[Descriptive analysis of the use of atypical antipsychotics under compassionate-use in a health area in Ferrol (La Coruña, Spain)].
OBJECTIVE
Although atypical antipsychotics (AA) provoke fewer extra-pyramidal symptoms (ES) than classic antipsychotics, their use in patients greater than or equal to 75 years old with dementia must be under compassionate-use. This is an important limitation. We performed a descriptive analysis of the use of atypical antipsychotics under compassionate-use (AACU) in the Ferrol health area.


METHODS
We retrospectively assessed all the patients who were receiving an AACU from March, 2004 (that is the date when prescription under compassionate-use of AA came into force in Spain) to November 30, 2008.


RESULTS
One hundred and thirty-three of 164 patients (63.6% women; median ages, 81.9 ± 4.95 years) were included. Diagnostic aetiologies were: 42.9% Alzheimer's disease, 30.8% Parkinson-dementia/Lewy body disease, and 15.8% vascular/mixed dementia. A total of 68.4% of patients had received other anti-psychotic drugs previously and 32.3% had ES due to antipsychotics. The AACU received were: quetiapine (76.7%), ziprasidone (18.8%), and olanzapine (4.5%). Median follow-up time was 20.25 ± 20.38 months. Side effects were observed in 19.7% of patients. Improvement of NPI (Neuropsychiatric Inventory) was 33.3 ± 24.75 points. Agitation/aggressiveness (5.6 ± 4.55), delirious ideas (4.94 ± 5.07), irritability (4.38 ± 4.94), and anxiety (4.32 ± 4.83) were the symptoms that most improved. Although there were no differences between AACU, quetiapine was associated with significant maintenance in monotherapy (94.1% vs 72% for ziprasidone and 83.3% for olanzapine; p < 0.0001).


CONCLUSIONS
AACU are effective and well tolerated drugs. Quetiapine was the most frequently used AACU. An excessive percentage of patients previously received other antipsychotics and present with ES.
Santos-García
D
D
Sección de Neurología, Hospital A. Marcide, Ferrol, La Coruña, España. diegosangar@yahoo.es
Macías
M
M
Casás-Martínez
A
A
Llaneza
M
M
Abella
J
J
Aneiros
A
A
Santos
H
H
Domínguez-Urbistondo
G
G
Salazar-Laya
B
B
D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D057176:Compassionate Use Trials; D003704:Dementia / Q000188:drug therapy*; D003987:Dibenzothiazepines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077152:Olanzapine; D010879:Piperazines / Q000627:therapeutic use; D000069348:Quetiapine Fumarate; D012189:Retrospective Studies; D013030:Spain; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D010879:Piperazines; D013844:Thiazoles; D001569:Benzodiazepines; D000069348:Quetiapine Fumarate; C092292:ziprasidone; D000077152:Olanzapine