Atypical antipsychotics off-label use increases diabetes risk among elderly: new study

Atypical antipsychotics are used for treating schizophrenia, bipolar mania and acute mania and are s

Prescription Solutions, a pharmacy benefits management organisation and UnitedHealth Group company have released results of a new study which showed an important new evidence that the use of atypical antipsychotics among the elderly for off-label purposes is associated with increased risk of developing diabetes.

Prescription Solutions and UnitedHealth Group company said that Atypical antipsychotics (AAs) are a group of newer-generation antipsychotic drugs that are indicated for the treatment of psychiatric conditions including schizophrenia, bipolar mania and acute mania; but are often prescribed for unapproved indications ('off-label') by physicians.

The correlation between the use of AAs and new-onset metabolic syndrome (which often leads to diabetes) has been widely documented in younger and middle-aged schizophrenic and bipolar patients. Previous studies suggested that because the elderly are usually given AAs in smaller doses than younger patients, the same weight gain and resulting diabetes would not be expected.

However, in this retrospective study of 78,450 elderly patients without diagnoses of schizophrenia, bipolar disorder or diabetes, an association was demonstrated between study patients being on an atypical antipsychotic and starting a diabetic medication.

This was demonstrated even though 97 per cent of the study patients with AA fills had doses within recommended guidelines for the treatment of dementia. Elderly patients with at least one fill of an AA drug had 32 per cent greater odds of starting a medication for diabetes within one year compared to similar patients without AA exposure.

Reportedly, AAs are widely used for off-label indications in the elderly for conditions such as dementia. Earlier studies may not have shown the same correlation between AAs and diabetes due to smaller study sample sizes or missing data. For example, the CATIE-AD trial2 demonstrated that female patients with Alzheimer's disease had weight gain with AA treatment, but the study was not powered to measure outcomes related to diabetes.

Joseph Addiego, senior vice president and chief medical officer of Prescription Solutions, said: "We are fortunate to have a wealth of retrospective data that helps us study the effects of medications on this growing population.

"The message for physicians who may be prescribing atypical antipsychotics for the elderly is to be careful not to discount the risk of new-onset diabetes, even when prescribing these drugs in small doses".