Patient Characteristics and Initial Prescribing Patterns of Atypical Antipsychotics in Mentally Retarded Adults

Aims and MethodTo compare current prescribing practice for psychotic and behavioural symptoms in dementia with the available research. An anonymous questionnaire was sent to all members of the Faculty of Old Age Psychiatry, enquiring about preferred drug treatments.ResultsClassical antipsychotics were chosen by 50% for psychotic symptoms over atypical antipsychotics (43%) and were preferred for aggression (48%) and sexual disinhibition (55%). Antidepressants were favoured in treating anxiety (41%) and lability (45%).Clinical ImplicationsAlternatives to classical antipsychotics, especially for behavioural symptoms, have yet to be researched satisfactorily. In view of the continued widespread use of classical antipsychotics and recent concerns about their safety, we call for this to be addressed.

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Patient Characteristics and Prescribing Patterns for Patients Approved and Denied PCSK9 Inhibitors in Real-World Practice

Journal of Clinical Lipidology ◽

10.1016/j.jacl.2019.04.064 ◽

2019 ◽

Vol 13 (3) ◽

pp. e38

Author(s):

Alexander Blake Smith ◽

Drew Johnson ◽

Kumar Sarkar ◽

Alissa Connelly ◽

Dean Karalis

Keyword(s):

Real World ◽

Patient Characteristics ◽

Prescribing Patterns ◽

Pcsk9 Inhibitors

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Introduction of Leukotriene Receptor Antagonists in Manitoba

Canadian Respiratory Journal ◽

10.1155/2006/724167 ◽

2006 ◽

Vol 13 (2) ◽

pp. 94-98 ◽

Cited By ~ 1

Author(s):

C Macie ◽

K Wooldrage ◽

J Manfreda ◽

NR Anthonisen

Keyword(s):

Inhaled Corticosteroids ◽

Patient Characteristics ◽

Prescribing Patterns ◽

Chronic Obstructive ◽

Receptor Antagonists ◽

Obstructive Pulmonary Disease ◽

Physician Visits ◽

Leukotriene Receptor Antagonists ◽

Leukotriene Receptor ◽

Health Database

Patient characteristics and prescribing patterns during the introduction of leukotriene receptor antagonists (LTRA) in Manitoba are described using the provincial health database. Residents of Manitoba with asthma, chronic obstructive pulmonary disease, bronchitis or claims for respiratory medications were identified. Six thousand forty-one of 160,626 (3.8%) patients received LTRA; the likelihood of receiving LTRA increased if a patient was younger than 15 years, lived in a rural locale, had asthma, had frequent physician visits or used inhaled corticosteroids. Subsequent prescriptions (68%) were associated with the number of physician visits and inhaled corticosteroid use, which were thought to be indexes of severity. Patients, especially children, who received more than five prescriptions showed evidence of increased asthma control, but there was little evidence of benefit in less selected patient groups due, at least in part, to poor compliance with all respiratory drugs.

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Risperidone treatment in elderly patients with dementia: relative risk of cerebrovascular events versus other antipsychotics

International Psychogeriatrics ◽

10.1017/s1041610205002280 ◽

2005 ◽

Vol 17 (4) ◽

pp. 617-629 ◽

Cited By ~ 59

Author(s):

Sanford Finkel ◽

Chris Kozma ◽

Stacey Long ◽

Andrew Greenspan ◽

Ramy Mahmoud ◽

...

Keyword(s):

Elderly Patients ◽

Atypical Antipsychotics ◽

Reference Group ◽

Wide Spectrum ◽

Patient Characteristics ◽

Antipsychotic Treatment ◽

Cerebrovascular Events ◽

Increased Risk ◽

Significant Difference ◽

Treatment Alternatives

Background:The possibility that low-dose antipsychotic treatment is associated with increased risk of cerebrovascular events (CVEs) in elderly patients with dementia has been raised. The objective was to determine whether risperidone is associated with an increased risk of CVEs relative to other commonly considered alternative treatments.Methods:An analysis of Medicaid data from 1999 to 2002, representing approxi-mately 8 million enrollees from multiple states, was conducted. The primary outcome was the incidence of acute inpatient admission for a CVE within 3 months following initiation of treatment with atypical antipsychotics (risperidone, olanzapine, quetiapine, or ziprasidone), haloperidol, or benzo-diazepines.Results:Descriptive analyses found similar rates of incident CVEs across evaluated agents. Multivariate analyses found no differences in comparisons of risperidone with olanzapine or quetiapine. Risperidone and other antipsychotics as a group were also not associated with a higher odds ratio (OR) of incident CVE than either haloperidol or benzodiazepines. With risperidone as the reference group: olanzapine, OR=1.05, 95% CI 0.63–1.73; quetiapine, OR=0.66, 95% CI 0.23–1.87; haloperidol, OR=1.91, 95% CI 1.02–3.60; benzodiazepines, OR=1.97, 95% CI 1.30–2.98. With benzodiazepines as the reference group, the OR of incident CVE for all antipsychotics as a class was 0.49, 95%CI 0.35–0.69.Conclusions:This study found no significant difference in the incidence of CVEs between patients taking risperidone and those taking other atypical antipsychotics. Risperidone and all atypical antipsychotics were not associated with higher risk than two common treatment alternatives (haloperidol and benzodiazepines). These findings do not support the conclusion that risperidone is associated with a higher risk of CVE than other available treatment alternatives. The data also suggest that patient characteristics other than antipsychotic use are more significant predictors of CVEs. Given the relatively low rates of incident CVEs, a larger sample of patients with groups closely balanced on a wide spectrum of potential risk factors could provide a more precise assessment of risk.

