Metabolic Testing Rates in 3 State Medicaid Programs After FDA Warnings and ADA/APA Recommendations for Second-Generation Antipsychotic Drugs
Metabolic Testing Rates in 3 State Medicaid Programs After FDA Warnings and ADA/APA Recommendations for Second-Generation Antipsychotic Drugs
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DOI：
10.1001/archgenpsychiatry.2009.179
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发表时间：
2010-01-01
影响因子：
--
通讯作者：
Newcomer, John W.
中科院分区：
文献类型：
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作者：
Morrato, Elaine H.;Druss, Benjamin;Newcomer, John W.
背景：2003年，美国食品和药物管理局（FDA）要求对第二代抗精神病药物（SGA）的糖尿病风险提出警告。美国糖尿病协会（ADA）和美国精神病学协会（阿帕）建议对所有开始接受SGA药物治疗的患者进行血糖和血脂检测。目的：描述联合警告和建议与基线代谢检测和SGA药物选择之间的关联。设计：中断时间序列分析。设置：加州、密苏里州和俄勒冈州。患者：共有109451人接受医疗补助谁开始服用SGA药物和对照队列的203527例患者谁开始服用沙丁胺醇，但没有接受抗精神病药物。干预措施：使用2002年1月1日至2005年12月31日收集的队列的实验室声明，比较代谢检测的预警和预警后趋势。SGA处方实践的变化进行了类似的evaluated.Main结果措施：每月的基线血糖和血脂测试的SGA治疗和倾向匹配的albuterol治疗的患者和每月的新处方的份额为每个SGA drug.Results：初始测试率为SGA治疗的患者低（葡萄糖，27%;血脂，10%）。警告与SGA治疗患者中血糖检测的增加无关，仅与血脂检测率的轻微增加相关（1.7%; P = 0.02）。SGA治疗组患者的检测率和趋势与沙丁胺醇对照组的背景率没有差异。奥氮平（高代谢风险）的新处方在警告期内下降（年份额下降，19.9%; P <0.001）。阿立哌唑（较低代谢风险）的新处方在警告期间增加（份额增加，12.1%; P < .001），但可能归因于在同一时间范围内加州取消了事先授权。奎替鲁肽，利培酮，齐拉西酮的使用与warning.Conclusions：在接受医疗补助的人群中，基线血糖和血脂检测的SGA治疗的患者是罕见的，并显示出很少的变化后，糖尿病警告和监测的建议。观察到SGA药物选择的变化与降低代谢风险的意图一致。精神病学硕士。2010;67（1）：17-24
Context: In 2003, the Food and Drug Administration (FDA) required a warning on diabetes risk for second-generation antipsychotic (SGA) drugs. The American Diabetes Association (ADA) and American Psychiatric Association (APA) recommended glucose and lipid testing for all patients starting to receive SGA drugs.Objective: To characterize associations between the combined warnings and recommendations and baseline metabolic testing and SGA drug selection.Design: Interrupted time-series analysis.Setting: California, Missouri, and Oregon.Patients: A total of 109 451 individuals receiving Medicaid who began taking SGA medication and a control cohort of 203 527 patients who began taking albuterol but did not receive antipsychotic medication.Interventions: Prewarning and postwarning trends in metabolic testing were compared using laboratory claims for the cohort collected January 1, 2002, through December 31, 2005. Changes in SGA prescribing practices were similarly evaluated.Main Outcome Measures: Monthly rates of baseline serum glucose and lipid testing for SGA-treated and propensity-matched albuterol-treated patients and monthly share of new prescriptions for each SGA drug.Results: Initial testing rates for SGA-treated patients were low (glucose, 27%; lipids, 10%). The warning was not associated with an increase in glucose testing among SGA-treated patients and was associated with only a marginal increase in lipid testing rates (1.7%; P = .02). Testing rates and trends in SGA-treated patients were not different from background rates observed in the albuterol control group. New prescriptions of olanzapine (higher metabolic risk) declined during the warning period (annual share decline, 19.9%; P < .001). New prescriptions of aripiprazole (lower metabolic risk) increased during the warning period (share increase, 12.1%; P < .001) but may be attributable to the elimination of prior authorization in California during the same time frame. Quetiapine, risperidone, and ziprasidone use were not associated with the warning.Conclusions: In a Medicaid-receiving population, baseline glucose and lipid testing for SGA-treated patients was infrequent and showed little change following the diabetes warning and monitoring recommendations. A change in SGA drug selection consistent with intentions to reduce metabolic risk was observed. Arch Gen Psychiatry. 2010;67(1):17-24