Hospitalization Risk in Pediatric Bipolar Patients Treated with Lurasidone vs. Other Oral Atypical Antipsychotics: A Real-World Retrospective Claims Database Study

Background: Real-world evidence on atypical antipsychotic (AAP) use in pediatric bipolar disorder is limited.

Objective: To compare the risk of all-cause and psychiatric hospitalization among children treated with lurasidone vs. other AAPs.

Methods: This retrospective claims study using the MarketScan Commercial database identified children (≤17 years) with bipolar disorder treated with oral AAPs from 01JAN2011 to 30JUN2017. The first AAP claim was defined as the index date, with pre-post index enrollment of 180 days. Each month of the post-index period was categorized as monotherapy treatment (≥ 22 days) with lurasidone, quetiapine, aripiprazole, olanzapine, risperidone, no/minimal therapy (≤7 days), and other therapy (8-21 days or concomitant use with lithium/valproate /other AAPs). A marginal structural model (MSM) was employed to ascertain the risk of all-cause or psychiatric hospitalization adjusting for demographics, comorbidities, medications, and time varying covariates.

Results: Of the 16,021 commercially insured children initiating AAPs, 49% were female (mean age 13.8 years). In month 1, about 2% received lurasidone, 3% olanzapine, 17% quetiapine, 27% risperidone, 35% aripiprazole, 0.5% no/minimal therapy and 16% other. MSM analyses showed that compared to lurasidone the odds of all cause and psychiatric hospitalization were higher for aripiprazole (all cause: OR=1.60, 95% CI [1.08-2.36]; psychiatric OR=1.61, 95% CI [1.08-2.38]) and olanzapine (all cause: OR=1.68, 95% CI [1.03-2.71]; psychiatric OR=1.73, 95% CI [1.06-2.80]) and were similar for quetiapine and risperidone.

Conclusions: This claims database study showed that lurasidone-treated children with bipolar disorder in real-world settings had lower risks of all cause and psychiatric-related hospitalizations compared with children treated with aripiprazole and olanzapine.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.