Antipsychotic treatment patterns in Alzheimer’s disease patients with agitation: a cohort study using the UK clinical practice research datalink

Abstract

Objectives

There is a lack of robust epidemiological evidence on antipsychotic (AP) use in patients with agitation in Alzheimer’s disease (AD). Authors studied AP use in patients with AD and agitation and compared their use with patients with other or no neuropsychiatric symptoms (NPS).

Methods

A retrospective cohort study in the UK Clinical Practice Research Datalink, included patients with AD between January 1^st, 2015, and December 31^st, 2017. AP use was compared between patients with agitation, other types of NPS and no NPS.

Results

There were 24,464 patients with AD, median follow-up of 1.1 years (interquartile range [IQR] 0.5–2.1), and median age 83 years (78–88). A larger percentage of patients with agitation (n = 2432) were prescribed APs (38.2%) than other NPS (n = 13,076, 20.4%) and no NPS (n = 11,816, 12.2%). Compared to patients with no NPS, adjusted hazard ratios for AP use were 3.45 (95% CI 2.86–4.17) for patients with agitation and 1.31 (95% CI 1.19–1.44) for patients with other NPS. Among users of APs, the treatment discontinuation rate at six months was 44.8% in patients with agitation (other NPS 57.1%; no NPS 63.5%).

Conclusions

Patients with AD and agitation were frequently prescribed APs and for long periods in routine clinical practice in the UK. The high real-life usage of APs suggests that physicians prefer using APs for the treatment of agitation despite recommendations against their long-term use. These data support a need for AP therapies that better address known safety concerns with currently used APs to treat agitation in elderly patients with AD.

Keywords:

• Agitation
• Alzheimer’s disease
• dementia
• antipsychotics
• neuropsychiatric symptoms

Transparency

Declaration of funding

This study was sponsored by Lundbeck.

Declaration of financial/other relationships

Lundbeck and Otsuka are manufacturers of drugs that are used in Alzheimer´s disease. OXON Epidemiology, and its employees, was funded to conduct this study by Lundbeck.

MB, SL, RAB, KTJ are/were employees of Lundbeck and Otsuka which manufacture drugs used in Alzheimer´s disease. CTT, SLC, MJ, NQ are/were employees of OXON Epidemiology, which was funded by Lundbeck to conduct this study. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

KTJ conceived the idea. All authors contributed to the study design. SC, CT and MJ carried out the data management and statistical analysis. NQ reviewed the clinical and drug codes. CT and NQ drafted the first version of the manuscript. KTJ, MB, CT, SC, MJ and NQ contributed to the interpretation of results. All authors revised the manuscript critically for important intellectual content and approved the final version of this manuscript.