A propensity score matching analysis for cardio metabolic risk of antipsychotics in patients with schizophrenia using Japanese claims data

Ichiro Kusumi,Tadashi Nosaka,Kenji Baba,Toshihisa Anzai,Sachie Inoue

doi:10.1186/s12888-020-02987-1

Ichiro Kusumi, Tadashi Nosaka + Show 3 more

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https://doi.org/10.1186/s12888-020-02987-1

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Abstract

BackgroundThe aim of this study was to evaluate the cardio-metabolic risk in schizophrenia patients treated by atypical antipsychotic drugs compared with that in those treated without atypical antipsychotic drugs using a nationwide insurance claims database and medical examination database in Japan.MethodsEligible patients were defined as those meeting the following two criteria: (i) A diagnosis of schizophrenia (ICD-10 code: F20) was made between 1 January 2005 and 31 December 2017, with data available for at least 6 months before the diagnosis was made (index month), and (ii) health check-up data were available within ±3 months of the index month. The primary endpoint was changes in cardio-metabolic risk based on the Suita score at 1 year, and the secondary endpoints were changes in medical examination data related to cardio-metabolic risk (total cholesterol [TC], triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, body mass index [BMI], and hemoglobin A1c) at 1 year. The primary endpoint was evaluated by multivariate analysis, with the cumulative chlorpromazine equivalent amount and the baseline Suita score added as covariates.ResultsOne-hundred eighty five pairs of propensity score (PS)-matched patients were evaluated. Patients receiving atypical antipsychotic drugs exhibited a greater change in the Suita score and a risk of coronary heart disease based on the Suita score of 0.530 and 0.098%, respectively, than patients not receiving atypical antipsychotic drugs, but there was no significant difference (p = 0.412 and 0.610). The significant changes in TC and BMI were determined as 6.525 mg/dL and 0.380 kg/m2 greater, respectively, in patients treated with atypical antipsychotic drugs (p = 0.037 and 0.011).ConclusionsThere were no significant increases in changes in the Suita score at 1 year by treatment with atypical antipsychotic drugs compared with treatment without atypical antipsychotic drugs. However, the TC and BMI were significantly higher in patients treated with atypical antipsychotic drugs.

Highlights

IntroductionSchizophrenia is associated with a broad array of symptoms such as hallucinations and delusions (positive symptoms), abulia and autism (negative symptoms), cognitive impairment, and affective disorder (depressive symptoms)
The aim of this study was to evaluate the cardio-metabolic risk in schizophrenia patients treated by atypical antipsychotic drugs compared with that in those treated without atypical antipsychotic drugs using a nationwide insurance claims database and medical examination database in Japan
3464 patients who were newly diagnosed with schizophrenia and having medical examination data were identified as eligible patients

Summary

Introduction

Schizophrenia is associated with a broad array of symptoms such as hallucinations and delusions (positive symptoms), abulia and autism (negative symptoms), cognitive impairment, and affective disorder (depressive symptoms). It is associated with considerable disability, which affects educational and occupational performance. Typical antipsychotic drugs block dopamine D2 receptors alone, whereas atypical antipsychotic drugs act on serotonin 5-HT2A receptors and other neurotransmitters [3]. The blockage of receptors, such as histamine H1, serotonin 5-HT2A and 5-HT2C, muscarinic M3, and adrenergic α1 and α2, is implicated in the onset of weight gain in patients receiving atypical antipsychotic drugs, and involvement of genetic factors has been pointed out [7]

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