Tuesday, March 6, 2018

Lithium, LAI Antipsychotics Found Best to Prevent Rehospitalization in Patients With Bipolar Disorder

Lithium appears to be the most effective medication for preventing rehospitalization for any reason among patients with bipolar disorder and should be the first-line of treatment, according to a report in JAMA Psychiatry. The study also revealed that long-acting injectable (LAI) antipsychotics were associated with substantially better outcomes compared with identical oral antipsychotics.

“When a patient with bipolar disorder uses an LAI, the patient’s risk of relapse leading to psychiatric hospitalization as well as all-cause hospitalization owing to mental or somatic illness is about 30% lower than during time periods when the same patient uses an identical oral antipsychotic,” Marrku Lähteenvuo, M.D., Ph.D., of the University of Eastern Finland and colleagues wrote. “Although more research is needed to support the notion, LAIs might offer a safe and effective option for relapse prevention in bipolar disorder for patients for whom lithium is not suitable."

Lähteenvuo and colleagues used Finnish national registry databases to examine the risk of psychiatric, cardiovascular, and all-cause hospitalization from January 1987 through December 2012 in patients in Finland who had been hospitalized for bipolar disorder. These databases include information on incidences, duration, and reasons for rehospitalization as well as information on reimbursed medications dispensed from pharmacies.

Among a cohort of more than 18,000 patients, 9,721 patients (54.0%) had at least one psychiatric rehospitalization during the study period. Of all medications studied, lithium was associated with the lowest risk of rehospitalization for any reason, with a hazard ratio (HR) of 0.71. Quetiapine fumarate, the most frequently used antipsychotic treatment, showed only modest effectiveness in reducing risk of all-cause rehospitalization (HR, 0.93).

Long-acting risperidone was associated with the lowest risk of psychiatric rehospitalization (HR, 0.58). The researchers also observed a marked association for reduced risk of psychiatric hospitalization with lithium (HR, 0.67).

“The main results of our study indicate that lithium is superior to other mood stabilizers and that LAIs are markedly better than identical oral formulations of antipsychotics.”

For related information see the Psychiatric News article, “Lithium Protects Against Suicide inBipolar Disorder, Study Finds.”



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