February 23, 2012

expert reaction to study of antipsychotics and mortality in elderly dementia patients as published in BMJ

A study in the British Medical Journal suggested that elderly nursing home residents taking certain antipsychotic medication had an increased risk of death.

Dr Anne Corbett, Research Manager, Alzheimer’s Society, said:

“This research supports existing studies that have shown antipsychotics can raise the risk of death, particularly when used over the longer term. As many as 150,000 of the 180,000 people with dementia who are on the drugs in the UK have been prescribed inappropriately. For a minority of people with dementia antipsychotics should be used, but then only for up to twelve weeks, and under the correct circumstances. For the majority, they do far more harm than good.

“It is essential alternative treatment approaches are provided to help GPs and other medical professionals reduce the prescribing of these dangerous drugs.”

Dr Chris Fox, Senior Lecturer in Dementia Research, University of East Anglia, said:

“This study provides an interesting insight into the differential harm of these medicines. More work is needed on alternatives to these medicines in dementia with behavioural problems. In addition, there is a need to consider duration of use in more acute situations such as severe distress – is 6 or 12 week use safe in people with dementia?”

David Nutt, Professor of Neuropsychopharmacology, Imperial College London, said:

“It’s good to have a more fine-grained analysis of the relative effects of these different compounds. This should help direct safer and more rational prescribing. However, more research is required before we really understand the reasons for these differences, which are likely to relate to the different receptor interactions of these drugs, which vary a great deal, though their kinetics also need to be considered, particularly as quetiapine [the safest] has the shortest half-life.”

Rebecca Wood, Chief Executive at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:

“The risks associated with antipsychotics are well-established, and these findings underline the importance of ensuring that where these drugs are prescribed, their use must be carefully monitored. Antipsychotics should only be used for people with dementia where there is no alternative for dealing with challenging behaviour. Alzheimer’s Research UK has called for action to reduce the use of antipsychotics and develop alternatives, yet progress has been frustratingly slow.

“While we welcome research that can inform doctors’ decisions about prescribing existing medication, we urgently need to find safer, more effective treatments for people with dementia. These can only come through research, but funding for dementia research still lags far behind that of other serious diseases. If we are to improve the lives of people with dementia, we must invest in research.”

‘Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study’ by Huybrechts, K.F. et al., published in BMJ on Thursday 23rd February.