Hospitalization risk in pediatric patients with bipolar disorder treated with lurasidone vs. other oral atypical antipsychotics: a real-world retrospective claims database study

Figures & data

Figure 1. Patient selection.

Table 1. Pre-index patient demographics, comorbidities, and healthcare utilization by treatment group at month 1.

Variable	Lurasidone (n = 303)	Quetiapine (n = 2,679)	Risperidone (n = 4,304)	Aripiprazole (n = 5,649)	Olanzapine (n = 436)
Demographics
Age, mean (SD)	15.3 (1.7)	14.8 (2.3)	12.4 (3.6)*	14.0 (2.9)*	14.9 (2.4)*
Female, %	32.0	42.3	61.2*	43.2*	58.7*
Region, %
Northeast	13.9	17.5	15.1	17.0	10.8
North Central	28.7	26.9	27.9	26.0	24.3
South	39.9	35.3	39.0	38.8	37.8
West	16.5	18.5	16.3	16.8	26.4
Comorbidities, %
Pervasive development disorder or mental retardation	8.9	4.3*	9.7	6.5	6.2
Disruptive behavior/conduct disorder	21.8	23.7	32.8*	25.6	21.8
Attention deficit hyperactivity disorder	38.0	32.6	47.8*	36.3	31.4
Depression or mood disorder, not otherwise specified	52.8	56.6	33.5*	49.8	47.5
Anxiety disorder	15.5	18.4	11.1*	15.0	16.7
Adjustment disorder	19.8	24.4	20.2	22.8	18.1
Communication and learning disorders	2.3	1.8	4.2	2.5	1.8
Drug abuse	11.6	20.8*	9.4	11.4	20.9*
Other mental disorders	98.0	91.8*	87.8*	92.7*	91.1*
Obesity	8.6	4.1*	2.1*	3.9*	1.8*
Diabetes	2.0	0.6*	0.3*	0.7*	0.7
Concomitant medications, %
Antidepressants	52.1	52.9	39.7*	52.2	46.8
Anxiolytics	18.2	10.1*	4.7*	6.9*	9.9*
Others	61.7	39.5*	51.3*	42.0*	39.7*
Stimulants	30.7	24.6*	37.3*	27.3	24.5
Mood stabilizers	43.2	16.1*	12.8*	13.8*	18.6*
α2-agonists	13.9	13.3	21.9*	13.9	10.3
All-cause healthcare resource utilization, mean
Number of inpatient admissions	0.50	0.66*	0.43	0.50	0.65*
Number of emergency room visits	0.56	0.62	0.50	0.51	0.56
Psychiatric healthcare resource utilization, mean
Number of inpatient admissions	0.50	0.65*	0.42	0.49	0.64*
Number of emergency room visits	0.29	0.34	0.26	0.28	0.28

*p < .05; statistically significantly different from the lurasidone treatment group.

Table 2. Number of patients in each treatment group by month.

	Month
Treatment	1	2	3	4	5	6
Lurasidone	303	160	138	122	106	92
Quetiapine	2,679	1,616	1,506	1,314	1,295	1,214
Risperidone	4,304	2,688	2,454	2,109	1,981	1,806
Aripiprazole	5,649	3,467	3,064	2,819	2,592	2,395
Olanzapine	436	238	197	173	147	143
No/Minimal	78	4,175	5,131	6,168	6,822	7,378
Other	2,572	3,677	3,531	3,316	3,078	2,993

In the MSM model patients could switch treatment over time.

No/Minimal treatment was defined as ≤7 days of treatment with an atypical antipsychotic of interest.

Another treatment was defined as the use of multiple oral atypical antipsychotics, the use of any of the antipsychotics of interest for 8–21 days, or the use of an antipsychotic combined with lithium or valproate.

Table 3. Unadjusted rates of psychiatric and all-cause hospitalizations by antipsychotic treatment.

Treatment	Number of hospitalizations	Patient-months	Rate per 100 patient-months	p
All-cause hospitalizations
Lurasidone	36	829	4.3	–
Quetiapine	436	8,410	5.2	.307
Risperidone	489	13,536	3.6	.287
Aripiprazole	1,196	17,591	6.8	.008*
Olanzapine	100	1,191	8.4	.001*
Psychiatric hospitalizations
Lurasidone	35	829	4.2	–
Quetiapine	425	8,410	5.1	.307
Risperidone	474	13,536	3.5	.286
Aripiprazole	1,179	17,591	6.7	.007*
Olanzapine	98	1,191	8.2	.001*

*p < .05; statistically significantly different from the lurasidone treatment group.

Figure 2. All-cause hospitalizations during the 6-month follow-up period from the marginal structural model. ADHD, attention deficit hyperactivity disorder; OR, odds ratio; CI, confidence interval. ^Includes stimulants, mood stabilizers, or α₂-agonists.

Figure 3. Psychiatric hospitalizations during the 6-month follow-up period from the marginal structural model. ADHD, attention deficit hyperactivity disorder; OR, odds ratio; CI, confidence interval. ^Includes stimulants, mood stabilizers, or α₂-agonists.