Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1008 — Comparison of Risk of Cerebrovascular Events in an Elderly VA Population with Dementia between Antipsychotic and Non-Antipsychotic Users

Barnett MJ (Iowa City, VAMC (CRIISP)) , Wehring HJ (Touro University, College of Pharmacy), Schultz SK (University of Iowa, College of Medicine), Perry PJ (Touro University, College of Pharmacy)

Objectives:
Second generation antipsychotics (2nd GAPs) are often used to control behavioral problems associated with dementia because of lower side effects than first generation antipsychotics (1st GAPs). However, concerns have surfaced about the increased risk for cerebrovascular events (CVEs) of 2nd GAPs. This study determined the risk of CVEs associated with 1st and 2nd GAPs in veterans with dementia.

Methods:
The Patient Treatment and Outpatient Care files for FY 2001 identified veterans 65 years and older with Alzheimer’s or vascular dementia. 1st and 2nd GAP use during an 18 month observation period (4/02-9/03) were determined using DSS Pharmacy files. Hospitalizations for CVEs in VHA or private sector hospitals were identified from the Patient Treatment File and Medicare Part A files. Cox regression was used to model the time to first CVE, censoring for death and adjusting for demographics, comorbidity, and use of specific medications (e.g., anticoagulants, anti-hypertensives, diabetic medications).

Results:
The mean age of patients (n=21,304) was 78.2 (SD, 5.5) years; 97% were male and 24% and 76% were categorized as having Alzheimer’s and vascular dementias, respectively. 2% and 15% of patients received prescriptions for a 1st or 2nd GAP during the observation period. Relative to patients who received no antipsychotics, the risk of a CVE was similar for patients receiving 1st GAPs (hazard ratio [HR], 1.27; 95% CI, 0.79-2.02) or 2nd (HR, 1.01; 95% CI, 0.84-1.20) GAPs. These results were similar in separate analyses of patients with Alzheimer’s or vascular dementia. In analyses of patients receiving antipsychotics, no increased risk of a CVE was found for individual 2nd GAPs (olanzapine [HR, 0.88; 95% CI, 0.50-1.55], risperidone [HR, 0.62; 95% CI, 0.37-1.06], or quetiapine [HR, 0.82; 95% CI, 0.46-1.44]), relative to haloperidol (1st GAP).

Implications:
In contrast to a recent FDA warning, this study found no increase in the risk of CVEs in veterans with dementia who received 2nd GAPs, relative to veterans receiving 1st GAPs or without anti-psychotic use.

Impacts:
While 2nd GAPs are more expensive, the current study suggests that clinicians should weigh the benefits of 1st and 2nd GAPs in controlling behavioral symptoms in dementia, independent of concerns about the risk of CVEs.