Objective: To analyze the burden of antipsychotic (AP) dose reduction in Medicare patients with schizophrenia (SZ).
Background: Tardive dyskinesia (TD) develops in patients treated with APs. Although AP dose reduction has been used to manage TD, its impact has not been well studied and may increase burden to patients.
Method: Medicare claims data from 2006–2017 were retrospectively analyzed for patients with SZ and ≥2 claims for APs, with ≥1 AP monotherapy period ≥90 days. Patients with AP dose reductions ≥10% (cases) and patients with stable doses, including dose reductions <10% (controls), were classified into cohorts. A subgroup of patients with dose reductions ≥30% and their matched controls was also assessed. Outcomes included SZ relapse, psychiatric relapse, TD, all-cause emergency room (ER) visits, and all-cause inpatient (IP) visits.
Results: 276,030 patients with ≥10% and 211,575 patients with ≥30% dose reductions were included in the analysis. Patients with ≥10% dose reductions and matched controls were similar in age (mean 57 y), sex (50% male), and use of second-generation APs (88%); characteristics in the ≥30% cohort were largely similar to the ≥10% cohort. Patients with ≥10% or ≥30% dose reductions had a shorter time to SZ relapse, psychiatric relapse, TD, ER visit, and IP visit vs controls (all P<0.001). Adjusting for differences in unmatched baseline characteristics for cases vs controls showed that ≥10% dose reduction led to an increased risk of SZ relapse (hazard ratio [HR] 1.24; 95% confidence interval [CI] 1.22–1.26; P<0.001), psychiatric relapse (HR 1.13; 95% CI 1.12–1.15; P<0.001), TD (HR 1.43; 95% CI 1.32–1.54; P<0.001), ER visit (HR 1.08; 95% CI 1.07–1.09; P<0.001), and IP visit (HR 1.22; 95% CI 1.21–1.23; P<0.001) vs controls. Patients with ≥30% dose reduction also had higher risk for SZ relapse (HR 1.25; 95% CI 1.23–1.27; P<0.001), psychiatric relapse (HR 1.17; 95% CI 1.16–1.19; P<0.001), TD (HR 1.39; 95% CI 1.26–1.52; P<0.001), ER visit (HR 1.11; 95% CI 1.10–1.12; P<0.001), and IP visit (HR 1.26; 95% CI 1.24–1.27; P<0.001) vs controls.
Conclusion: Patients with AP dose reductions may be at risk for significant unfavorable mental health–related clinical outcomes and increased hospitalizations, suggesting that dose reduction may increase overall healthcare burden in some patients with SZ and highlights the need for alternative strategies in the management of TD.
To cite this abstract in AMA style:
R. Ayyagari, F. Mu, A. Lax, B. Carroll. The Impact of Antipsychotic Dose Reduction Within a Medicare Population [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/the-impact-of-antipsychotic-dose-reduction-within-a-medicare-population/. Accessed June 15, 2025.« Back to MDS Virtual Congress 2020
MDS Abstracts - https://www.mdsabstracts.org/abstract/the-impact-of-antipsychotic-dose-reduction-within-a-medicare-population/