UK Scientists: ANTIPSYCHOTIC 'STROKE RISK' higher than thought

UK Scientists: ANTIPSYCHOTIC 'STROKE RISK' higher than thought

Joined: April 19th, 2005, 7:01 pm

September 2nd, 2008, 9:43 am #1

<DIV><FONT face=Arial size=2>Posted for Keith </FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=Arial size=2>http://news.bbc.co.uk/1/hi/health/7586627.stm</FONT></DIV>
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Antipsychotic drug 'stroke risk' </DIV></TD></TR><TR><TD class=storybody><!-- S BO --><!-- S IIMA -->
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<P class=first>More people than previously thought could be at higher risk of having a stroke caused by their antipsychotic drugs, say UK scientists.

Previous research suggested only some types of the drug increased the risk, particularly for people with dementia.

However a study published in the British Medical Journal says all forms of antipsychotics boost the risk, in all patients.

A mental health charity said patients on the drugs must be closely monitored. <!-- E SF -->

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<DIV>Marjorie Wallace
Sane</DIV></DIV></TD></TR></TBODY></TABLE><!-- E IBOX -->
Antipsychotic drugs are generally used to control psychotic symptoms in patients with disorders such as schizophrenia, and some severe forms of depression.

They are also thought to be widely used to control symptoms of dementia such as aggression, leading to accusations they were being used unnecessarily as a "chemical cosh" in some circumstances.

They fall into two types - newer "atypical" and older "typical" antipsychotics.

When the first concerns were raised in 2002, these focused on the "atypical" drugs.

These worries led to a recommendation from drug safety watchdogs in the UK that they not be given to people with dementia, and the government has been urged to strengthen this in England in its forthcoming dementia strategy.

The latest findings, from researchers at the London School of Hygiene and Tropical Medicine, confirm the fears over dementia patients, but raise wider concerns.

They identified 6,700 patients from a GP database, all with an average age of 80, and concluded that there was more than a tripling of risk for dementia patients taking any sort of anti-psychotic drug.

Patients without dementia taking any sort of antipsychotic had a 40% increase in risk.

The researchers repeated the recommendation that patients with dementia should not be prescribed these drugs.

'Last resort'

Neil Hunt, from the Alzheimer's Society, said that doctors now needed to heed these warnings.

"The over-prescription of antipsychotics is a serious breach of human rights, these drugs should only be a last resort.

"The forthcoming National Dementia Strategy is a crucial opportunity to stop this dangerous over-prescribing and we look forward to its launch in the autumn."

Marjorie Wallace, the chief executive of the mental health charity Sane, said that while the drugs were capable of transforming lives, different patients reacted differently to their side-effects.

"This study should remind us all that antipsychotics are powerful drugs which can both be essential for some people, while carrying other risks.

"This is another warning that all antipsychotics should be prescribed with great thought and care and be subject to rigorous follow-up."
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Joined: January 1st, 1970, 12:00 am

September 3rd, 2008, 4:25 pm #2


http://www.pharmatimes.com/ClinicalNews ... x?id=14246

<SPAN class=headline id=lblArticleTitle>"<FONT size=5>Antipsychotics more than triple stroke risk in dementia</FONT></SPAN><FONT size=5> </FONT>
<SPAN class=body id=lblArticleDate style="FONT-WEIGHT: bold">01 September 2008</SPAN>
<SPAN class=body></SPAN>

<SPAN class=body>A new analysis of patient records in the UK confirms that prescribing antipsychotics to people with dementia is not only ethically dubious but carries a serious risk of stroke, particularly when the newer atypical antipsychotics are used.

Researchers from the London School of Hygiene and Tropical Medicine found that any patients given antipsychotics were 1.73 times more likely to have a stroke than when they were not taking the drugs, with 1.69 times the risk on typical and 2.32 times on atypical antipsychotics.

When those patients had recorded dementia, they were 3.50 times more likely to have a stroke while on antipsychotics than when not taking the drugs. The risk was slightly lower at 3.26 times the non-exposed population on typical antipsychotics but rose to 5.86 times when patients took atypical antipsychotics.

