All-cause mortality and antipsychotic use among elderly persons with high baseline cardiovascular and cerebrovascular risk: a multi-center retrospective cohort study in Italy

Janet Sultana, Francesco Giorgianni, Federico Rea, Ersilia Lucenteforte, Niccolò Lombardi, Alessandro Mugelli, Alfredo Vannacci, Rosa Liperoti, Ursula Kirchmayer, Cristiana Vitale, Alessandro Chinellato, Giuseppe Roberto, Giovanni Corrao, Gianluca Trifirò

Research output: Contribution to journalArticle

Abstract

Background: Little is known about the comparative risk of death with atypical or conventional antipsychotics (APs) among persons with cardiovascular or cerebrovascular disease (CCD). Research design and methods: A cohort study was conducted using five Italian claims databases. New atypical AP users with CCD aged ≥65 (reference) were matched to new conventional AP users. Mortality per 100 person-years (PYs) and hazard ratios (HR), estimated using Cox models, were reported. Incidence and risk of death were estimated for persons having drug–drug interactions. Outcome occurrence was evaluated 180 days after AP initiation. Results: Overall 24,711 and 27,051 elderly new conventional and atypical AP users were identified. The mortality rate was 51.3 and 38.5 deaths per 100 PYs for conventional and atypical AP users. Mortality risk was 1.33 (95%CI: 1.27–1.39) for conventional APs. There was no increased mortality risk with single drug–drug interactions (DDIs) vs. no DDI. AP users with ≥1 DDI had a 29% higher mortality risk compared to no DDI in the first 90 days of treatment (HR: 1.29 (95% CI: 1.00–1.67)). Conclusions: Conventional APs had a higher risk of death than atypical APs among elderly persons with CCD. Having ≥1 DDI was associated with an increased risk of death.

Original languageEnglish
Pages (from-to)179-188
Number of pages10
JournalExpert Opinion on Drug Metabolism and Toxicology
Volume15
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

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Keywords

  • Antipsychotics
  • cohort study
  • drug interactions
  • elderly
  • mortality

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology

Cite this

Sultana, J., Giorgianni, F., Rea, F., Lucenteforte, E., Lombardi, N., Mugelli, A., Vannacci, A., Liperoti, R., Kirchmayer, U., Vitale, C., Chinellato, A., Roberto, G., Corrao, G., & Trifirò, G. (2019). All-cause mortality and antipsychotic use among elderly persons with high baseline cardiovascular and cerebrovascular risk: a multi-center retrospective cohort study in Italy. Expert Opinion on Drug Metabolism and Toxicology, 15(2), 179-188. https://doi.org/10.1080/17425255.2019.1561860