Small increased risk of death with atypicals
Atypical antipsychotic drugs may be associated with a small increased risk of death compared with placebo, researchers say (JAMA 2005;294:1934).
Lon Schneider, University of Southern California, Los Angeles, and colleagues
conducted a meta-analysis of published and unpublished clinical trials
of antipsychotic drugs in patients with Alzheimer’s disease or
dementia.
A total of 3,353 patients taking either aripiprazole (Abilify), olanzapine
(Zyprexa), quetiapine (Seroquel) or risperidone (Risperdal), plus 1,757
taking placebo, were included.
For treatment periods of less than eight to 12 weeks, the researchers
found that death occurred more frequently in patients treated with antipsychotics
compared with placebo (overall odds ratio 1.54; 95 per cent confidence
interval 1.06–2.23, P=0.02). They found no evidence for differential
risks for individual drugs and the increased risk could only be identified
when the data were combined in a meta-analysis.
The researchers estimate that the likelihood of the drugs helping rather than
harming may be modest. “For every nine to 25 persons helped in these trials
there possibly will be one death,” they say. “The established risks
for cerebrovascular adverse events together with the present observations suggest
that antipsychotic drugs should be used with care in these patients.”
They add that the effect may not be limited to atypical drugs and may be associated
with haloperidol and other drugs used in elderly patients with dementia.
The authors of an accompanying editorial (ibid, p1963) say the results do not
contraindicate use of antipsychotic drugs in this patient group but change the
risk-benefit analysis. They should only be used when there is an identifiable
risk of harm to others, the distress caused by symptoms is significant, or when
other therapies have failed, they say. |
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