Purpose
A 2003 FDA advisory warned of increased hyperlipidemia and diabetes risk for patients taking second-generation antipsychotics (SGAs). Following the advisory a professional society consensus statement provided treatment recommendations and stratified SGAs into high, intermediate, and low metabolic risk. We examine subsequent changes in incident and prevalent SGA use among individuals with severe mental illness.
Methods
Retrospective, observational study using Florida Medicaid’s claims from 2001–2006. We include non-Medicare eligible adults with bipolar disorder or schizophrenia who filled a SGA prescription. Among prevalent users we assess changes in overall and agent-specific use; discontinuations; interruptions; and therapeutic alternative use; among incident users, agent-specific use. Pre-advisory utilization was compared with utilization initially following the advisory and two subsequent periods.
Results
Among prevalent users, overall SGA use declined slightly and no increases in treatment interruptions or discontinuations were observed following the advisory and consensus statement publication. Compared with the pre-advisory period, in the months immediately following use of the highest metabolic-risk agent, olanzapine, decreased by 34% among prevalent users with bipolar disorder (adjusted risk ratio [aRR]=0.66; 95% confidence intervals [CI]=0.59–0.74) and 26% among prevalent users with schizophrenia (aRR=0.74, CI=0.72–0.76). A greater decline was estimated among incident users with bipolar disorder (aRR=0.37; CI=0.29–0.47) and schizophrenia (aRR=0.42; CI=0.35–0.51) during this period. During each subsequent post-advisory period, olanzapine use continued to decline while quetiapine, ziprasidone, and aripiprazole use increased.
Conclusions
The metabolic risk advisory and published consensus statement were associated with a selective reduction in olanzapine use without evidence of treatment disruptions among this population.