Reduction in Use of Risperidone for Dementia in Australia Following Changed Guidelines

Abstract

Background: Risperidone is the only antipsychotic approved in Australia for the management of the behavioural and psychological symptoms of dementia (BPSD). In June 2015, the Australian Government Therapeutic Goods Administration (TGA) amended the indication to restrict use in BPSD to patients with Alzheimer’s dementia for a maximum twelve-week duration. We aimed to determine whether the rate and duration of risperidone use for BPSD decreased following the regulatory changes. Methods: we conducted a study using the Australian Government Department of Veterans’ Affairs administrative claims data and Pharmaceutical Benefits Scheme (PBS) 10% sample data. We included people aged 65 years or older and compared the rate and duration of risperidone use before and after the TGA labelling changes. Results: There was a sustained decrease in the trend of risperidone use for BPSD following the TGA labelling changes, with a monthly decrease of 1.7% in the aged care population, 0.5% in the community living population and 1.5% in the general older Australian population. Overall, in the 24 months post the TGA changes the reduction in the rate of use of risperidone ranged from 20% to 28% lower than compared to what the rate would have been without the TGA changes. The median duration of use of risperidone in aged-care residents decreased from 338 days in the year prior to the TGA labelling changes, to 240 days per person in the year after the changes. Conclusion: The TGA labelling changes were associated with a significant reduction in the rate of use of risperidone for BPSD in veterans living in both the aged care and community settings, and in the general older Australian population. The labelling changes were also associated with a reduced duration of risperidone use in aged care residents, although for most people the duration of use still exceeded the recommended 12-week maximum duration.

Using data linkage for national surveillance of clinical quality indicators for dementia care among Australian aged care users

“…These rates are higher than reported in previous studies that included older people without dementia 41 and are consistent with evidence from veteran populations where a modest decrease in dispensing over time has been reported 42 . There was also little variation between geographical regions, suggesting that high rates of antipsychotic and other sedative medicine prescribing are common across most regions of Australia.…”

Medication‐related hospital admissions in aged care residents

“…Our study was conducted using administrative claims data for DVA clients (veterans and spouses), and prior research has shown that this population has comparable use of health services to other Australians of similar age and health status 32 . Seventy‐one per cent of our study population were female, which is similar to the proportion of females in aged care in other studies in the veteran population 33,34 and in the general Australian population 35…”

National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services

“…during this period. Our findings are in keeping with another population-based study which found the monthly rate of risperidone use among Australian veterans living in PRAC facilities decreased during 2012-2015, with further decreases observed immediately following changes to prescribing criteria in August 2015 47. It is important to note that data for the present study were only available to mid-2016 at the time of cohort construction and changes in the prevalence of prolonged antipsychotic use and overall duration of use may have occurred since this period.…”