Second-Generation Antipsychotics and Pneumonia-Related Hospitalizations

Milano, Victoria; Kayhart, Bryce M.; Morgan, Robert J.; DeSimone, Daniel C.; Mara, Kristin C.; Leung, Jonathan G.

doi:10.4088/pcc.20m02594

Cited by 9 publications

(5 citation statements)

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Section: Introductionmentioning

confidence: 99%

“…17,18 There is some evidence supporting the effectiveness of clozapine, 14,19 but its use is associated with an increased risk of pneumonia-related hospitalization, myocarditis, hematologic malignancies, orthostatic hypotension, syncope, neutropenia, and lifethreatening agranulocytosis. 11,[20][21][22][23] Thus, treatment with clozapine requires intensive ANC monitoring. 24 While previous studies of patients with PDP evaluated pimavanserin's relative efficacy and safety compared with other AAPs, no studies have assessed the comparative acceptability of AAPs, including pimavanserin, on a broad range of acceptability outcomes defined as discontinuations due to lack of efficacy, adverse events (AEs), and all causes.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Efficacy, Safety, and Acceptability of Pimavanserin and Other Atypical Antipsychotics for Parkinson’s Disease Psychosis: Systematic Review and Network Meta-Analysis

Yunusa

Rashid

Seyedin³

et al. 2023

J Geriatr Psychiatry Neurol

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Background The current comparative efficacy, safety, and acceptability of atypical antipsychotics (AAPs) in treating Parkinson's Disease Psychosis (PDP) are not entirely understood. Objective To evaluate comparative efficacy, safety, and acceptability of AAPs in patients with PDP. Methods We conducted a systematic review and a network meta-analysis to compare the efficacy, safety, and acceptability of pimavanserin, quetiapine, olanzapine, clozapine, ziprasidone, and risperidone. We estimated relative standardized mean differences (SMDs) for continuous outcomes and odds ratios (OR) for binary outcomes, with their respective 95% confidence intervals (CIs). Results We included 19 unique studies evaluating AAPs in a total of 1,242 persons with PDP. Based on Clinical Global Impression Scale for Severity, pimavanserin (SMD, −4.81; 95% CI, −5.39, −4.24) and clozapine (SMD, −4.25; 95% CI, −5.24, −3.26) significantly improved symptoms compared with placebo. Also, compared to placebo, pimavanserin (OR, 1.16; 95% CI, 1.07, 1.24) significantly improved psychotic symptoms based on Scale for Assessment of Positive Symptoms for Parkinson's Disease Psychosis/Hallucinations and Delusions scores. In comparison to placebo, clozapine (SMD, −0.69; 95% CI, −1.35, −0.02), pimavanserin (SMD, −0.01; 95% CI, −0.56, 0.53), and quetiapine (SMD, 0.00; 95% CI, −0.68, 0.69) did not impair motor function per Unified Parkinson's Disease Rating scale. Based on Mini-Mental State Examination scale, quetiapine (SMD, 0.60; 95% CI, 0.07, 1.14) significantly impaired cognition compared to placebo. Conclusions In patients with PDP, pimavanserin and clozapine demonstrated significant improvement in psychosis without affecting motor function. With quetiapine being associated with a significant decline in cognition and despite not impairing motor function, our findings suggest that it should be avoided in patients with PDP and reduced cognitive abilities.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy, Safety, and Acceptability of Pimavanserin and Other Atypical Antipsychotics for Parkinson’s Disease Psychosis: Systematic Review and Network Meta-Analysis

Yunusa

Rashid

Seyedin³

et al. 2023

J Geriatr Psychiatry Neurol

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“…22 Antipsychotic exposure, especially second generation antipsychotics, is associated with an increased risk of pneumonia. 23,24 Our previously published article on the systematic review and meta-analysis studying the effect of antipsychotics on respiratory function provide the evidence that FGAs are particularly associated with a lower risk for pneumonia compared to exposure to other psychotropics drugs, whereas SGAs are more significantly associated with the development of pneumonia. 25 Studies have reported the increased risk of respiratory illness, including pneumonia and respiratory failure following Benzodiazepine (BZD) usage.…”

Section: Introductionmentioning

confidence: 99%

Risk of Respiratory Diseases with Use of Psychotropic Drugs: Results of a Community-based Cross-sectional Study from South India

