use among PD patients.
根据2015年美国老年医学会（AGS）的Beers标准，由于存在使帕金森病（PD）患者帕金森症状恶化的风险，大多数抗精神病药物不适用于PD患者。本研究调查了患有PD且合并抑郁症的长期护理机构居民中不适当使用抗精神病药物的发生率及预测因素。
这项回顾性队列研究利用了2007 - 2009年的最小数据集（MDS），该数据集与涉及PD合并抑郁症患者的慢性病仓库（CCW）医疗保险数据文件相关联。以12个月为基线期，24个月为随访期，研究调查了2015年AGS Beers标准中规定的不适当非典型抗精神病药物的发生率，即阿塞那平、布雷哌唑、伊潘立酮、鲁拉西酮、奥氮平、帕利哌酮、利培酮或齐拉西酮。适当的非典型抗精神病药物包括阿立哌唑、氯氮平或喹硫平。基于安德森行为模型，采用多变量逻辑回归分析与PD患者不适当使用抗精神病药物相关的各种社会人口统计学和临床因素。
在为期2年的随访中，PD患者中非典型抗精神病药物的使用率为17.50%（13352/76294）。非典型抗精神病药物使用者中不适当使用的比例为36.32%。患有痴呆症（OR = 1.22，95% CI：1.12 - 1.33）或慢性阻塞性肺疾病（OR = 1.13，95% CI：1.03 - 1.24）的患者使用不适当抗精神病药物的可能性更高。然而，正在服用左旋多巴（OR = 0.62，95% CI：0.57 - 0.67）、多巴胺激动剂（OR = 0.90，95% CI：0.82 - 0.98）、儿茶酚 - O - 甲基转移酶（COMT）抑制剂（OR = 0.77，95% CI：0.68 - 0.86）、单胺氧化酶（MAO）B型抑制剂（OR = 0.72，95% CI：0.60 - 0.86）或金刚烷胺（OR = 0.84，95% CI：0.71 - 0.98）的患者接受不适当抗精神病药物治疗的可能性较小。
在接受非典型抗精神病药物治疗的PD患者中，超过三分之一使用了不适当的抗精神病药物。各种社会人口统计学和临床因素与老年PD患者不适当使用抗精神病药物有关。需要共同努力减少PD患者中不适当的非典型抗精神病药物的使用。
