Abstract
Objectives
To assess the antipsychotic use and the prevalence/incidence of antipsychotic drug users in Italy during the years 1999–2002. To estimate the persistence with antipsychotic medications, and to measure their off-label use.
Methods
We selected 465,061 individuals registered by June 2002 in the lists of 320 general practitioners, homogeneously distributed throughout Italy, from the Health Search Database. We measured the antipsychotic drug consumption, calculated as defined daily dose (DDD) per 1000 inhabitants per day. We also calculated the number of individuals receiving at least one antipsychotic prescription, to estimate the annual prevalence and incidence of antipsychotic users. Among incident users, we evaluated the percentage of patients adherent to drug label indications and the average duration of treatment, estimated as medical possession ratio (MPR).
Results
Atypical antipsychotic use has continuously increased from 1999 to 2002. Women, older people and patients affected by psychotic disorders other than schizophrenia were seen to be more likely to receive antipsychotic prescriptions. Persistence with atypical drug treatment (MPR=0.213 in 2002) appeared longer than that of typical drugs (0.169). The percentage of patients adherent to drug label indications was significantly higher among typical antipsychotic users (P<0.001). The most common off-label use for atypical drug was senile dementia.
Conclusion
Atypical drug use has been continuously expanding over the years 1999–2002, particularly in older people with dementia. The rapidly increasing use of this new class of antipsychotics highlights the need for a better evaluation regarding their safety profile and a better definition of their role in psychiatric treatments.
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References
Canadian clinical practice guidelines for the treatment of schizophrenia. The Canadian Psychiatric Association (1998) Can J Psychiatry 43:25S–40S
Treatment of schizophrenia. The Expert Consensus Guideline Series (1999) J Clin Psychiatry 60:3–80
Apiquian R, Fresan A, De La Fuente-Sandoval C, Nicolini H, Ulloa RE (2004) Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns. BMC Psychiatry 4:12
Ananth J, Parameswaran S, Gunatilake S (2004) Side effects of atypical antipsychotic drugs. Curr Pharm Des (Review) 10:2219–2229
Hamann J, Ruppert A, Auby P, Pugner K, Kissling W (2003) Antipsychotic prescribing patterns in Germany: a retrospective analysis using a large outpatient prescription database. Int Clin Psychopharmacol 18:237–242
http://medicines.mhra.gov. uk/ourwork/monitorsafequalmed/safetymessages/antipsystroke_9304.htm Atypical antipsychotic drugs and stroke: Message from Professor Gordon Duff, Chairman, Committee on Safety of Medicines (CEM/CMO/2004/1)
Ashcroft DM, Frischer M, Lockett J, Chapman SR (2002) Variations in prescribing atypical antipsychotic drugs in primary care: cross-sectional study. Pharmacoepidemiol Drug Saf 11:285–289
Kaye JA, Bradbury BD, Jick H (2003) Changes in antipsychotic drug prescribing by general practitioners in the United Kingdom from 1991 to 2000: a population-based observational study. Br J Clin Pharmacol 56:569–75
Barbui C, Danese A, Guaiana G, Mapelli L, Miele L, Monzani E, Percudani M (2002) Study group. Prescribing second-generation antipsychotics and the evolving standard of care in Italy. Pharmacopsychiatry 35:239–243
Filippi A, Bignamini AA, Sessa E, Samani F, Mazzaglia G (2003) Secondary prevention of stroke in Italy: a cross-sectional survey in family practice. Stroke 34:1010–1014
Filippi A, Sabatini A, Badioli L, Samani F, Mazzaglia G, Catapano A, Cricelli C (2003) Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behavior among Italian general practitioners in diabetic patients: an intervention trial. Diabetes Care 26:1497–1500
Lawrenson R, Williams T, Farmer R (1999) Clinical information for research: the use of general practice databases. J Pub Health Med 21:299–304
Guidelines for ATC classification and DDD Assignment. WHO Collaborating Centre for Drug Statistics and Methodology: Oslo, 2001
Italian Office of National Statistics. Italian Statistician Annal 2002: Population. Rome: ISTAT, 2002
Schectman JM, Bovbjerg VE, Voss JD (2002) Predictors of medication refill adherence in an indigent rural population. Med Care 40:1294–1300
Al-Zakwani IS, Barron JJ, Bullano MF, Arcona S, Drury CJ, Cockerham TR (2003) Analysis of healthcare utilization patterns and adherence in patients receiving typical and atypical antipsychotic medications. Curr Med Res Opin 19:619–626
Hermann RC, Yang D, Ettner SL, Marcus SC, Yoon C, Abraham M (2002) Prescription of antipsychotic drugs by office-based physicians in the United States, 1989–1997. Psychiatr Serv 53:425–430
Alonso J, Angermeyer MC et al European Study of the Epidemiology of Mental Disorders (ESEMeD) Project (2004) Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl:21–27
Dewa CS, Remington G, Herrmann N, Fearnley J, Goering P (2002) How much are atypical antipsychotic agents being used, and do they reach the populations who need them? A Canadian experience. Clin Ther 24:1466–1476
CSM warning on atypical psychotics and stroke may be detrimental for dementia (2004) BMJ 328:1262
Tempier RP, Pawliuk NH (2003) Conventional, atypical, and combination antipsychotic prescriptions: a 2-year comparison. J Clin Psychiatry 64:673–679
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Trifirò, G., Spina, E., Brignoli, O. et al. Antipsychotic prescribing pattern among Italian general practitioners: a population-based study during the years 1999–2002. Eur J Clin Pharmacol 61, 47–53 (2005). https://doi.org/10.1007/s00228-004-0868-3
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DOI: https://doi.org/10.1007/s00228-004-0868-3