Compared with olanzapine and aripiprazole, lurasidone was linked to lower risk for all-cause and psychiatric hospitalization in pediatric patients, according to study results presented at Psych Congress 2019, held October 3 to 6 in San Diego, California.
Previous meta-analyses have shown an approximate prevalence of bipolar I disorder of 1.2% in children and adolescents. These studies also demonstrated efficacy and tolerability of second-generation antipsychotic medications, such as lurasidone, although no real-world studies have been conducted to investigate the risk for hospitalization in this population. Researchers, therefore, conducted a retrospective cohort study using data gathered from insurance claims in the Truven Health MarketScan database between January 1, 2011 and June 30, 2017.
Researchers included patients aged <17 years who had >1 diagnosis code bipolar disorder, received treatment with an oral atypical antipsychotic medication, and were enrolled in a health plan for >6 months. Researchers catalogued treatment in units of months and controlled effects due to timing of switching/concomitant therapy by splitting the 180-day post treatment period into 30-day intervals, and patients were assigned 1 of 7 exclusive antipsychotic monotherapies per month.
The investigators used marginal structural models to investigate the number of hospitalizations during each period of monotherapy compared with those while patients were receiving lurasidone.
A total of 16,201 patients were included: 303 received lurasidone, 2679 quetiapine, 4304 risperidone, 5649 aripiprazole, and 436 received olanzapine in the first treatment month post index date.
Of note, the lurasidone group was composed of more patients aged 12 to 17 years, and had a higher percentage of anxiolytic and antidepressant use (92.4%, 18.2%, and 52.1% respectively).
The marginal structural model-adjusted relative odds for both all-cause hospitalization and psychiatric hospitalization were higher for aripiprazole and olanzapine compared with lurasidone; this odds ratio was unchanged for lurasidone, quetiapine, and risperidone. Further, conduct/disruptive disorder, unspecified mood disorder, anxiety disorder, adjustment disorder, and drug abuse were also associated with a higher risk for all-cause hospitalization, whereas being male and the use of stimulants, mood stabilizers, or alpha agonists were linked with a lower risk.
Due to the claims-based nature of this study, limitations included potential coding errors and missing information as a result of administrative errors, as well as residual confounders from unmeasured characteristics. In addition, investigators highlighted concerns that results may be applicable only to children covered by commercial employer-provided insurance and may not be generalizable.
The study investigators concluded that “hospitalization is a major cost driver of direct healthcare cost of individuals with bipolar disorder, [and therefore] lurasidone may be a cost saving treatment option.”
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Ng-Mak D, Kadakia A, Shrestha S, Wang L, Loebel A. Hospitalization risk in pediatric bipolar patients treated with lurasidone vs. other oral atypical antipsychotics: a real-world retrospective claims database study. Presented at: Psych Congress 2019; October 3-6, 2019, San Diego, CA. Poster 229.