Benefits and harms of atypical antipsychotics for agitation in adults with dementia

Martin Farlow, Tatyana A. Shamliyan

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

We evaluated the most current evidence regarding the benefits and harms of atypical antipsychotics in adults with dementia. In June 2016, following a protocol developed a priori, we systematically searched several databases for published and unpublished data from randomized controlled trials (RCT), observational studies, and meta-analyses; conducted direct meta-analyses using a random effects model; and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. One high-quality meta-analysis and published and unpublished data from 8 RCTs and 12 large observational studies met inclusion criteria. When compared with placebo, aripiprazole, risperidone, and olanzapine but not quetiapine result in modest (standardized mean difference <0.5 standard deviations) improvement in neuropsychiatric symptoms. Aripiprazole, risperidone, quetiapine, and olanzapine are associated with increased odds of acute myocardial infraction, and risperidone and olanzapine are associated with increased odds of hip fracture. Observational studies suggest no differences in all-cause mortality between atypical antipsychotics. Observational studies suggest that atypical antipsychotics are associated with lower risk of all-cause mortality and extrapyramidal symptoms but higher risk of stroke when compared with conventional antipsychotics. To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms, informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infraction and bone fractures.

Original languageEnglish (US)
Pages (from-to)217-231
Number of pages15
JournalEuropean Neuropsychopharmacology
Volume27
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

olanzapine
Antipsychotic Agents
Dementia
Observational Studies
Risperidone
Meta-Analysis
Behavioral Symptoms
Mortality
Bone Fractures
Hip Fractures
Caregivers
Randomized Controlled Trials
Stroke
Placebos
Databases

Keywords

  • Aripiprazole
  • Atypical antipsychotics
  • Evidence-based medicine
  • Olanzapine
  • Quality of evidence
  • Quetiapine
  • Risperidone

ASJC Scopus subject areas

  • Pharmacology
  • Neurology
  • Clinical Neurology
  • Psychiatry and Mental health
  • Biological Psychiatry
  • Pharmacology (medical)

Cite this

Benefits and harms of atypical antipsychotics for agitation in adults with dementia. / Farlow, Martin; Shamliyan, Tatyana A.

In: European Neuropsychopharmacology, Vol. 27, No. 3, 01.03.2017, p. 217-231.

Research output: Contribution to journalReview article

@article{9a3ec3e319f243528461b6009b409237,
title = "Benefits and harms of atypical antipsychotics for agitation in adults with dementia",
abstract = "We evaluated the most current evidence regarding the benefits and harms of atypical antipsychotics in adults with dementia. In June 2016, following a protocol developed a priori, we systematically searched several databases for published and unpublished data from randomized controlled trials (RCT), observational studies, and meta-analyses; conducted direct meta-analyses using a random effects model; and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. One high-quality meta-analysis and published and unpublished data from 8 RCTs and 12 large observational studies met inclusion criteria. When compared with placebo, aripiprazole, risperidone, and olanzapine but not quetiapine result in modest (standardized mean difference <0.5 standard deviations) improvement in neuropsychiatric symptoms. Aripiprazole, risperidone, quetiapine, and olanzapine are associated with increased odds of acute myocardial infraction, and risperidone and olanzapine are associated with increased odds of hip fracture. Observational studies suggest no differences in all-cause mortality between atypical antipsychotics. Observational studies suggest that atypical antipsychotics are associated with lower risk of all-cause mortality and extrapyramidal symptoms but higher risk of stroke when compared with conventional antipsychotics. To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms, informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infraction and bone fractures.",
keywords = "Aripiprazole, Atypical antipsychotics, Evidence-based medicine, Olanzapine, Quality of evidence, Quetiapine, Risperidone",
author = "Martin Farlow and Shamliyan, {Tatyana A.}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.euroneuro.2017.01.002",
language = "English (US)",
volume = "27",
pages = "217--231",
journal = "European Neuropsychopharmacology",
issn = "0924-977X",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Benefits and harms of atypical antipsychotics for agitation in adults with dementia

AU - Farlow, Martin

AU - Shamliyan, Tatyana A.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - We evaluated the most current evidence regarding the benefits and harms of atypical antipsychotics in adults with dementia. In June 2016, following a protocol developed a priori, we systematically searched several databases for published and unpublished data from randomized controlled trials (RCT), observational studies, and meta-analyses; conducted direct meta-analyses using a random effects model; and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. One high-quality meta-analysis and published and unpublished data from 8 RCTs and 12 large observational studies met inclusion criteria. When compared with placebo, aripiprazole, risperidone, and olanzapine but not quetiapine result in modest (standardized mean difference <0.5 standard deviations) improvement in neuropsychiatric symptoms. Aripiprazole, risperidone, quetiapine, and olanzapine are associated with increased odds of acute myocardial infraction, and risperidone and olanzapine are associated with increased odds of hip fracture. Observational studies suggest no differences in all-cause mortality between atypical antipsychotics. Observational studies suggest that atypical antipsychotics are associated with lower risk of all-cause mortality and extrapyramidal symptoms but higher risk of stroke when compared with conventional antipsychotics. To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms, informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infraction and bone fractures.

AB - We evaluated the most current evidence regarding the benefits and harms of atypical antipsychotics in adults with dementia. In June 2016, following a protocol developed a priori, we systematically searched several databases for published and unpublished data from randomized controlled trials (RCT), observational studies, and meta-analyses; conducted direct meta-analyses using a random effects model; and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. One high-quality meta-analysis and published and unpublished data from 8 RCTs and 12 large observational studies met inclusion criteria. When compared with placebo, aripiprazole, risperidone, and olanzapine but not quetiapine result in modest (standardized mean difference <0.5 standard deviations) improvement in neuropsychiatric symptoms. Aripiprazole, risperidone, quetiapine, and olanzapine are associated with increased odds of acute myocardial infraction, and risperidone and olanzapine are associated with increased odds of hip fracture. Observational studies suggest no differences in all-cause mortality between atypical antipsychotics. Observational studies suggest that atypical antipsychotics are associated with lower risk of all-cause mortality and extrapyramidal symptoms but higher risk of stroke when compared with conventional antipsychotics. To manage agitation in adults with progressive dementia, clinicians may recommend atypical antipsychotics with continuous monitoring of behavioral symptoms, informing patients and their families or caregivers of the significant risk of adverse effects and baseline risk of acute myocardial infraction and bone fractures.

KW - Aripiprazole

KW - Atypical antipsychotics

KW - Evidence-based medicine

KW - Olanzapine

KW - Quality of evidence

KW - Quetiapine

KW - Risperidone

UR - http://www.scopus.com/inward/record.url?scp=85009729285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009729285&partnerID=8YFLogxK

U2 - 10.1016/j.euroneuro.2017.01.002

DO - 10.1016/j.euroneuro.2017.01.002

M3 - Review article

C2 - 28111239

AN - SCOPUS:85009729285

VL - 27

SP - 217

EP - 231

JO - European Neuropsychopharmacology

JF - European Neuropsychopharmacology

SN - 0924-977X

IS - 3

ER -