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An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events

Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the...

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Autores principales: Delapaz, Noah R., Hor, William K., Gilbert, Michael, La, Andrew D., Liang, Feiran, Fan, Peihao, Qi, Xiguang, Guo, Xiaojiang, Ying, Jian, Sakolsky, Dara, Kirisci, Levent, Silverstein, Jonathan C., Wang, Lirong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001183/
https://www.ncbi.nlm.nih.gov/pubmed/33806416
http://dx.doi.org/10.3390/jpm11030178
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author Delapaz, Noah R.
Hor, William K.
Gilbert, Michael
La, Andrew D.
Liang, Feiran
Fan, Peihao
Qi, Xiguang
Guo, Xiaojiang
Ying, Jian
Sakolsky, Dara
Kirisci, Levent
Silverstein, Jonathan C.
Wang, Lirong
author_facet Delapaz, Noah R.
Hor, William K.
Gilbert, Michael
La, Andrew D.
Liang, Feiran
Fan, Peihao
Qi, Xiguang
Guo, Xiaojiang
Ying, Jian
Sakolsky, Dara
Kirisci, Levent
Silverstein, Jonathan C.
Wang, Lirong
author_sort Delapaz, Noah R.
collection PubMed
description Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed.
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spelling pubmed-80011832021-03-28 An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events Delapaz, Noah R. Hor, William K. Gilbert, Michael La, Andrew D. Liang, Feiran Fan, Peihao Qi, Xiguang Guo, Xiaojiang Ying, Jian Sakolsky, Dara Kirisci, Levent Silverstein, Jonathan C. Wang, Lirong J Pers Med Article Post-traumatic stress disorder (PTSD) is a prevalent mental disorder marked by psychological and behavioral changes. Currently, there is no consensus of preferred antipsychotics to be used for the treatment of PTSD. We aim to discover whether certain antipsychotics have decreased suicide risk in the PTSD population, as these patients may be at higher risk. A total of 38,807 patients were identified with a diagnosis of PTSD through the ICD9 or ICD10 codes from January 2004 to October 2019. An emulation of randomized clinical trials was conducted to compare the outcomes of suicide-related events (SREs) among PTSD patients who ever used one of eight individual antipsychotics after the diagnosis of PTSD. Exclusion criteria included patients with a history of SREs and a previous history of antipsychotic use within one year before enrollment. Eligible individuals were assigned to a treatment group according to the antipsychotic initiated and followed until stopping current treatment, switching to another same class of drugs, death, or loss to follow up. The primary outcome was to identify the frequency of SREs associated with each antipsychotic. SREs were defined as ideation, attempts, and death by suicide. Pooled logistic regression methods with the Firth option were conducted to compare two drugs for their outcomes using SAS version 9.4 (SAS Institute, Cary, NC, USA). The results were adjusted for baseline characteristics and post-baseline, time-varying confounders. A total of 5294 patients were eligible for enrollment with an average follow up of 7.86 months. A total of 157 SREs were recorded throughout this study. Lurasidone showed a statistically significant decrease in SREs when compared head to head to almost all the other antipsychotics: aripiprazole, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone (p < 0.0001 and false discovery rate-adjusted p value < 0.0004). In addition, olanzapine was associated with higher SREs than quetiapine and risperidone, and ziprasidone was associated with higher SREs than risperidone. The results of this study suggest that certain antipsychotics may put individuals within the PTSD population at an increased risk of SREs, and that careful consideration may need to be taken when prescribed. MDPI 2021-03-04 /pmc/articles/PMC8001183/ /pubmed/33806416 http://dx.doi.org/10.3390/jpm11030178 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ).
spellingShingle Article
Delapaz, Noah R.
Hor, William K.
Gilbert, Michael
La, Andrew D.
Liang, Feiran
Fan, Peihao
Qi, Xiguang
Guo, Xiaojiang
Ying, Jian
Sakolsky, Dara
Kirisci, Levent
Silverstein, Jonathan C.
Wang, Lirong
An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title_full An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title_fullStr An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title_full_unstemmed An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title_short An Emulation of Randomized Trials of Administrating Antipsychotics in PTSD Patients for Outcomes of Suicide-Related Events
title_sort emulation of randomized trials of administrating antipsychotics in ptsd patients for outcomes of suicide-related events
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001183/
https://www.ncbi.nlm.nih.gov/pubmed/33806416
http://dx.doi.org/10.3390/jpm11030178
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