title: Changes in antipsychotic use among patients with severe mental illness after a Food and Drug Administration advisory.
abstract: OBJECTIVE
  A 2003 Food and Drug Administration advisory warned of increased hyperlipidemia and diabetes risk for patients taking second-generation antipsychotics (SGAs). After the advisory, a professional society consensus statement provided treatment recommendations and stratified SGAs into high, intermediate, and low metabolic risk. We examine subsequent changes in incident and prevalent SGA use among individuals with severe mental illness.
  
  
  METHODS
  We created a retrospective cohort using Florida Medicaid's claims from 2001 to 2006. We included non-Medicare eligible adults with bipolar disorder or schizophrenia who filled an SGA prescription. We assessed changes in overall and agent-specific use, discontinuations, interruptions, and therapeutic alternative use among prevalent users and agent-specific use among incident users. Pre-advisory utilization was compared with utilization initially after the advisory and two subsequent periods.
  
  
  RESULTS
  Among prevalent users, overall SGA use decreased slightly, and no increases in treatment interruptions or discontinuations were observed after the advisory and consensus statement publication. Compared with the pre-advisory period, in the months immediately after the advisory, the use of the highest metabolic-risk agent, olanzapine, decreased by 34% among prevalent users with bipolar disorder (adjusted risk ratio [aRR] = 0.66, 95%CI = 0.59-0.74) and 26% among prevalent users with schizophrenia (aRR = 0.74, 95%CI = 0.72-0.76). A greater decrease was estimated among incident users with bipolar disorder (aRR = 0.37, 95%CI = 0.29-0.47) and schizophrenia (aRR = 0.42, 95%CI = 0.35-0.51) during this period. During each subsequent post-advisory period, olanzapine use continued to decrease whereas quetiapine, ziprasidone, and aripiprazole use increased.
  
  
  CONCLUSIONS
  The metabolic risk advisory and the published consensus statement were associated with a selective reduction in olanzapine use without evidence of treatment disruptions among this population.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. Dusetzina@hcp.med.harvard.edu
authors.forename: Stacie B
authors.initials: SB
authors.lastname: Dusetzina
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Busch
authors.forename: Rena M
authors.initials: RM
authors.lastname: Conti
authors.forename: Julie M
authors.initials: JM
authors.lastname: Donohue
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D014150:Antipsychotic Agents