|
|
Older Antipsychotics Are Found as Risky for Elderly as New Ones
By Benedict Carey, The New York Times
December 1, 2005
Older, lower-cost medications for schizophrenia raise the risk of premature death in elderly people, researchers are reporting today.
The finding comes amid a growing debate over the safety and effectiveness of antipsychotic drugs. The researchers found that the older drugs were at least as likely to hasten death in elderly patients as newer antipsychotics, which already carry a strong warning about mortality risk in the aged.
Doctors say the risk from either type, however, is still very low.
Over the last decade, antipsychotic drugs have been increasingly prescribed to elderly patients for a variety of conditions, including delirium and agitation associated with dementia. But recent research suggests that older patients are especially vulnerable to side effects, perhaps because they often have other medical problems, like heart disease.
In April, the Food and Drug Administration warned that the newer drugs, called atypical antipsychotics, nearly doubled the risk of premature death in elderly people. The agency ordered then that strong cautions be placed on the drugs' labels.
If confirmed, the new finding, being published today in The New England Journal of Medicine, would suggest that older antipsychotic drugs should carry similar warnings, the authors write.
"This paper is important because it corrects the mistaken perception I think many physicians may have that the older generation of drugs is safer when it comes to the mortality risk," said Dr. John Davis, a psychiatrist at the University of Illinois who had no role in the study and said he had no financial ties to drug makers.
Newer antipsychotics, like Risperdal and Zyprexa, have been widely promoted as more effective than their predecessors, but in September a large government-financed study found that they offered little if any benefit over the old ones, like Haldol and Thorazine. Still, the new study suggests that doctors may want to think twice about moving patients from newer drugs to older ones.
In the study, researchers at Brigham and Women's Hospital in Boston analyzed the medical records, for 1994 to 2003, of 22,890 men and women ages 65 and over whose antipsychotic medication was covered under a Pennsylvania state insurance program. In addition to dementia or delirium, most of the patients had a variety of other medical problems.
Six months after starting on an antipsychotic drug, 18 percent of the patients on the older drugs and about 15 percent of those on the newer ones had died, the researchers found. After controlling for differences like age and severity of illness, the investigators found that the patients who took standard doses of the older medicines ran a 37 percent higher risk of dying prematurely than those on the new drugs. At more modest doses, the older drugs elevated mortality risk by 14 percent over the newer ones, the researchers determined, with the risk tapering off to about the same level in both groups by the end of the six-month period.
No one knows how the drugs increase the risk of premature death, but the problem may be related in part to their effect on the cardiovascular system, said the study's lead author, Dr. Philip S. Wang. Previous research suggests that many elderly people who die while taking antipsychotics suffer strokes or other vascular problems. The drugs are known to interfere with the transmission of the messenger chemical dopamine in some parts of the brain, but they may also affect chemicals that help regulate heart function, Dr. Wang said.
|
|
