Trends of antipsychotic prescribing for people with dementia in Spain

Abstract

Background

Antipsychotic medications are frequently prescribed in people with dementia (PwD), despite concern regarding risk-benefit balance.

Objective

To describe the evolution of antipsychotic prescribing for PwD in Spain, with special interest in the effect of administration regulatory warnings (2004 and 2008).

Methods

Longitudinal retrospective study using the national Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP). We included patients with incident dementia during the study period (January 1, 2002 to December 31, 2018) and excluded those with major psychiatric conditions, mental retardation, or previous use of antipsychotics. Paper-based and electronic prescriptions of antipsychotics were collected. Annual prevalence of prescribing was obtained for single medications and antipsychotic group. All calculations were conducted for the total sample and stratified by sex. The results were compared with those of other countries.

Results

Antipsychotic prescribing doubled during the study period, raising from 12.6% (2002) to 23.8% (2018). A mild decrease of prescribing was observed from 2004 to 2007, followed by steady increase from 2007 on. This increase was due to atypical antipsychotic use, specifically quetiapine, which grew from 0.2% (2002) to 16.4% (2018) and was more frequently utilized in men. Spain prevalence of antipsychotics doubled the UK's.

Conclusions

Better designed warnings appear as a key means to rationalize use of antipsychotics in Spain and other countries, ideally as part of national dementia strategies. Dearly needed non-pharmacological approaches for comprehensive treatment of neuropsychiatric symptoms could be generalized as a first step through nursing home and day care networks. Quetiapine requires the agencies’ urgent attention.