Objective: To describe the use of antipsychotics in patients with Parkinson’s disease (PD) and study its associated mortality risks.

Background: The US Food and Drug Administration has issued the black-box warning regarding the increased mortality risks of atypical antipsychotics use for more than a decade, but the impact on the prescription pattern of antipsychotics for patients with PD is not known.

Method: We identified incident PD cases from a random sample of 1 million individuals in Taiwan National Health Insurance program during 2001-2011. The use of antipsychotics was defined by medication codes and minimum daily dosage. We then described the frequency, type and timing of antipsychotics use in PD cases. Within the incident PD case group, we identified antipsychotic users and selected age, sex and index year-matched non-users in a 1:1 ratio for a nested case-control study. We employed Cox proportional hazards regression models to study the associations between antipsychotics use and mortality.

Results: A total of 1783 patients with newly diagnosed PD were identified. About 15% (n=276) of these patients were found to use antipsychotics during follow-up, and they were first exposed to antipsychotics at 2.9 years on average after PD diagnosis. The proportion of atypical antipsychotics use appeared to increase over time and has become the major prescription, among which quetiapine (53%) was the most common prescription, followed by risperidone (13%). PD cases with antipsychotics use were slightly older (71.9 vs 70.3 years, p=0.02) and more likely to have comorbid dementia, insomnia, hypertension and stroke. Eighty-eight antipsychotics users (31.9%) and 312 non-users (20.7%) were deceased as of December 31, 2011. After adjusting for age, sex and index year, antipsychotics users had higher mortality risks than non-users (HR=2.26, p=0.001).

Conclusion: Antipsychotic medication, particularly quetiapine, is commonly prescribed for PD in Taiwan, despite the black-box warning. The cause of higher mortality risks among antipsychotics users in PD warrants further investigation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antipsychotics-use-in-parkinsons-disease-and-mortality-risks/