Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders
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2021
Authors
Smith, RobertTveito, Marit
Kyllesø, Lennart
Jukić, Marin

Ingelman-Sundberg, Magnus

Andreassen, Ole
Molden, Espen

Article (Published version)

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Background: Nonadherence to antipsychotics may cause relapse and hospitalizations in patients with psychotic disorders. The purpose was to quantify and compare the outpatient's nonadherence rates of atypical antipsychotics by objective detection in blood samples. Methods: Totally, 13,217 outpatients with therapeutic drug monitoring (TDM) data of atypical antipsychotics were included. An event of complete nonadherence was defined as an occurrence of undetectable level of a prescribed antipsychotic in the blood sample submitted for TDM. Patients with such an event(s) were defined as nonadherent of the respective drug treatment (outcome). The rates of nonadherence patients were compared between the drugs by logistic regression. Results: In the study population, 70.2% of the patients were prescribed doses compliant with a schizophrenia diagnosis. The mean olanzapine equivalent dose in the population was 13.4 mg (95% confidence interval (CI): 13.3, 13.6). The frequency of nonadherence patie...nts, regardless of drug, was 3.7% (CI: 3.4–4.0). The nonadherence patient rate was lowest in clozapine-treated patients (2.2%; CI: 1.5–2.8), followed by aripiprazole (2.3%; 1.7–2.8), risperidone (2.4%; 1.6–3.0), quetiapine (2.8%; 2.3–3.2) and olanzapine (4.9%; 4.1–5.3). Users of olanzapine had significantly higher risk of complete nonadherence (Odds ratio: 1.9; CI: 1.6–2.3, p < 0.001) compared to patients treated with other antipsychotics as a group. Conclusions: In this study, complete nonadherence of atypical antipsychotics, measured as undetectable blood level, was disclosed for ~5% of outpatients with psychotic disorders. The rate of complete nonadherence was significantly higher during olanzapine treatment compared to other atypical antipsychotics. Further studies should investigate if this reflects drug differences in tolerability or other causal relationships.
Keywords:
Atypical antipsychotics / Nonadherence / Olanzapine / Outpatient treatment / Therapeutic drug monitoringSource:
Schizophrenia Research, 2021, 228, 590-596Publisher:
- Elsevier B.V.
Funding / projects:
- South-Eastern NorwayRegional Health Authority, Hamar, Norway (grant numbers 2016097 to RLS and EM,2017085 to MT)
- Research Council of Norway, Oslo, Norway (grant number 223273 toOAA.)
- H2020 program U-PGx, Stockholm, Sweden (grant number 668353 to MI-S)
- The Swedish Research Council, Stockholm, Sweden (grant number 2015-02760 to MI-S)
- The Swedish Brain Foundation, Stockholm, Sweden
DOI: 10.1016/j.schres.2020.11.025
ISSN: 0920-9964
WoS: 000631081000087
Scopus: 2-s2.0-85096900463
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PharmacyTY - JOUR AU - Smith, Robert AU - Tveito, Marit AU - Kyllesø, Lennart AU - Jukić, Marin AU - Ingelman-Sundberg, Magnus AU - Andreassen, Ole AU - Molden, Espen PY - 2021 UR - https://farfar.pharmacy.bg.ac.rs/handle/123456789/3805 AB - Background: Nonadherence to antipsychotics may cause relapse and hospitalizations in patients with psychotic disorders. The purpose was to quantify and compare the outpatient's nonadherence rates of atypical antipsychotics by objective detection in blood samples. Methods: Totally, 13,217 outpatients with therapeutic drug monitoring (TDM) data of atypical antipsychotics were included. An event of complete nonadherence was defined as an occurrence of undetectable level of a prescribed antipsychotic in the blood sample submitted for TDM. Patients with such an event(s) were defined as nonadherent of the respective drug treatment (outcome). The rates of nonadherence patients were compared between the drugs by logistic regression. Results: In the study population, 70.2% of the patients were prescribed doses compliant with a schizophrenia diagnosis. The mean olanzapine equivalent dose in the population was 13.4 mg (95% confidence interval (CI): 13.3, 13.6). The frequency of nonadherence