Antipsychotic therapy and risk of life-threatening medical events

  • Papola D & al.
  • Acta Psychiatr Scand
  • 2 Jul 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Antipsychotics (APs) use was strongly associated with the risk for pneumonia, followed by hip fracture and thromboembolism.
  • The association was weak for stroke, sudden cardiac death, and myocardial infarction (MI) risks.

Why this matters

  • Data from previous studies on the association between AP exposure and life-threatening medical events are controversial, fragmented and difficult to be stratified into a pragmatic risk quantification.

Study design

  • Umbrella review included 68 observational studies (26 cohort, 42 case-control) from six systematic reviews after a search across electronic databases.
  • Quality of review was evaluated using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) and the strength of associations was measured using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and quantitative umbrella review criteria (URC).
  • Funding: None.

Key results

  • Antipsychotic use was strongly associated with the risk for:
    • pneumonia (URC=class I; GRADE=low quality; OR, 1.84; 95% CI, 1.62-2.09),
    • hip fracture (URC=class II; GRADE=low quality; OR, 1.57; 95% CI, 1.42-1.74), and
    • thromboembolism (URC=class II; GRADE=very low quality; OR, 1.55; 95% CI, 1.31-1.83).
  • A weak association was observed between antipsychotic use and the risk for:
    • stroke (URC=class III; GRADE=very low quality; OR, 1.45; 95% CI, 1.24-1.70),
    • sudden cardiac death (URC=class III; GRADE=very low quality; OR, 2.24; 95% CI, 1.45-3.47), and
    • and MI (URC=class III; GRADE=very low quality; OR, 2.21; 95% CI, 1.41-3.46).

Limitations

  • Observational nature of the primary studies could not prove causality.