The Resource Off-label use of atypical antipsychotics : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Southern California Evidence-Based Practice Center ; authors, Margaret Maglione [and others], (electronic resource)

Off-label use of atypical antipsychotics : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Southern California Evidence-Based Practice Center ; authors, Margaret Maglione [and others], (electronic resource)

Label
Off-label use of atypical antipsychotics : an update
Title
Off-label use of atypical antipsychotics
Title remainder
an update
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Southern California Evidence-Based Practice Center ; authors, Margaret Maglione [and others]
Contributor
Subject
Genre
Language
eng
Summary
OBJECTIVES: Antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for treatment of schizophrenia, bipolar disorder, and for some drugs, depression. We performed a systematic review on the efficacy and safety of atypical antipsychotic drugs for use in conditions lacking FDA approval. DATA SOURCES: We searched PubMed, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane DARE (Database of Abstracts of Reviews of Effects), and Cochrane CENTRAL (Cochrane Central Register of Controlled Trials) from inception to May 2011. We included only English-language studies. REVIEW METHODS: Controlled trials comparing an atypical antipsychotic (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone, asenapine, iloperidone, paliperidone) to either placebo, another atypical antipsychotic drug, or other pharmacotherapy, for the off-label conditions of anxiety disorder, attention deficit hyperactivity disorder, dementia and severe geriatric agitation, major depressive disorder, eating disorders, insomnia, obsessive compulsive disorder (OCD), post traumatic stress disorder (PTSD), personality disorders, substance abuse, and Tourette's syndrome were included. Observational studies with sample sizes greater than 1,000 were included to assess rare adverse events. Two investigators conducted independent article review, data abstraction, and study quality assessment. RESULTS: One hundred seventy trials contributed data to the efficacy review. Among the placebo-controlled trials of elderly patients with dementia reporting a total/global outcome score that includes symptoms such as psychosis, mood alterations, and aggression, small but statistically significant effect sizes ranging from 0.12 and 0.20 were observed for aripiprazole, olanzapine, and risperidone. For generalized anxiety disorder, pooled analysis of three large trials showed that quetiapine was associated with a 26 percent greater likelihood of "responding," defined as at least 50 percent improvement on the Hamilton Anxiety Scale, compared with placebo. For obsessive-compulsive disorder, risperidone was associated with a 3.9-fold greater likelihood of "responding," defined as a 25 to 35 percent improvement on the Yale Brown Obsessive Compulsive Scale (YBOCS) compared with placebo. We identified 6 trials on eating disorders, 12 on personality disorder, an existing meta-analysis and 10 trials of risperidone or olanzapine for PTSD, 36 trials for depression of which 7 assessed drugs without an FDA-approved indication, and 33 trials of aripiprazole, olanzapine, quetiapine, or risperidone for treating substance abuse disorders. We identified one small trial (N=13) of atypical antipsychotics for insomnia which was inconclusive. For eating disorder patients specifically, evidence shows that atypicals are do not cause significant weight gain. The level of evidence is mixed regarding personality disorders and moderate for an association of risperidone with improving post-traumatic stress disorder. Evidence does not support efficacy of atypical antipsychotics for substance abuse. In elderly patients, adverse events included an increased risk of death (number needed to harm [NNH]=87), stroke (for risperidone, NNH=53), extrapyramidal symptoms (for olanzapine (NNH=10) and risperidone (NNH=20), and urinary symptoms (NNH= from 16 to 36). In nonelderly adults, adverse events included weight gain (particularly with olanzapine), fatigue, sedation, akithisia (for aripiprazole) and extrapyramidal symptoms. Direct comparisons of different atypical antipsychotics for off-label conditions are rare. CONCLUSIONS: Benefits and harms vary among atypical antipsychotics for off-label usage. For symptoms associated with dementia in elderly patients, small but statistically significant benefits were observed for aripiprazole, olanzapine, and risperidone. Quetiapine was associated with benefits in the treatment of generalized anxiety disorder, and risperidone was associated with benefits in the treatment of OCD; however, adverse events were common
Member of
Cataloging source
NLM
Funding information
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by: Southern California Evidence-based Practice Center
Government publication
federal national government publication
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
QV 77.9
http://library.link/vocab/relatedWorkOrContributorName
  • Maglione, Margaret
  • United States
  • Southern California Evidence-Based Practice Center/RAND
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness reviews
  • AHRQ publication
Series volume
  • no. 43
  • no. 11-EHC087-EFAHRQ
http://library.link/vocab/subjectName
  • Antipsychotic Agents
  • Off-Label Use
http://bibfra.me/vocab/relation/supportingbody
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Label
Off-label use of atypical antipsychotics : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Southern California Evidence-Based Practice Center ; authors, Margaret Maglione [and others], (electronic resource)
Instantiates
Publication
Note
"September 2011."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
773978659
Dimensions
unknown
Extent
1 online resource (437 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)773978659
Label
Off-label use of atypical antipsychotics : an update, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Southern California Evidence-Based Practice Center ; authors, Margaret Maglione [and others], (electronic resource)
Publication
Note
"September 2011."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Color
multicolored
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
773978659
Dimensions
unknown
Extent
1 online resource (437 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)773978659

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