patients, regardless of drug, was 3.7% (CI: 3.4–4.0). The nonadherence patient rate was lowest in clozapine-treated patients (2.2%; CI: 1.5–2.8), followed by aripiprazole (2.3%; 1.7–2.8), risperidone (2.4%; 1.6–3.0), quetiapine (2.8%; 2.3–3.2) and olanzapine (4.9%; 4.1–5.3). Users of olanzapine had significantly higher risk of complete nonadherence (Odds ratio: 1.9; CI: 1.6–2.3, p < 0.001) compared to patients treated with other antipsychotics as a group. Conclusions: In this study, complete nonadherence of atypical antipsychotics, measured as undetectable blood level, was disclosed for ~5% of outpatients with psychotic disorders. The rate of complete nonadherence was significantly higher during olanzapine treatment compared to other atypical antipsychotics. Further studies should investigate if this reflects drug differences in tolerability or other causal relationships. PB - Elsevier B.V. T2 - Schizophrenia Research T1 - Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders VL - 228 SP - 590 EP - 596 DO - 10.1016/j.schres.2020.11.025 ER -
@article{ author = "Smith, Robert and Tveito, Marit and Kyllesø, Lennart and Jukić, Marin and Ingelman-Sundberg, Magnus and Andreassen, Ole and Molden, Espen", year = "2021", abstract = "Background: Nonadherence to antipsychotics may cause relapse and hospitalizations in patients with psychotic disorders. The purpose was to quantify and compare the outpatient's nonadherence rates of atypical antipsychotics by objective detection in blood samples. Methods: Totally, 13,217 outpatients with therapeutic drug monitoring (TDM) data of atypical antipsychotics were included. An event of complete nonadherence was defined as an occurrence of undetectable level of a prescribed antipsychotic in the blood sample submitted for TDM. Patients with such an event(s) were defined as nonadherent of the respective drug treatment (outcome). The rates of nonadherence patients were compared between the drugs by logistic regression. Results: In the study population, 70.2% of the patients were prescribed doses compliant with a schizophrenia diagnosis. The mean olanzapine equivalent dose in the population was 13.4 mg (95% confidence interval (CI): 13.3, 13.6). The frequency of nonadherence patients, regardless of drug, was 3.7% (CI: 3.4–4.0). The nonadherence patient rate was lowest in clozapine-treated patients (2.2%; CI: 1.5–2.8), followed by aripiprazole (2.3%; 1.7–2.8), risperidone (2.4%; 1.6–3.0), quetiapine (2.8%; 2.3–3.2) and olanzapine (4.9%; 4.1–5.3). Users of olanzapine had significantly higher risk of complete nonadherence (Odds ratio: 1.9; CI: 1.6–2.3, p < 0.001) compared to patients treated with other antipsychotics as a group. Conclusions: In this study, complete nonadherence of atypical antipsychotics, measured as undetectable blood level, was disclosed for ~5% of outpatients with psychotic disorders. The rate of complete nonadherence was significantly higher during olanzapine treatment compared to other atypical antipsychotics. Further studies should investigate if this reflects drug differences in tolerability or other causal relationships.", publisher = "Elsevier B.V.", journal = "Schizophrenia Research", title = "Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders", volume = "228", pages = "590-596", doi = "10.1016/j.schres.2020.11.025" }
Smith, R., Tveito, M., Kyllesø, L., Jukić, M., Ingelman-Sundberg, M., Andreassen, O.,& Molden, E.. (2021). Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders. in Schizophrenia Research Elsevier B.V.., 228, 590-596. https://doi.org/10.1016/j.schres.2020.11.025
Smith R, Tveito M, Kyllesø L, Jukić M, Ingelman-Sundberg M, Andreassen O, Molden E. Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders. in Schizophrenia Research. 2021;228:590-596. doi:10.1016/j.schres.2020.11.025 .
Smith, Robert, Tveito, Marit, Kyllesø, Lennart, Jukić, Marin, Ingelman-Sundberg, Magnus, Andreassen, Ole, Molden, Espen, "Rates of complete nonadherence among atypical antipsychotic drugs: A study using blood samples from 13,217 outpatients with psychotic disorders" in Schizophrenia Research, 228 (2021):590-596, https://doi.org/10.1016/j.schres.2020.11.025 . .