Treatment Patterns Among Patients With Antipsychotic Medication Polypharmacy

Background: Providing meaningful symptom relief can be a difficult balance for clinicians treating patients with severe mental illness. Antipsychotic medications (APs) are reliable treatments for some patients, however, little is known about antipsychotic polypharmacy (APP) treatment patterns in an insured population.

Methods: Commercial and Medicare Advantage Part D enrollees with ≥1 AP claim from 01JAN2016 - 31DEC2016 were identified in an administrative database of a large health insurer. Index date was the first AP claim. Continuous health plan enrollment was required for 6-months pre-index and 12-months post-index. Patients with ≥1 pre-index AP claim or < 5 weeks of follow-up AP days supply were excluded. An episode of APP was defined as ≥37 overlapping days of >1 AP. A line of therapy (LOT) approach was utilized to explore AP treatment patterns.

Results: 29,951 patients were included and stratified by age (children, adults 18-64, and seniors (≥65)); 1,303 (4%) experienced ≥1 APP episode post-index. Mean time to first APP episode was 155 days for children, adults 122 days and seniors 129 days. APP patients experienced significantly more LOT changes after index (mean 2.7 versus 1.4, p<0.001). Aripiprazole+quetiapine and quetiapine+risperidone were common APP combinations. Among APP patients, a smaller percentage of children had APP in their first LOT (21%) than adults/seniors (nearly 40% each). Tardive dyskinesia diagnosis was rare but more frequent among patients with APP (0.6%) versus non-APP (0.3%, p=0.02).

Conclusions: APP patients experienced more medication changes than non-APP patients. Treatment patterns among APP patients often included polypharmacy during the first LOT.

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