The incidence of diabetes in atypical antipsychotic users differs according to agent--results from a multisite epidemiologic study.
OBJECTIVE
The purpose of this study was to examine the association between atypical antipsychotics, including the newer agents, aripiprazole and ziprasidone, and newly treated diabetes, using the largest post-marketing cohort of patients exposed to these newer treatments that has been studied to date.


METHODS
Identified two overlapping cohorts-a simple cohort (all antipsychotic users) and an inception cohort (new users of antipsychotics)-using automated data from three United States sites (60.4 million covered lives). Patients exposed to antipsychotics > or = 45 days were identified and followed for incident diagnoses of treated diabetes. Data analysis accounted for drug switching and non-consistent drug use.


RESULTS
In the 55 287-member inception cohort, 357 cases of newly treated diabetes were identified. Compared with current use of typical antipsychotics, current users of aripiprazole (adjusted hazard ratio (aHR) 0.93, 95% confidence interval (CI) 0.50-1.76), quetiapine (aHR 1.04, 95%CI, 0.67-1.62), risperidone (aHR 0.85, 95%CI, 0.54-1.36) and ziprasidone (aHR 1.05, 95%CI, 0.54-2.08) had similar low risk of diabetes. Patients exposed to olanzapine had an increased risk of diabetes (aHR 1.71, 95%CI, 1.12-2.61), and although the effect estimate is imprecise, clozapine-exposed patients had a trend towards an elevated hazard ratio (aHR 2.58, 95%CI, 0.76-8.80). Results for the simple cohort were similar.


CONCLUSIONS
Relative to typical antipsychotics, aripiprazole, ziprasidone, risperidone and quetiapine were not associated with an increased risk of diabetes; olanzapine and clozapine were associated with an increased risk. This analysis constitutes the largest post-marketing pharmacoepidemiologic study to date that includes the newer agents.
Yood
Marianne Ulcickas
MU
EpiSource, Hamden, CT, USA. muyood@muyood.com
DeLorenze
Gerald
G
Quesenberry
Charles P
CP
Oliveria
Susan A
SA
Tsai
Ai-Lin
AL
Willey
Vincent J
VJ
McQuade
Robert
R
Newcomer
John
J
L'Italien
Gilbert
G
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000068180:Aripiprazole; D001569:Benzodiazepines / Q000627:therapeutic use; D003024:Clozapine / Q000627:therapeutic use; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D008875:Middle Aged; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D015363:Quinolones / Q000627:therapeutic use; D012189:Retrospective Studies; D013844:Thiazoles / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D014150:Antipsychotic Agents; D010879:Piperazines; D015363:Quinolones; D013844:Thiazoles; D001569:Benzodiazepines; C092292:ziprasidone; D000068180:Aripiprazole; D003024:Clozapine; D000077152:Olanzapine