title: Patterns of atypical antipsychotic therapy use in adults with bipolar I disorder in the USA.
abstract: OBJECTIVE
  This study aims to describe the utilization patterns of atypical antipsychotics (AA) among insured patients with bipolar I disorder in the USA.
  
  
  METHODS
  We studied patients with bipolar I disorder who newly initiated an oral AA between 2002 and 2008. Utilization measures included adherence [medication possession ratio (MPR) ≥80%], persistence (gaps ≤15 days between refills and an absence of ≥30 days of continuous concomitant non-index AA use), non-compliance (16-29 day gaps with no evidence of switch/augmentation), and discontinuation of the index AA (≥30 days without index AA, no evidence of switch/augmentation).
  
  
  RESULTS
  The study included 16 807 patients: mean age 43.3 years, 67.7% female. Overall, adherence to the index AA was low (8.3%; mean MPR = 0.2). Only 10.5% of the patients were persistent to index AA, another 13.6% were non-compliant, and 63.4% discontinued index AA with an average time to discontinuation of 66 days. A majority (69.5%) of the discontinued patients did not resume any antipsychotic therapy. Results were similar across insurance types and index AA.
  
  
  CONCLUSIONS
  Adherence to and persistence with AA treatment were low in new users with bipolar I disorder. Most patients discontinued the index AA and did not restart any antipsychotic treatment. Future study should distinguish physician-directed discontinuation versus patient non-adherence.
authors.affiliation: Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, New Jersey, USA; Merck & Co., Inc, Whitehouse Station, New Jersey, USA; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
authors.forename: Wenjia
authors.initials: W
authors.lastname: Chen
authors.forename: Angela M
authors.initials: AM
authors.lastname: Deveaugh-Geiss
authors.forename: Liisa
authors.initials: L
authors.lastname: Palmer
authors.forename: Nicole
authors.initials: N
authors.lastname: Princic
authors.forename: Ya-Ting
authors.initials: YT
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007344:Insurance Claim Reporting / Q000639:trends; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents
keywords: adherence; atypical antipsychotics; bipolar I disorder; discontinuation; persistence; treatment pattern