Rashid Nazia, Wetmore James B, Irfan Muna, Peng Yi, Abler Victor
Acadia Pharmaceuticals Inc., San Diego, California.
Division of Nephrology, Hennepin County Medical Center.
Int Clin Psychopharmacol. 2022 May 1;37(3):84-91. doi: 10.1097/YIC.0000000000000401.
Currently, no agents are approved in the USA to treat dementia-related psychosis. After failure of a nonpharmacologic approach to treatment, antipsychotics or divalproex is often prescribed. We characterized existing treatment patterns in patients with dementia-related psychosis. Medicare claims data from 2008 to 2016 were used to identify patients with dementia-related psychosis. The agents and associated dosages prescribed, time to first use, and patterns of use were evaluated for agents prescribed to treat dementia-related psychosis. In total, 49 509 patients were identified as having dementia-related psychosis. Over three-quarters (76.8%) received an antipsychotic or divalproex. The most prescribed first-line agents were quetiapine (30.5%), risperidone (19.5%), and divalproex (11.2%). More than 80% of patients received a low dose of an agent, and 65.5% switched or discontinued their first-line treatment during a mean follow-up period of 1.8 years. In the absence of US FDA-approved therapies to treat dementia-related psychosis, treatment after behavioral intervention involves frequent use of low-dose antipsychotics or divalproex. The high rate of treatment switching or discontinuation is consistent with current treatment guidelines and suggests a need for an improved, standardized pharmacological approach to treat dementia-related psychosis.
目前，美国尚无获批用于治疗痴呆相关精神病的药物。在非药物治疗方法失败后，常开具抗精神病药物或丙戊酸镁。我们对痴呆相关精神病患者现有的治疗模式进行了特征描述。利用2008年至2016年的医疗保险理赔数据来识别痴呆相关精神病患者。对开具用于治疗痴呆相关精神病的药物的使用药物及相关剂量、首次使用时间和使用模式进行了评估。总共识别出49509例患有痴呆相关精神病的患者。超过四分之三（76.8%）的患者接受了抗精神病药物或丙戊酸镁治疗。最常开具的一线药物是喹硫平（30.5%）、利培酮（19.5%）和丙戊酸镁（11.2%）。超过80%的患者接受低剂量药物治疗，在平均1.8年的随访期内，65.5%的患者更换或停用了一线治疗药物。在没有美国食品药品监督管理局批准的治疗痴呆相关精神病的疗法的情况下，行为干预后的治疗频繁使用低剂量抗精神病药物或丙戊酸镁。治疗更换或停药的高发生率与当前治疗指南一致，并表明需要一种改进的、标准化的药物治疗方法来治疗痴呆相关精神病。