Patients without recorded dementia were 1.41 times more likely to have a stroke if they were taking antipsychotics, with the risk dropping marginally to 1.40 times with typical antipsychotics but increasing to 1.90 times on the atypicals.

The team led by Ian Douglas, research fellow in the School’s Department of Epidemiology and Population Health, used data from the General Practice Research Database, which includes clinical information on more than six million patients registered at over 400 general practices in the UK.

The assessed the effect of exposure to antipsychotic drugs on the likelihood of stroke in 6,790 patients with a recorded incident of stroke and at least one prescription of any antipsychotic between January 1988 and the end of 2002. Of the total cohort, 1,423 patients had recorded dementia during the study period.

The study design was the self-controlled case series method, which is derived from cohort studies and relies on intra-person comparisons in a population of individuals who have both the outcome (i.e., stroke in this case) and exposure (i.e., antipsychotics) of interest.

Rate ratios compare the rate of events during periods of exposure with the rate during all other observed time periods. This removes the potential confounding effect of characteristics that vary between individuals, such as frailty and risk factors for vascular disease, the authors explained.

Presenting their results in the BMJ, they commented: “As the background risk of stroke in elderly patients is relatively high, we re-affirm that the risks associated with antipsychotic drug use in patients with dementia generally outweigh the potential benefits, and use of antipsychotic drugs in these patients should be avoided wherever possible”.

In March 2004, the UK’s Committee on Safety of Medicines (CSM) warned that Eli Lilly’s Zyprexa (olanzapine) and Johnson & Johnson’s Risperdal (risperidone) had been linked to a three-fold increase in stroke when used to treat behavioural problems in older patients with dementia. The CSM recommended against off-label use of the antipsychotics in this setting.

Earlier this year, however, a report published by the All Party Parliamentary Group on Dementia in partnership with the Alzheimer’s Society claimed that as many as 105,000 dementia patients in the UK were being treated inappropriately with antipsychotic drugs.
<EM>By Peter Mansell</EM> "

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Joined: January 1st, 1970, 12:00 am

September 3rd, 2008, 4:28 pm #3

<EM>"...Researchers from the London School of Hygiene and Tropical Medicine found that any patients given antipsychotics were 1.73 times more likely to have a stroke than when they were not taking the drugs, with 1.69 times the risk on typical and 2.32 times on atypical antipsychotics..."
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Joined: January 1st, 1970, 12:00 am

September 3rd, 2008, 4:40 pm #4

<DIV><FONT face=Arial size=2>Posted for Keith </FONT></DIV>
<DIV>&nbsp;</DIV>
<DIV><FONT face=Arial size=2>http://news.bbc.co.uk/1/hi/health/7586627.stm</FONT></DIV>
<DIV><TR><TD colspan="2">
<DIV class=mxb>
Antipsychotic drug 'stroke risk' </DIV></TD></TR><TR><TD class=storybody><!-- S BO --><!-- S IIMA -->
<TABLE cellSpacing=0 cellPadding=0 width=226 align=right border=0>
<TBODY>
<TR>
<TD>
<DIV><IMG height=170 alt="Man with head in hands" hspace=0 src="http://webmail.ntlworld.com/agent/mobmain/_44967324_headinhands226.jpg?msgvw=AGoAAgA%%2bAAAAJwBvAD8AewBiAHoAaAAUABcAdAAtAD8AAgBGAE0AXQBBADcAAQBrAEkAeQAmADUAOwAgAHoAUw" width=226 border=0>
</DIV></TD></TR></TBODY></TABLE><!-- E IIMA --><!-- S SF -->
<P class=first>More people than previously thought could be at higher risk of having a stroke caused by their antipsychotic drugs, say UK scientists.

Previous research suggested only some types of the drug increased the risk, particularly for people with dementia.

However a study published in the British Medical Journal says all forms of antipsychotics boost the risk, in all patients.

