Impact of antipsychotic polypharmacy on nonadherence of oral antipsychotic drugs - A study based on blood sample analyses from 24,239 patients.

Autor: Smith RL; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway. Electronic address: RobertLovsletten.Smith@diakonsyk.no., Tveito M; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway., Kyllesø L; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway., Jukic MM; Section of Pharmacogenetics, Department of Physiology and Pharmacology, Biomedicum 5B, Karolinska Institutet, Stockholm, Sweden; Department of Physiology, Faculty of Pharmacy, University of Belgrade, Serbia., Ingelman-Sundberg M; Section of Pharmacogenetics, Department of Physiology and Pharmacology, Biomedicum 5B, Karolinska Institutet, Stockholm, Sweden., Andreassen OA; NORMENT center, Institute of Clinical Medicine, University of Oslo and Oslo University Hospital, Oslo, Norway., Molden E; Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo 0319, Norway; Department of Pharmaceutical Biosciences, School of Pharmacy, University of Oslo, Oslo, Norway.
Jazyk: angličtina
Zdroj: European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology [Eur Neuropsychopharmacol] 2020 Aug; Vol. 37, pp. 64-69. Date of Electronic Publication: 2020 Jun 25.
DOI: 10.1016/j.euroneuro.2020.06.007
Abstrakt: Nonadherence to oral antipsychotic drugs is a major issue in clinical psychiatry giving rise to treatment failure. Further, polypharmacy is common in the treatment of psychotic disorders due to insufficient treatment effect during monotherapy. As a potential circuit problem, we hypothesized that antipsychotic polypharmacy is associated with increased risk of nonadherence. To investigate this, in terms of 'complete' nonadherence, the rates of undetectable serum drug concentrations during prescribing of doses used in psychotic disorders were compared during antipsychotic 'monotherapy' vs 'polypharmacy' treatment using therapeutic drug monitoring (TDM) data of 24,239 patients. A complete nonadherence patient was objectively defined as the detection of at least one event of undetectable serum concentration of a prescribed antipsychotic drug. The rate of complete nonadherence patients was compared between antipsychotic monotherapy and polypharmacy by multivariate logistic regression analyses. The overall rate of complete nonadherence in the population was 6.8% (n = 1,644; 95%CI: 6.5-7.1). Compared to monotherapy patients, the rate of nonadherence increased significantly with the number of co-prescribed antipsychotic drugs. After adjusting for sex (p = 0.091) and age (p < 0.001) as covariates, the rates of nonadherence vs monotherapy were 1.69-fold (95% CI: 1.48-1.92; p < 0.001) for two, 2.60-fold (95% CI: 1.88-3.59; p < 0.001) for three, and 3.54-fold (95% CI: 1.46-8.58; p = 0.005) for four or more co-prescribed antipsychotics, respectively. The present naturalistic study shows that antipsychotic polypharmacy significantly increases the rate of complete nonadherence, which is positively correlated with increasing number of concurrently used antipsychotic drugs. Thus, the intended clinical benefit of combining oral antipsychotic drugs may probably be reduced by increased nonadherence.
Competing Interests: Declaration of Competing Interests O.A.A. received speaker's honorarium from Lundbeck. E.M. received speaker´s honorarium from Lilly, Lundbeck and Otsuka. The remaining authors have no conflicts of interest to declare.
(Copyright © 2020 Elsevier B.V. and ECNP. All rights reserved.)
Databáze: MEDLINE
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