HEALTH NEWS

Study Title:

Pneumonia Risk and Antipsychotic Drug Use

Study Abstract

Background: According to safety alerts from the U.S. Food and Drug Administration, pneumonia is one of the most frequently reported causes of death in elderly patients with dementia who are treated with antipsychotic drugs. However, epidemiologic evidence of the association between antipsychotic drug use and pneumonia is limited.

Objective: To evaluate whether typical or atypical antipsychotic use is associated with fatal or nonfatal pneumonia in elderly persons.

Design: Population-based, nested case–control study.

Setting: Dutch Integrated Primary Care Information database.

Patients: Cohort of persons who used an antipsychotic drug, were 65 years or older, and were registered in the IPCI database from 1996 to 2006. Case patients were all persons with incident community-acquired pneumonia. Up to 20 control participants were matched to each case patient on the basis of age, sex, and date of onset.

Measurements: Risk for fatal or nonfatal community-acquired pneumonia with atypical and typical antipsychotic use. Antipsychotic exposure was categorized by type, timing, and daily dose, and the association with pneumonia was assessed by using conditional logistic regression.

Results: 258 case patients with incident pneumonia were matched to 1686 control participants. Sixty-five (25%) of the case patients died in 30 days, and their disease was considered fatal. Current use of either atypical (odds ratio [OR], 2.61 [95% CI, 1.48 to 4.61]) or typical (OR, 1.76 [CI, 1.22 to 2.53]) antipsychotic drugs was associated with a dose-dependent increase in the risk for pneumonia compared with past use of antipsychotic drugs. Only atypical antipsychotic drugs were associated with an increase in the risk for fatal pneumonia (OR, 5.97 [CI, 1.49 to 23.98]).

Limitations: Antipsychotic exposure was based on prescription files. Residual confounding due to unmeasured covariates or severity of disease was possible.

Conclusion: The use of either atypical or typical antipsychotic drugs in elderly patients is associated in a dose-dependent manner with risk for community-acquired pneumonia.

From press release:

Anti-psychotic pneumonia warning
The use of anti-psychotic drugs in the elderly doubles the risk of potentially fatal pneumonia, say Dutch researchers.

A study of almost 2,000 patients found the increased risk starts soon after treatment begins and concluded that patients should be closely monitored.

An expert review published in 2009 found the drugs are overused in many cases and are responsible for up to 1,800 deaths in the UK every year.

Ministers have said they want to see a significant cut in their use.

The latest research published in the Annals of Internal Medicine compared the health records of 258 over-65s with pneumonia with 1,686 patients without the infection.

"This paper yet again gives us evidence why we should not prescribe them unless absolutely necessary," Professor Steve Field, Royal College of GPs.

Of those with pneumonia, a quarter died within a month.

When they looked at prescribed drugs, they found current use of anti-psychotics was associated with a roughly two-fold increase in the risk of pneumonia.

Those on the newer types of anti-psychotic drugs were slightly less likely to have the infection than those on the older class of drugs but were still at significant increased risk.

The risk was found to start soon after treatment and increased the higher the dose of drugs the patient was prescribed.

The researchers from Erasmus University Medical Center in Rotterdam said: "Clinicians who start treatment with anti-psychotic drugs should closely monitor patients, particularly at the start of therapy and if high doses are given."

Last year's UK review found that around 180,000 dementia patients a year are given the drugs in care homes, hospitals and their own homes to manage aggression but only around 36,000 would actually benefit from them.

Measures suggested in the report and accepted by the government included better monitoring of prescribing practices and ensuring that, where necessary, they were prescribed for short periods of time.

Professor Steve Field, chair of the Royal College of GPs said: "Anti-psychotics are prescribed too frequently without doctors thinking about the consequences.

"This paper yet again gives us evidence why we should not prescribe them unless absolutely necessary and if you do you should closely monitor the patient."

Study Information

Gianluca Trifirò, Giovanni Gambassi, Elif F. Sen, Achille P. Caputi, Vincenzo Bagnardi, Jose Brea, and Miriam C.J.M. Sturkenboom
Association of Community-Acquired Pneumonia With Antipsychotic Drug Use in Elderly Patients: A Nested Case–Control Study
Ann Intern Med April
2010 April
Erasmus University Medical Center, Rotterdam, the Netherlands