Eby,

Dang,

Jacob

2023

Ind. J. Pharm. Edu. Res

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Background:The study evaluated the effect of various psychotropics on pulmonary function to identify the psychotropic drug class most commonly associated with risk of respiratory disorders. Since psychotropic medications have safety concerns for usage in general population, their use in people with Coronavirus Disease (COVID-19) is considered challenging. The study may also serve to draw evidence-based practical recommendations for the treatment of people with COVID-19. Materials and Methods: A 10-item containing questionnaire was designed to capture clinical information regarding psychotropic use and respiratory disorders. Internal consistency and reproducibility were determined using Cronbach's alpha and intra-class correlation coefficient respectively. A validated questionnaire was administered to patients or caregivers at a community pharmacy setup and data was collected through electronic data capture. All captured data were summarized descriptively and statistically analyzed using R Studio 4.0. Results: Cronbach's alpha and intra-class correlation coefficient values were found to be 0.92 and 0.85 respectively. In a sample of 198 patients, benzodiazepines were the commonly used medication (43.9%) followed by selective serotonin reuptake inhibitors (21.2%), anti-psychotics (15.1%), mood stabilizers (7.6%) and others (12.2%). A statistically significant association was observed between benzodiazepine, second-generation antipsychotics, and respiratory disorders p<0.1]). However, the use of first-generation antipsychotics was found to be less associated with respiratory infections. Conclusion: Benzodiazepine and second-generation antipsychotics were found to be significantly associated with respiratory disorders. Hence patients on psychotropics should be monitored for respiratory symptoms and the choice of anti-psychotic medications should be on existing clinical evidence. The psychotropics which were found to be safer through the study can be chosen to improve the quality of psychiatric care in COVID-19 patients, also promoting an optimal management of psychiatric conditions without worsening the medical condition due to COVID-19.

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“…In these patients, hospitalization can occur due to serious adverse events (AEs) associated with AP use ( 4 , 8 – 10 ). For example, persons treated with clozapine can experience seizures, myocarditis, pneumonia, and lifethreatening agranulocytosis and may need to be hospitalized for treatment ( 1 , 3 , 4 , 11 , 12 ). Also, persons with a clinical indication for long-term AP use who do not adhere to their medications can experience acute episodes that may necessitate admission to the hospital ( 13 – 16 ).…”

Section: Introductionmentioning

confidence: 99%

Comparative Safety Signal Assessment of Hospitalization Associated With the Use of Atypical Antipsychotics

et al. 2022

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BackgroundPersons with symptoms of psychosis receiving treatment with atypical antipsychotics (AAPs) can experience serious adverse events (AEs) requiring admission to the hospital. The comparative likelihood of AE-related hospitalization following the use of all AAPs has not been fully characterized. Therefore, we evaluated the safety signals of hospitalizations associated with the use of AAPs.MethodsWe conducted a cross-sectional analysis using the FDA Adverse Event Reporting System (FAERS) database (from January 1, 2004, to December 31, 2021) to examine disproportionality in reporting hospitalizations suspected to be associated with 12 AAPs (aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, and pimavanserin, quetiapine, risperidone, and ziprasidone). Hospitalization in the FAERs database is an outcome that is recorded as a result of an AE occurring at any drug dose. We estimated reporting odds ratios (RORs) by comparing the odds of hospitalization occurring with a particular AAP to the odds of its occurrence with other drugs. In addition, we considered the presence of a significant safety signal when the lower limit of the 95% confidence interval (CI) of the ROR is >1.ResultsA total of 204,287 cases of hospitalizations were reported to the FDA for individuals treated with AAPs. There were significant safety signals of hospitalization associated with using clozapine (ROR, 2.88; 95% CI, 2.84–2.92), olanzapine (ROR, 2.61; 95% CI, 2.57–2.64), quetiapine (ROR, 1.87; 95% CI, 1.85–1.89), risperidone (ROR, 1.41; 95% CI, 1.39–1.43), aripiprazole (ROR, 1.34; 95% CI, 1.32–1.35), and ziprasidone (ROR, 1.14; 95% CI, 1.10–1.18). However, no hospitalization-related safety signals were observed with the use of paliperidone, pimavanserin, iloperidone, asenapine, lurasidone, and brexpiprazole. The ROR estimates were numerically higher among older adults than younger adults.ConclusionsThis cross-sectional assessment of data from FAERs (2004–2021) suggested that users of clozapine, olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone were more likely to report being hospitalized than users of other AAPs. Given that the FAERs database only contains spontaneous reports of AEs experienced by persons exposed to a drug but without information on exposed persons who did not have an event, a cohort study comparing hospitalizations among new users of individual AAPs against each other is needed to delineate these safety signals further.

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Second-Generation Antipsychotics and Pneumonia-Related Hospitalizations

Cited by 9 publications

References 0 publications

Comparative Efficacy, Safety, and Acceptability of Pimavanserin and Other Atypical Antipsychotics for Parkinson’s Disease Psychosis: Systematic Review and Network Meta-Analysis

Comparative Efficacy, Safety, and Acceptability of Pimavanserin and Other Atypical Antipsychotics for Parkinson’s Disease Psychosis: Systematic Review and Network Meta-Analysis

Risk of Respiratory Diseases with Use of Psychotropic Drugs: Results of a Community-based Cross-sectional Study from South India

Comparative Safety Signal Assessment of Hospitalization Associated With the Use of Atypical Antipsychotics

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