A mental health charity said patients on the drugs must be closely monitored. <!-- E SF -->

<!-- S IBOX -->

<TABLE cellSpacing=0 cellPadding=0 width=231 align=right border=0>
<TBODY>
<TR>
<TD width=5><IMG height=1 alt="" hspace=0 src="http://webmail.ntlworld.com/agent/mobmain/o.gif?msgvw=ADcABgAsABoAHgALAA8AGQB7AGgAXAAWAAMAPAANACIAUgB%%2fAEEABwBMADwAOABwAFsAYgA8AB0AFgAcAD8AWg" width=5 border=0></TD>
<TD class=sibtbg>
<DIV>
</DIV>
<DIV class=mva>
<DIV>Marjorie Wallace
Sane</DIV></DIV></TD></TR></TBODY></TABLE><!-- E IBOX -->
Antipsychotic drugs are generally used to control psychotic symptoms in patients with disorders such as schizophrenia, and some severe forms of depression.

They are also thought to be widely used to control symptoms of dementia such as aggression, leading to accusations they were being used unnecessarily as a "chemical cosh" in some circumstances.

They fall into two types - newer "atypical" and older "typical" antipsychotics.

When the first concerns were raised in 2002, these focused on the "atypical" drugs.

These worries led to a recommendation from drug safety watchdogs in the UK that they not be given to people with dementia, and the government has been urged to strengthen this in England in its forthcoming dementia strategy.

The latest findings, from researchers at the London School of Hygiene and Tropical Medicine, confirm the fears over dementia patients, but raise wider concerns.

They identified 6,700 patients from a GP database, all with an average age of 80, and concluded that there was more than a tripling of risk for dementia patients taking any sort of anti-psychotic drug.

Patients without dementia taking any sort of antipsychotic had a 40% increase in risk.

The researchers repeated the recommendation that patients with dementia should not be prescribed these drugs.

'Last resort'

Neil Hunt, from the Alzheimer's Society, said that doctors now needed to heed these warnings.

"The over-prescription of antipsychotics is a serious breach of human rights, these drugs should only be a last resort.

"The forthcoming National Dementia Strategy is a crucial opportunity to stop this dangerous over-prescribing and we look forward to its launch in the autumn."

Marjorie Wallace, the chief executive of the mental health charity Sane, said that while the drugs were capable of transforming lives, different patients reacted differently to their side-effects.

"This study should remind us all that antipsychotics are powerful drugs which can both be essential for some people, while carrying other risks.

"This is another warning that all antipsychotics should be prescribed with great thought and care and be subject to rigorous follow-up."
</DIV>
<EM><STRONG>"...RESULTS:</STRONG> A 24% increased risk of a CVE was noted in patients with current exposure to selective serotonin-reuptake inhibitors (SSRIs; adjusted hazard ratio
1.24; 95% CI 1.07 to 1.44), 34% increased risk for current exposure to tricyclic antidepressants (HR 1.34; 95% CI 1.10 to 1.62), and 43% increased risk for current exposure to other antidepressants (HR 1.43; 95% CI 1.21 to 1.69). The risk of ischemic stroke in current SSRI users was significantly higher (HR 1.55; 95% CI 1.00 to 2.39) compared with remote/nonusers. </EM>
<EM>CONCLUSIONS: Current users of antidepressants may be at <STRONG>increased risk of a CVE. </STRONG>Clinicians should consider the relationship of antidepressants with the occurrence of CVEs when determining the risk-benefit profile of pharmacologic treatment in patients with depression, particularly those with existing risk factors for a CVE...."</EM>
<STRONG></STRONG>&nbsp;
<STRONG>http://www.theannals.com/cgi/content/abstract/42/2/177</STRONG>
"NEUROLOGY
Risk of Cerebrovascular Events Associated with Antidepressant Use in Patients with Depression: A Population-Based, Nested Case-Control Study
<STRONG></NOBR><NOBR>Yan Chen, MB MPH PhD</NOBR> </STRONG>
Research Associate of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, Cincinnati, OH
<STRONG></NOBR><NOBR>Jeff J Guo, PhD</NOBR> </STRONG>
Associate Professor of Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center
<STRONG></NOBR><NOBR>Hong Li, PhD MPH</NOBR> </STRONG>
Group Director, Outcomes Research, Asia Pacific, Bristol-Myers Squibb Co., Singapore
<STRONG></NOBR><NOBR>Lawson Wulsin, MD</NOBR> </STRONG>
Professor, Department of Psychiatry, College of Medicine, University of Cincinnati Medical Center
<STRONG></NOBR><NOBR>Nick C Patel, PharmD PhD</NOBR> </STRONG>
Assistant Professor, College of Pharmacy, University of Georgia; Department of Psychiatry, Medical College of Georgia, Augusta, GA
Reprints: Dr. Chen, Department of Pharmacy Practice and Administrative Sciences, School of Pharmacy, University of Cincinnati Medical Center, 3225 Eden Ave., Cincinnati, OH 45267, fax 513/558-4372, <SPAN id=em0>[url=mailto:yance@email.uc.edu]yance@email.uc.edu[/url]</SPAN>
<SCRIPT type=text/javascript><!--
var u = "yance", d = "email.uc.edu"; document.getElementById("em0").innerHTML = '<a href="mailto:' + u + '@' + d + '">' + u + '@' + d + '<\/a>'//--></SCRIPT>


