Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders.

Autor: Smith RL; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway. Electronic address: RobertLovsletten.Smith@diakonsyk.no., Tveito M; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway; Norwegian National Advisory Unit on Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway., Kyllesø L; Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, 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, Oslo, Norway; Department of Pharmacy, University of Oslo, Norway.
Jazyk: angličtina
Zdroj: Schizophrenia research [Schizophr Res] 2021 Feb; Vol. 228, pp. 590-596. Date of Electronic Publication: 2020 Nov 19.
DOI: 10.1016/j.schres.2020.11.025
Abstrakt: Background: Nonadherence to antipsychotics may cause relapse and hospitalizations in patients with psychotic disorders. The purpose was to quantify and compare the outpatient's nonadherence rates of atypical antipsychotics by objective detection in blood samples.
Methods: Totally, 13,217 outpatients with therapeutic drug monitoring (TDM) data of atypical antipsychotics were included. An event of complete nonadherence was defined as an occurrence of undetectable level of a prescribed antipsychotic in the blood sample submitted for TDM. Patients with such an event(s) were defined as nonadherent of the respective drug treatment (outcome). The rates of nonadherence patients were compared between the drugs by logistic regression.
Results: In the study population, 70.2% of the patients were prescribed doses compliant with a schizophrenia diagnosis. The mean olanzapine equivalent dose in the population was 13.4 mg (95% confidence interval (CI): 13.3, 13.6). The frequency of nonadherence patients, regardless of drug, was 3.7% (CI: 3.4-4.0). The nonadherence patient rate was lowest in clozapine-treated patients (2.2%; CI: 1.5-2.8), followed by aripiprazole (2.3%; 1.7-2.8), risperidone (2.4%; 1.6-3.0), quetiapine (2.8%; 2.3-3.2) and olanzapine (4.9%; 4.1-5.3). Users of olanzapine had significantly higher risk of complete nonadherence (Odds ratio: 1.9; CI: 1.6-2.3, p < 0.001) compared to patients treated with other antipsychotics as a group.
Conclusions: In this study, complete nonadherence of atypical antipsychotics, measured as undetectable blood level, was disclosed for ~5% of outpatients with psychotic disorders. The rate of complete nonadherence was significantly higher during olanzapine treatment compared to other atypical antipsychotics. Further studies should investigate if this reflects drug differences in tolerability or other causal relationships.
Competing Interests: Declaration of competing interest O.A. Andreassen received speaker's honorarium from Lundbeck. E. Molden received speaker's honorarium from Lilly, Lundbeck and Otsuka. The remaining authors have no conflicts of interest to declare.
(Copyright © 2020. Published by Elsevier B.V.)
Databáze: MEDLINE
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