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Mortality, attempted suicide, re-hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden-a register-based study

Weitoft, Gunilla Ringback; Berglund, Mats LU ; Lindstrom, Eva A.; Nilsson, Mikael; Salmi, Peter and Rosen, Mans (2014) In Pharmacoepidemiology and Drug Safety 23(3). p.290-298
Abstract
PurposeThe aim of this study was to analyse prescription refill, re-hospitalisation, total mortality, mortality because of suicide and attempted suicide among patients who were taking various types of antipsychotics. MethodsA population-based cohort study analysed all patients (n=26046) in Sweden who had been treated for schizophrenia from 2006 to 2009 with regard to re-hospitalisation and prescription refill for various types of antipsychotic treatment. A case-control study nested within the cohort analysed all-cause mortality, mortality because of suicide and attempted suicide in relation to antipsychotic use. The study adjusted for history of hospitalisation for psychiatric and medical care, attempted suicide and use of antidepressants.... (More)
PurposeThe aim of this study was to analyse prescription refill, re-hospitalisation, total mortality, mortality because of suicide and attempted suicide among patients who were taking various types of antipsychotics. MethodsA population-based cohort study analysed all patients (n=26046) in Sweden who had been treated for schizophrenia from 2006 to 2009 with regard to re-hospitalisation and prescription refill for various types of antipsychotic treatment. A case-control study nested within the cohort analysed all-cause mortality, mortality because of suicide and attempted suicide in relation to antipsychotic use. The study adjusted for history of hospitalisation for psychiatric and medical care, attempted suicide and use of antidepressants. ResultsAripiprazole users were the only ones who showed significantly lower all-cause risks of death, but so few events occurred among users of this relatively new drug that the results should be interpreted with caution. Clozapine users showed lower odds of death by suicide (odds ratio [OR]=0.45 [95%CI 0.20-0.98]) and of attempted suicide (OR=0.44 [0.28-0.70]) than haloperidol users after adjustment for age, sex and year of discharge. Olanzapine users showed approximately the same favourable pattern. Patients who used clozapine were most likely to refill prescriptions and had lower rates of re-hospitalisation. Only one death and 23 cases of agranulocytosis were reported compared with 223 suicides and 831 suicide attempts. An etiologic fraction calculation suggests that the use of clozapine rather than traditional drugs could have prevented 95 suicide attempts during the period. ConclusionClozapine and olanzapine reduce the risk of suicide, attempted suicide and re-hospitalisation. Copyright (c) 2014 John Wiley & Sons, Ltd. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
mortality, suicide, suicide attempts, antipsychotics, re-hospitalisation, epidemiology, pharmacoepidemiology
in
Pharmacoepidemiology and Drug Safety
volume
23
issue
3
pages
290 - 298
publisher
John Wiley & Sons
external identifiers
  • wos:000332952400009
  • scopus:84895506968
ISSN
1053-8569
DOI
10.1002/pds.3567
language
English
LU publication?
yes
id
770301b2-af7c-4392-a6e2-e3ed7ef726d7 (old id 4559521)
date added to LUP
2014-08-01 07:44:32
date last changed
2017-10-22 03:18:35
@article{770301b2-af7c-4392-a6e2-e3ed7ef726d7,
  abstract     = {PurposeThe aim of this study was to analyse prescription refill, re-hospitalisation, total mortality, mortality because of suicide and attempted suicide among patients who were taking various types of antipsychotics. MethodsA population-based cohort study analysed all patients (n=26046) in Sweden who had been treated for schizophrenia from 2006 to 2009 with regard to re-hospitalisation and prescription refill for various types of antipsychotic treatment. A case-control study nested within the cohort analysed all-cause mortality, mortality because of suicide and attempted suicide in relation to antipsychotic use. The study adjusted for history of hospitalisation for psychiatric and medical care, attempted suicide and use of antidepressants. ResultsAripiprazole users were the only ones who showed significantly lower all-cause risks of death, but so few events occurred among users of this relatively new drug that the results should be interpreted with caution. Clozapine users showed lower odds of death by suicide (odds ratio [OR]=0.45 [95%CI 0.20-0.98]) and of attempted suicide (OR=0.44 [0.28-0.70]) than haloperidol users after adjustment for age, sex and year of discharge. Olanzapine users showed approximately the same favourable pattern. Patients who used clozapine were most likely to refill prescriptions and had lower rates of re-hospitalisation. Only one death and 23 cases of agranulocytosis were reported compared with 223 suicides and 831 suicide attempts. An etiologic fraction calculation suggests that the use of clozapine rather than traditional drugs could have prevented 95 suicide attempts during the period. ConclusionClozapine and olanzapine reduce the risk of suicide, attempted suicide and re-hospitalisation. Copyright (c) 2014 John Wiley & Sons, Ltd.},
  author       = {Weitoft, Gunilla Ringback and Berglund, Mats and Lindstrom, Eva A. and Nilsson, Mikael and Salmi, Peter and Rosen, Mans},
  issn         = {1053-8569},
  keyword      = {mortality,suicide,suicide attempts,antipsychotics,re-hospitalisation,epidemiology,pharmacoepidemiology},
  language     = {eng},
  number       = {3},
  pages        = {290--298},
  publisher    = {John Wiley & Sons},
  series       = {Pharmacoepidemiology and Drug Safety},
  title        = {Mortality, attempted suicide, re-hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden-a register-based study},
  url          = {http://dx.doi.org/10.1002/pds.3567},
  volume       = {23},
  year         = {2014},
}