Antipsychotics increase mortality regardless of comorbidity

Results of a Danish nationwide study confirm that antipsychotic treatment strongly increases risk of mortality in patients with dementia [1]. Adjusted risk of death was increased by about one third. The mortality risk was not influenced by diabetes, cardiovascular, and cerebrovascular comorbidity.

Dr Ane Nørgaard (Rigshospitalet, Denmark) said that there is limited evidence for an effect of antipsychotic treatment on behavioural symptoms and psychosis in dementia. Numbers needed to harm (death of a patient) after 12 weeks of treatment is 100. A matched cohort study was conducted, including all Danish residents aged 65-95 years diagnosed with dementia between 2009 and 2014. Every patient exposed to antipsychotics (n=8,244) was matched with up to three unexposed patients (n=24,730). Total mortality was 5,938 after 180 days of follow-up (3,945 in the unexposed group vs 1,993 in the exposed group). The crude mortality rate per 100 person-years was 36.3 and 58.3, respectively (HR 1.49). Adjusted HR was 1.35. “Patients with pre-existing cardiovascular disease and diabetes are at increased risk of death when treated with antipsychotics”, Dr Nørgaard said. She stated that clinical guidelines should include a risk stratification to identify patients who can benefit from antipsychotic treatment with the lowest risks. This is a very common and disturbing problem for the family and the patients but the study does not provide information on alternatives in handling psychotic behaviour in dementia patients.

1. Nørgaard A, et al. EAN 2019, O1104.

Posted on 27 August 201917 March 2021