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Costi ed effetti di Risperidone Long Acting (RLA) rispetto ad antipsicotici atipici nel trattamento dei soggetti schizofrenici in Italia

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v5i1.782 ◽

2004 ◽

Vol 5 (1) ◽

pp. 5-11 ◽

Cited By ~ 5

Author(s):

Lorenzo G. Mantovani ◽

Patrizia Berto ◽

Anna D. Ausilio ◽

Bart Heeg

Keyword(s):

Atypical Antipsychotics ◽

Transition Probabilities ◽

Discrete Event ◽

Group Analysis ◽

Patient Characteristics ◽

Time Dependent ◽

Sensitivity Analyses ◽

Cumulative Score ◽

Dependent Variables ◽

Long Acting

Objective: to estimate the costs and effects of long-acting risperidone (LAR) in the treatment of schizophrenic patients in Italy, as compared to conventional and oral atypical antipsychotics. Methods: a discrete event model was used. The model simulates patients. history for every single therapeutic alternative and selects incident events, on the basis of pre-defined probability distribution-powered, randomized repetitions. The model operates on two types of parameters: patient characteristics and time-dependent variables. Patient characteristics (age, sex, illness profile and severity, probability of incurring in an adverse event and potential dangerousness) remain fixed during the 5 simulated years. Time-dependent variables are subject to changes and include outpatient visits, severity of psychotic episodes, symptom-scores, compliance, incidence of adverse effects, site of treatment and dangerousness. Three treatments have been selected: scenario 1 begins with LAR, switches to olanzapine and then to clozapine; scenario 2 starts with olanzapine, switches to oral risperidone and ends with clozapine. Direct medical costs have been computed on the basis of psychiatric visits, drug costs and costs of the institution in which the patient is treated (hospital, rehabilitation clinic, etc.) Outcome measures were number of psychotic episodes in 5 years, total time spent during these episodes and cumulative score of positive and negative symptoms at 5 years. Information on alternatives, transition probabilities, model structure and health resources utilization were derived from the literature and from a panel of experts. Results: it has been estimated that LAR is economically dominant (more effective at lower cost) respect to oral atypical antipsychotics, being able to prevent 0.87 psychotic episodes per patient, with a net cost saving of 4,773 euro per patient. Sub-group analysis indicate that LAR is always more effective than the considered alternatives and, in general, also less costly than oral atypical antipsychotics. Sensitivity analyses confirmed the robustness of the model to several variations of key parameters. Conclusions: LAR therapy dominates oral atypical antipsychotics.

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Cost Comparison of Atypical Antipsychotics: Paliperidone ER and Risperidone

Hospital Pharmacy ◽

10.1177/0018578718809269 ◽

2018 ◽

Vol 54 (6) ◽

pp. 389-392

Author(s):

Kiranjit Luther ◽

Guang Mei Fung ◽

Farah Khorassani

Keyword(s):

Drug Utilization ◽

Atypical Antipsychotics ◽

Cost Savings ◽

Cost Comparison ◽

Prescribing Patterns ◽

Utilization Review ◽

Drug Utilization Review ◽

Potential Cost ◽

Therapy Cost ◽

The Cost

Purpose: Paliperidone and risperidone are atypical antipsychotics that are structurally and therapeutically similar. Risperidone is metabolized by the liver via cytochrome (CYP) 2D6 to an active metabolite, 9-hydroxyrisperidone. The atypical antipsychotic paliperidone is 9-hydroxyrisperidone formulated separately as an extended-release (ER) tablet and is considerably more expensive than risperidone. The purpose of this retrospective drug utilization review is to evaluate the prescribing patterns of paliperidone ER and evaluate potential cost savings by converting paliperidone ER orders to risperidone at an inpatient psychiatric hospital’s formulary. Methods: This retrospective drug utilization review includes 100 patients, older than 18 years old, who were prescribed oral paliperidone ER at an inpatient, psychiatric hospital between January 1, 2017, and June 2, 2017. The data were collected through the electronic medical records. Patients who were prescribed oral paliperidone ER and refused to take paliperidone ER were excluded from the study population. The cost of each patient’s oral paliperidone ER pharmacotherapy was calculated using average wholesale prices. An equivalent total dose of risperidone therapy was calculated using a 2:3 paliperidone ER to risperidone conversion. The cost savings were then analyzed by comparing the total costs of paliperidone ER with risperidone therapy. Results: The results indicate that from January through June 2017, approximately 68% of all paliperidone ER utilization was for its approved indication of schizophrenia and schizoaffective disorder. The other 32% of utilization was either off-label or for approved indications of risperidone. The total paliperidone ER therapy cost for 100 patients was approximately $17 000, while the cost of risperidone therapy would be approximately $400 for the same patients over 6 months. Overall, this would provide an estimated cost savings of over $33 000 per year or about $169 in savings per patient. Conclusion: The study analysis demonstrates that there are opportunities for cost savings through therapeutic interchange of paliperidone ER to risperidone.

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