Cerebrovascular risk comparable with first- and second-generation antipsychotics
MedWire News: Researchers have found no significant difference in the risk for cerebrovascular adverse events among patients aged 50 years and older taking first- and second-generation antipsychotics.
Antipsychotics, particularly second-generation antipsychotics, are often used to treat psychiatric disorders in older adults, they note, but the risk for cerebrovascular events in these individuals, who are more likely than younger patients to die from such events, has heightened safety concerns regarding their use.
“This study presents comparative safety of second-generation antipsychotics versus first-generation antipsychotics based on a propensity score-matched cohort, thus taking into account the issue of controlling cerebrovascular risk factors and confounding by indication,” Rajender Aparasu and colleagues, from the University of Houston in Texas, USA, report.
They note, however, that extent of antipsychotic treatment was associated with increased incidence of cerebrovascular adverse events, irrespective of class of antipsychotic used.
A total of 11,160 adults aged 50 years or older participated in the study, of whom half were taking first-generation antipsychotics, while the remainder were taking second-generation antipsychotics.
There were 798 cases of cerebrovascular adverse events, with at least one hospitalization or emergency room visit over the 7-year period of antipsychotic use.
The rate of such events was 7.46% for those taking second-generation antipsychotics and 6.85% for those taking first-generation antipsychotics.
A Cox proportional hazards regression model adjusted for duration of therapy and other drugs that might induce cerebrovascular adverse events showed no significant difference in the risk for cerebrovascular events between second- and first-generation antipsychotics (hazard ratio=0.858).
However, duration of therapy was associated with the risk for cerebrovascular adverse events, with the risk increased 1.70-fold in patients taking antipsychotics of either class for 30–90 days, compared with the initial 30 days of treatment, and 1.57-fold in those taking antipsychotics for more than 90 days.
The researchers suggest that there may be a correlation between atherosclerotic effects of antipsychotics and risk for cerebrovascular events.
“Orthostatic hypotension, thromboembolic effects, excessive sedation, and hyperprolactinemia leading to atherosclerosis can lead to increased incidence of stroke with the use of antipsychotics in the elderly,” Aparasu and team note in the Journal of Clinical Psychiatry.
They say that healthcare professionals should identify predisposing cerebrovascular risk factors when planning to treat patients for a longer period of time.
“Regular follow-up of patients and constant monitoring can be instrumental in minimizing risk of cerebrovascular adverse events associated with long-term use of antipsychotics,” they conclude.
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