<!-- ABS -->BACKGROUND: Given the widespread use of antidepressants and the negative consequence of cerebrovascular events (CVEs), an evaluation of the risk of CVEs associated with antidepressants is warranted.
OBJECTIVE: To examine the association between the use of an antidepressant and risk of CVEs among patients diagnosed with depression.
METHODS: A case-control study was performed using a managed care medical claims database from 1998 through 2002. A total of 1086 cases with CVEs were identified and matched with 6515 controls by age, sex, and the year of the index date of depression. Case patients were categorized by stroke type: hemorrhagic stroke, ischemic stroke, and other CVEs. Diagnoses of depression, CVEs, and other medical comorbidities were identified based on International Classification of Diseases, Ninth Revision, codes. Patients were defined as current users (antidepressant ended <IMG alt=¡Ü src="http://www.theannals.com/math/le.gif" border=0>30 days before CVE), recent users (31-60 days before CVE), past users (61-90 days before CVE), and remote/nonusers (<IMG alt=¡Ý src="http://www.theannals.com/math/ge.gif" border=0>91 days before CVE or nonuse). Cox proportional hazards regression analysis was conducted to estimate the risk of CVEs associated with antidepressant use.
RESULTS: A 24% increased risk of a CVE was noted in patients with current exposure to selective serotonin-reuptake inhibitors (SSRIs; adjusted hazard ratio
1.24; 95% CI 1.07 to 1.44), 34% increased risk for current exposure to tricyclic antidepressants (HR 1.34; 95% CI 1.10 to 1.62), and 43% increased risk for current exposure to other antidepressants (HR 1.43; 95% CI 1.21 to 1.69). The risk of ischemic stroke in current SSRI users was significantly higher (HR 1.55; 95% CI 1.00 to 2.39) compared with remote/nonusers.
CONCLUSIONS: Current users of antidepressants may be at increased risk of a CVE. Clinicians should consider the relationship of antidepressants with the occurrence of CVEs when determining the risk-benefit profile of pharmacologic treatment in patients with depression, particularly those with existing risk factors for a CVE.

<STRONG>Key Words:</STRONG> antidepressants, case-control study, cerebrovascular events, depression
Published Online, January 22, 2008. www.theannals.com, DOI 10.1345/aph.1K369 "
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Joined: January 1st, 1970, 12:00 am

September 3rd, 2008, 4:44 pm #5

<EM><STRONG>"...RESULTS:</STRONG> A 24% increased risk of a CVE was noted in patients with current exposure to selective serotonin-reuptake inhibitors (SSRIs; adjusted hazard ratio
1.24; 95% CI 1.07 to 1.44), 34% increased risk for current exposure to tricyclic antidepressants (HR 1.34; 95% CI 1.10 to 1.62), and 43% increased risk for current exposure to other antidepressants (HR 1.43; 95% CI 1.21 to 1.69). The risk of ischemic stroke in current SSRI users was significantly higher (HR 1.55; 95% CI 1.00 to 2.39) compared with remote/nonusers. ..."</EM>
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