(B-058) DARWIN-EU ®- Antipsychotic prescribing in people with dementia in Europe: a descriptive analysis of trends and patient characteristics

Background: Antipsychotic medications, primarily licensed for schizophrenia and bipolar disorder, are frequently prescribed to manage behavioural and psychological symptoms of dementia in elderly populations. There are two broad classifications of antipsychotics, typical and atypical, which have different recommendations for use. Given their association with adverse effects, regulatory guidelines recommend prescribing antipsychotics among people with dementia with caution.

Objectives: To describe the characteristics, drug utilisation and survival of patients with dementia initiating antipsychotics across Europe.

Methods: A cohort study using data mapped to OMOP CDM as part of the DARWIN-EU® network of six European databases: SIDIAP (Spain), IPCI (Netherlands), DK-DHR (Denmark), IQVIA DA Germany, IQVIA LPD Belgium, and NAJS (Croatia). We selected new users of antipsychotics (ATC: N05A) from 01/01/2013 to 31/12/2023 in people who were previously diagnosed with dementia, with at least 365 days of prior history. Index date was defined as the date of the first prescription of the antipsychotic of interest. Patient characteristics, drug utilisation and Kaplan-Meier one-year survival probabilities were described.

Results: We observed a total of 1.2 million patients with dementia initiating antipsychotics across databases. Median age ranged from 82-84 years, with a higher proportion of women (ranged from 55-64%). Highest prevalence of comorbidities were, obesity (4-40%), heart failure (9-21%), type 2 diabetes (18-31%) and hypertension (33-85%). Depression (8-43%), and insomnia and sleep disorders (3-49%) were the most frequent additional indications. Conversely, bipolar disorder or schizophrenia were infrequent ( < 5%).
Atypical antipsychotics were more commonly prescribed than typical antipsychotics in all databases except IPCI. The most prescribed atypical antipsychotics were quetiapine and risperidone, for typical antipsychotics it was haloperidol.
Duration of antipsychotic use ranged from 3 to 310 days based on drug type and database. There were no differences in initial daily dose between age groups or sex for the different drugs of interest.
Typical antipsychotic users had lower crude one-year survival probabilities compared to atypical antipsychotic users. Haloperidol users had the poorest crude survival (e.g., 22% survival in DK-DHR, median survival 17 days).

Conclusions: Antipsychotic prescribing among people with dementia showed higher use among older adults and females, underscoring the need for ongoing monitoring of antipsychotic use in dementia patients.