The initiation of aripiprazole therapy did not appear to be associated with psychiatric hospitalization or suicidality in patients previously exposed to antipsychotic medication, according to the results of a cohort study published in JAMA Psychiatry.
Investigators conducted a population-based cohort study using data from the United Kingdom Clinical Practice Research Datalink (CPRD). Linked with the Hospital Episode Statistics repository and the Office for National Statistics mortality database, the CPRD provides access to patient demographic data, lifestyle factors, prescriptions, and hospitalization records. The present analysis included data on all patients at least 13 years of age who initiated use of an oral antipsychotic drug between January 1, 2005, and March 31, 2015. Patients without at least 1 year of data in the CPRD, patients with prior antipsychotic use, and patients with acute schizophrenia were excluded. The primary outcome measure was first psychiatric treatment failure, defined as hospitalization for a psychiatric event, self-harm, or suicide. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for psychiatric treatment failure associated with aripiprazole use compared with use of other antipsychotic medications.
The final study analysis comprised 1643 patients starting aripiprazole (57.8% women) who were matched 1:1 with 1643 patients (53.0% women) starting another antipsychotic drug. The mean (standard deviation) ages of patients initiating aripiprazole or another drug were 42.1 (16.8) and 42.4 (17.1) years, respectively. Baseline profiles were similar in those starting aripiprazole and those starting another antipsychotic, except that the aripiprazole group had a slightly lower number of previous psychiatric admissions (18.3% vs 22.5%) and fewer episodes self-harm (3.0% vs 4.6%) in the 6 months prior to cohort entry.
During 2692 person-years of follow-up, 391 incident psychiatric treatment failures were recorded for a crude incidence rate of 14.52 (95% CI, 13.16-16.04) per 100 person-years. Initiation of aripiprazole was not associated with an increased rate of psychiatric treatment failure compared with initiation of another antipsychotic medication (HR, 0.87; 95% CI, 0.71-1.06). When assessed separately, no association was found between aripiprazole use and psychiatric hospitalization (HR, 0.85; 95% CI, 0.69-1.06) or self-harm and suicide (HR, 0.96; 95% CI, 0.68-1.36). Subgroup analyses showed that aripiprazole initiation was also not associated with an increased rate of psychiatric failure among patients recently treated with antipsychotic drugs (HR, 0.87; 95% CI, 0.67-1.15) or patients with schizophrenia (HR, 0.82; 95% CI, 0.62-1.08).
In a population-based cohort study, there was no evidence for an increased rate of psychiatric treatment failure following initiation of aripiprazole compared with other antipsychotic medication. Further research with a larger cohort is necessary to investigate the impact of aripiprazole on nonserious psychiatric exacerbation that do not result in hospitalization.
Montastruc F, Nie R, Loo S, et al. Association of aripiprazole with the risk for psychiatric hospitalization, self-harm, or suicide [published online January 30, 2019]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.4149